St. Lawrence School
                                                     231 Main Street
                                         West Haven, Connecticut 06516

                              Celebrating 90 Years of Educational Excellence

                                           3 and 4-year-old Application

Children must reach their 3rd or 4th birthday no later than December 31st

_______3 year old         _______4 year old

(A $250.00 non-refundable seat deposit is required to hold the students place)

(Check one)
_______M-F  8:00 a.m.-2:15 p.m.                                         ______  M-W-F  8:00 a.m.-2:15 p.m.
______  M-F  8: 00 a.m.- 11: 00 a.m.                                    ______  M-F  11:15 a.m. -  2:15 p.m.                                
______  M-W-F  8:00 a.m.– 11:00 a.m.                                 ______  M-W-F  11:15 a.m. – 2:15 p.m.


Child's name___________________________________________________            M______F______
                (First)                     (Middle)                      (Last)

Address____________________________________________________________________________
         (Street)                                                      (City)                                                 (Zip)

Date of Birth_________________     

Place of Birth________________________________
          (City)                                    (State)

Child lives with: Both parents_____      
            Mother_____       Father______        
            Other_____________________
                           (Relationship)

Present Church Membership_________________________    
Language spoken in the home_______________________   

                 MOTHER                                                                            FATHER

Name_______________________________                          Name ___________________________                      

Address_____________________________                          Address ________________________________

Home Phone_________________________                           Home Phone____________________________

Place of Work________________________                           Place of Work___________________________

Work Phone__________________________                          Work Phone_____________________________

Religion______________________________                         Religion ________________________________

SL Graduate Yes/Year _______ No_______                            SL Graduate Yes/Year _______ No_______

Church of Baptism_______________________    

Date, year of Baptism_____________________

City, State______________________________   

Child’s Social Security Number _____________________


                                   3 and 4-year-old Application
                                   Registration Form (Page 2)

These questions must be answered carefully and completely.
Failure to do so will result in an incomplete application.

1.  Why do you wish your child to attend St. Lawrence School?________________________________
___________________________________________________________________________________

2.  Does your child have any physical handicap or problem that might affect his/her schooling? If yes, please
explain.   ____________________________________________________________________

3.  Has your child received any special educational services? _________If yes, please explain.
___________________________________________________________________________________

4.  Is there any additional information that would be helpful to the principal, teachers, school nurse etc. in meeting
the academic, social, emotional or physical needs of your child?_____________________
____________________________________________________________________________________

5.  If my child is accepted to St. Lawrence School I agree to abide by the school policies and procedures as outlined
in the Parent-Student Pre-K Handbook, which is updated and distributed annually prior to the opening of school.        

                                      ____________________________________   _________________
                                                               (Parent signature)                                   (Date)       

Please attach a $25.00 non-refundable registration fee and a copy of the following documents:

1.        Baptismal Certificate………(unless baptized at St. Lawrence)
2.        Birth Certificate

__________________________________________________________________________________________
OFFICE USE ONLY

Records: Birth _____        Baptismal_____   Report Card  _____  Transcripts  ______  Health  _____

Interview with principal: _____________        Parish Status: ___________        

Application Fee _______________  Check # _____________        Date paid ____________

Tuition deposit ________________        Date due _____________        Date received _________

Tuition Payment Plan Choice: Full ______________        F.A.C.T.S. Application _________

Other __________________________________________________________________