FOR FAMILIES

Registration Form

(Extended Care)

This form enables you to register your student in the Extended Care program.

"*" indicates required fields

Student Information

Name of Child*

First Last

Gender

Female

Male

Date of Birth*

Child's Address*

Street Address City State ZIP Code

Is this student toilet-trained? This is a requirement for enrollment.*

I confirm that this student is toilet-trained.

Parent/Guardian Information

Name of Parent/Guardian

Prefix First Last

Phone*

Work Phone*

Email*

Enter Email Confirm Email

Name of Parent/Guardian

Prefix First Last

Phone*

Work Phone*

Email*

Enter Email Confirm Email

Comments

This field is for validation purposes and should be left unchanged.

Handbook & Forms

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Saint Mary School

307 E Wall St, Janesville, WI

(608) 754-5221

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Nativity of Mary Parish

Recent News

February 28, 2024

St. Mary’s Home & School Butter Braid Fundraiser

Saint Mary School admits students of any race, color, and national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. Learn more.