CORPUS CHRISTI ACADEMY

Sacred Heart of Jesus Parish Saint Clare Parish

Please print clearly in black or blue ink.

Registration forms are to be submitted to Corpus Christi Academy Office.

Parent Name___________________________

Student Last Name____________________________

Pre-Kindergarten Registration Agreement 2020-2021 School Year

Registering as Parishioner: ( ) Sacred Heart of Jesus ( ) St. Clare ( ) Holy Rosary

OR ( ) Non-Parishioner Registering as: ( ) Catholic ( ) Non-Catholic

Registration is complete ONLY upon following:

(1) Tuition payments are current for 2019-2020 with Corpus Christi Academy.

(2) Payment of $100 per student must accompany this Agreement. Registration Fee is non-refundable.

(3) Corpus Christi Academy and Parish Business Office review for accuracy and completeness.

(4) Immunizations and Entrance Forms (required for all Pre-Kindergarten students)

(5) Birth Certificate, Baptismal Certificate (if applicable) (new students)

Father/Guardian Information Mother/Guardian Information

( ) Custodial ( ) Non-Custodial ( ) Custodial ( ) Non-Custodial

Name __________________________________ Name ___________________________________

Address ________________________________ Address__________________________________

_________________________________ __________________________________

E-mail _________________________________ E-Mail___________________________________

Phone __________________________________ Phone___________________________________

(Please mark preferred phone) (Please mark preferred phone)

Student Information

Name (First & Last) Date of Birth Grade 2020-21 N (New) or R (Return)

____________________________ ________________ ________ _________

____________________________ ________________ ________ _________

____________________________ ________________ ________ _________

____________________________ ________________ ________ _________

CORPUS CHRISTI ACADEMY

2020-2021 Pre-K Tuition and Fees

Pre-K Students Non-Parish Half Day Full Day

Non-Parishioner Tuition

2,600

4,250

Registration fee (per student)

100

100

Family Total $ 2,700 $ 4,350

Pre-K Students In Parish Half Day Full Day

Active Parishioner Tuition 2,500 4,050

Registration Fee (per student) 100 100

Family Total $ 2,600 $ 4,150

Active Participation and Parish Contributions

The full cost to educate each Pre-K student is approximately $4,764.65. The difference between full cost

tuition and each student’s tuition is covered by subsidies from Saint Clare and Sacred Heart of Jesus Parishes funded through:

*Offertory contributions by active parishioners

*Full participation in fundraising activities

Your committed and consistent support of your parish and Corpus Christi Academy enable the reduced Active

Parishioner rate and demonstrates your appreciation for the support being provided by other members of

your parish.

Corpus Christi Academy

2020-2021 Tuition Payment Agreement

Family Name:

Student/Grade:

_________________________________ ________ ________________________________ ________

_________________________________ ________ ________________________________ ________

Total Family Tuition (prior to application of financial assistance): $4,250.00 Full Day

$2,600.00 Half Day

Fees:

• $100.00 non-refundable registration fee per student

Total Family Tuition and Fees: $4,350.00 Full Day

$2,700.00 Half Day

I agree to pay Corpus Christi Academy the tuition and all fees for the attendance of my child(ren) as established by the school for the 2020-2021 school year. I elect to pay the tuition and fees as follows. Please mark

preferred payment method(s):

Preferred

Payment

Option

Payment Type Payment

Amount

Payment Guidelines and Due Date

One Full Payment by cash

or check

Make checks payable to Corpus Christi Academy.

Payment due July 20, 2020. ($100.00 discount if tuition

paid on or before July 5, 2020.)

Semi Annual Payment by

cash or check

Make check payable to Corpus Christi Academy.

Payment due July 5, 2020 and December 5, 2020.

St. Margaret & Gregory

Credit Union loan

Pre-approved, interest bearing loan. Eleven monthly

payments beginning July 20, 2020. Please contact the

Credit Union directly at 216-691-0242.

One payment and semi-annual payment may be completed by using FACTS.

One Full Payment

through FACTS No additional fee. Payment due July 20, 2020.

Semi Annual Payment

through FACTS

$10.00 additional fee. Payments will be made on July 5

or 20 and December 5 or 20.

Monthly payment plan set forth below must be completed

by using FACTS as applicable.

11 Monthly Payments

through FACTS*

$45.00 additional fee. Payments will be made on

the 5th or 20th of the month beginning July 2020 and

ending May 2021. Balance must be brought to zero

with the final payment due on the Friday before

Memorial Day

Total Payments:

Total Family Tuition & Fees Due as listed above:

__________________________________

*If you choose a payment plan to use FACTS, you must enroll in FACTS Tuition Management at the following web

address: https://online.factsmgt.com/signin/4KS7J. Please note that credit card fees may apply if you choose to pay by

credit card.

