Mary Queen of Apostles School

RE-REGISTRATION FORM – RETURNING STUDENT

A $50.00 re-registration fee is also required, to be paid by credit or debit card.

FORMS MUST BE RETURNED TO MQA BY APRIL 15 TO GUARANTEE ENROLLMENT!

If you wish to pay by personal check, please PRINT a copy of the Returning Student Registration Form and send it along with your check to:

MARY QUEEN OF APOSTLES SCHOOL
110 ELMTREE ROAD
NEW KENSINGTON, PA 15068

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Qty

Description

Amount

Total

Registration Fee

$50.00

If you have already paid your $50 Family Registration Fee, please make sure to change the quantity above to the blank space above the (1) so that you are not charged a second time. You must then enter, below, the transaction code received on your email receipt from when you paid the first time.

Description

TRANSACTION CODE

Total: $50.00

STUDENT’S INFORMATION

First Name: *

Middle Name: *

Last Name: *

Full Name:

Grade Entering: *

Home Address: *

Address 2:

City: *

State: *

Zip Code: *

Home Phone: *

Cell Phone:

Date of Birth: *

Gender: *

Public School District: *

(Where you live)

Religion: *

If Catholic, please select your diocese:

If Greensburg Diocese:

Please select the parish where the student is registered.

If Pittsburgh Diocese:

Please indicate the parish (name and town) where the student is registered.

Ethnicity: *

PARENT/GUARDIAN INFORMATION

Mother's Name: *

Address:

(if different from student)

Address 2:

City:

State:

Zip Code:

Home Phone: *

Cell Phone: *

Emergency Phone: *

Email: *

If employed, complete the applicable fields.

Occupation:

Employer:

Business Phone:

Parish where registered:

Father's Name: *

Address:

(if different from student)

Address 2:

City:

State:

Zip Code:

Home Phone: *

Cell Phone: *

Emergency Phone: *

Email: *

If employed, complete the applicable fields.

Occupation:

Employer:

Business Phone:

Parish where registered:

Student resides with: *

Guardian Information

(if applicable)

Custody: A legal document stating guardianship must be provided in cases of divorce, adoption, physical/shared custody.

Student’s legal guardian:

(if other than parent)

Relationship to the student:

By typing your name below, you accept that this acts as your individual signature, and you also agree that the information contained above is accurate.

Parent/Guardian 1 Signature: *

Parent/Guardian 2 Signature: *

Date: *

Statement of Nondiscriminatory Acceptance Policy: Mary Queen of Apostles School will not discriminate on the basis of race, gender or national origin. Students seeking acceptance and enrollment to the school will be considered based on religion, academic performance, learning needs, attendance, character, morality and conduct consistent with Catholic doctrine and application payment history within a Catholic or private/nonpublic school. The school maintains the right to give preferential acceptance and enrollment to Catholic students. The student is not permitted to attend this school if he/she has an outstanding payment balance at another Catholic School within the Diocese of Greensburg. Your signature above indicates that you understand and accept the content and provision of this application.

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

Phone number to contact in case of questions

E-mail: *

A receipt will be e-mailed to this address.

ALL MAJOR CREDIT CARDS ACCEPTED

Please Note:
You may pay with a credit or debit card at the PayPal screen even if you don't have an account.

Please click Proceed to Confirmation below to pay with a credit card on the next page. No PayPal account is required.

ENTER YOUR PAYMENT INFORMATION ON THE NEXT SCREEN

Click 'Proceed to Confirmation' to pay with PayPal on the next page.