PK Registration 2019-2020
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Mt. St. Mary Academy

Pre-Kindergarten
Registration 2019-2020

PRE-KINDERGARTEN REGISTRATION FEE:
$150.00 per child (if paid by August 1st) non-refundable
Registration increases to $350.00 after August 1st, non-refundable
Please select desired program *



Please select one *
Please specify the days attending: *





Payment Options *




Family Name *
Registration Enrollment Information
Student's Name *
First Name * Middle Name Last Name *
Primary Home Address *
Address1 City State Zip
Parent/Guardian 1 Name *
First Name * Last Name *
Email Address *
Address
Address1 City State Zip
Home Phone
Cell Phone *
Employer *
Parent/Guardian 2 Name
First Name Last Name
Email
Address (if different)
Address1 City State Zip
Home Phone
Cell Phone
Employer

Parent/Guardian Signature *
Name * Date (MM/DD/YYYY) *
Please Direct all Registration Inquiries to the School Office
 
Mt. St. Mary Academy
400 South Church Grass Valley, CA 95945 • (530) 273-4694 • fax (530) 273-1724 • info@mtstmarys.org • www.mtstmarys.org 
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