ADDITIONAL TERMS AND CONDITIONS

1. I agree that all payments owed under this Agreement will be paid by the due date corresponding to the

payment method(s) selected above. I understand and agree that, regardless of what payment option is

selected, I am personally responsible for the payments and for ensuring that the tuition and fees are paid

in full. Should I be late in making any payment, I understand that the following process will be followed:

a. I, and the other parents/guardians (if they are not me), will be notified of any payment not

received. Notification will be via email from FACTS or Business Office.

b. I will be given 30 calendar days to bring the account to current status or meet with school

administration to have an adjusted payment agreement approved (not a guarantee and must be in

writing and signed by the parish pastor or school president).

c. A $25.00 late fee will be assessed.

d. If, within 30 calendar days, the account is not brought to current status, and an adjusted payment

agreement is not agreed upon and approved by school administration, the student enrollment will

cease at the end of the current quarter, and the school may immediately take any action available

and consistent with applicable law in order to collect unpaid tuition owed by me/us including but

not limited to limiting access to field trips and extra-curricular activities, withholding academic

transcripts, referral to a collection agency, and/or the institution of a civil lawsuit to recover the

unpaid balance.

2. Any family with an unpaid Tuition and/or Fees balance for the current School Year will not be allowed to

register for the following School Year and School records, diplomas or transcripts will not be released

until the current year’s Tuition and fees are paid, unless special arrangements have been made in

writing and signed by Parish pastor or School president.

3. Prepaid Tuition will only be refunded in full if written notice of cancellation is received by the School

before the first day that classes for the School year are scheduled to start. The Registration Fee is non-

refundable.

4. Once the School year begins, Tuition refunds are made on a quarterly basis. Should a Student attend

School during any portion of a quarter (one day or more), the full tuition amount for that quarter is

owed and no portion of that quarter’s tuition will be refunded.

5. The Student(s) and Student's parents/guardians agree that they and their child(ren)/ward(s) will abide

by the policies and guidelines as stated in the School handbook.

6. Returned checks: If two checks are returned for insufficient funds, the school will no longer accept

personal checks and you will be required to pay in cash, with a certified check from a local bank, or

through an approved electronic payment provider (such as FACTS) at the school’s discretion.

(continued on next page)

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7. I understand that the School will not reserve a place for my child(ren) for the upcoming school year until

after I have returned a completed and signed Tuition Agreement, plus the registration fee, and, if

applicable, an agreement has been created in FACTS for selected plans. I further understand that my

child’s/children’s eligibility for enrollment is conditioned upon (1) his/her/ successful completion of the

current School Year; (2) full payment of all Tuition and fees owed for the current and/or prior School

Years; and (3) acceptance by the school. I understand that the School reserves the right to deny

admission or enrollment for any lawful reason.

By signing below, I agree that I have read and understand all of the terms and conditions contained in this

agreement, and I agree to be personally bound by those terms and conditions.

________________________________________ __________________________________________

Parent/Guardian 1 Date Parent/Guardian 2 Date

_________________________________________ __________________________________________

Print Name Print Name

_________________________________________ __________________________________________

Telephone (Please mark preferred phone.) Telephone (Please mark preferred phone.)

_________________________________________ __________________________________________

Mailing Address Mailing Address (if different from Parent/Guardian 1)

_________________________________________ __________________________________________

City/State/Zip City/State/Zip

ALL FAMILIES MUST COMPLETE THIS FORM. REGISTRATION FOR THE 2020-2021 SCHOOL YEAR WILL NOT BE

ACCEPTED WITHOUT THIS FORM AND THE $100.00 NON-REFUNDABLE REGISTRATION FEE.

Corpus Christi Academy Catholic School

Tuition Rates and Scholarship Application for 2020/2021 School Year

Every Pre-K student at Corpus Christi Academy Catholic School may apply for scholarships. Working

in partnership with parents, who are the primary educators of their children, we want to ensure that the

young people in our school community have an opportunity to receive an affordable Catholic education.

Please apply for scholarships for the school using this worksheet, and additional forms as needed. Once

you have completed the form, please return it to Corpus Christi Academy, at the school office, or the

business office for processing. Families will be notified of scholarship awards as soon as possible.

Family Name: Date:

_____________________________________________ ___________________

Please list student(s) and grade(s): if there are more than six students, please list additional students on

the back

______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________ ______________________________ ________

TUITION RATE Pre-K

Please note that it costs Corpus Christi Academy Catholic School approximately $6,500.00 to educate per

pupil, at current enrollment levels. The Parishes covers the substantial financial difference between per

pupil cost and the actual tuition through its weekly offertory collection and otherwise through the

generosity of those associated with the Parishes.

