Kindergarten Interest Form

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Kindergarten Interest Form

2016-2017 Academic Year


Childs Name:____________________________________________________________

St. Therese School

Parent(s) Name(s):________________________________________________________
Address:________________________________________________________________
Phone Number: (Primary) _________________________ (Alt)_____________________
E-Mail:__________________________________________________________________
Catholic Y_____ N_____
St. Therese Parish Member Y_____ N_____
Other Child(ren) at St. Therese School Y_____ N_____
Has your child ever been recommended and/or evaluated for special needs? Y_____ N_____
Has your child ever received services for special needs? Y _____ N ______

If Yes, please submit a copy of the evaluation or an explanation

Interest Form is also available for submission online at www.sttheresenorth.org


Living a Faith, Building a Future

Statement of Non-Discrimination
St. Therese School admits students of any sex, race, color, national and/or ethnic origin to all the rights,
privileges, programs, and activities accorded to students of the school. Diocesan policy 300.2

Thank you for your interest in St. Therese School, we look forward to contacting you . For additional information, or to schedule a tour, please contact Teri Jo Garitz, Executive Secretary, at 816-741-5400 ext. 106.

www.sttheresenorth.org

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