Tuition Rates

Program

Enrolled

Tuition

Non Parishioner Parishioner

Half Day $2,700.00 $2,600.00

Full Day $4,350.00 $4,150.00

SCHOLARSHIPS

Corpus Christi Academy Catholic School offers scholarship opportunities that may be available to help

offset the cost of educating your child. Please indicate which scholarships option you are applying for by

placing a checkmark in front of the appropriate option(s):

_______ 1. Parish scholarship: $100.00 per student for Half Day Enrollees

This scholarship is available to those families who are registered at Sacred Heart of

Jesus, Church of St. Clare or Holy Rosary Parishes, and who regularly participate

in the life of the Parish, including regular attendance at Mass as determined in the

Parish’s discretion and as evidenced by the use of offertory cards or envelopes,

regardless of whether a donation is made.

_______ 2. Parish scholarship: $200.00 per student for Full Day Enrollees

This scholarship is available to those families who are registered at Sacred Heart of

Jesus, Church of St. Clare or Holy Rosary Parishes, and who regularly participate

in the life of the Parish, including regular attendance at Mass as determined in the

Parish’s discretion and as evidenced by the use of offertory cards or envelopes,

regardless of whether a donation is made.

.

Please note final scholarship is determined by Parish Offices. Prior to your student being enrolled, you

will be required to sign a tuition agreement. In addition, prior to your student being enrolled, all

required paperwork and forms must be submitted to the Corpus Christi Academy school office and

payment of the non-refundable registration fee must be received and tuition agreement commitments must

be implemented, such as FACTS registration, etc.

________________________________________________ _____________

Parent/Guardian Signature Date

________________________________________________ Print Name

Family Name:__________________________________________________________

Number of Students________________________ Grade Level (s)__________________________

Tuition Rate_______________________________ ()Qualifies for Parishioner Rate

BALANCE OF THIS PAGE - OFFICE USE ONLY

(a)______________ Review Registration Agreement for completeness

(b)______________ Registration Fee ($100/student) Check No.________ Cash_________

(c)______________ Parishioner status checked

(d)______________ Current on tuition payments checked

(e)______________ Tuition Payment Preference Form completed

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Received by____________________________________ Date Received__________________

Registration Approved by ___________________________ Date Approved___________________

School Registration Checklist: Pre-K

Child’s Name: __________________________________________

Grade for 2020-2021: Pre-K

Items REQUIRED at the time of Registration:

_______ School Registration Packet with signed Tuition Payment Preference Form

_______ Registration Fee - $100 per student Cash _______ Check #_______

_______ Emergency Authorization Medical and Contact Form

_______ Legal Custody Agreement Form

_______ Permanent Record Card

_______ Birth Certificate (copy)

_______ Baptismal Certificate (copy) – If applicable

_______ Preschool Medical Record & Physical Form with Immunization Records

Corpus Christi Academy 5655 MAYFIELD ROAD

LYNDHURST, OHIO 44124 (440) 449-4244

EMERGENCY MEDICAL AUTHORIZATION

2020-2021 SCHOOL YEAR

Family Name:___________________ First Name:__________________ Middle Name:______________

Sex: (circle) M F Grade Level:_____________ Date of Birth:________________

Business Phones: (Father):( )____________________ (Mother): ( )________________________

Cell Phones: (Father):( )_______________________ (Mother): ( )________________________

Address:___________________________ City:_______________ Home Phone: ( )_______________

Mother or Guardian:____________________ Occupation:___________________ With Family:____________

Father or Guardian:_____________________ Occupation:___________________ With Family:___________

IF I CANNOT BE CONTACTED and it is advisable to send my child home due to minor illness, injury

or emergency, my child can be released in the custody of: Name:________________________ Address:___________________________ Phone:____________________

Name:________________________ Address:___________________________ Phone:____________________

Name:________________________ Address:___________________________ Phone:____________________

*Must show proof of identification to be able to release said student.

Date:_________ Signature of Parent or Guardian:_________________________________

FACTS CONCERNING THE CHILD’S MEDICAL HISTORY INCLUDING ALLERGIES, MEDICATIONS BEING TAKEN, AND ANY PHYSICAL IMPAIRMENTS TO WHICH A

PHYSICIAN SHOULD BE ALERTED. PLEASE INCLUDE GLASSES/CONTACTS,

ORTHODONTIC APPLIANCES OR MEDICATIONS TAKEN AT HOME. _______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

Date:_________ Signature of Parent:___________________________________________

Transportation: (please check one) Bus_________ Walk________ Parent Pick-Up_________ If your child does not go directly home after school, please list where the child goes, on what days, with

phone numbers. Name_____________________________________________Phone Number_______________________ M T W TH F

*CONTINUE TO BACK OF THIS PAGE TO COMPLETE FORM*

Please provide your child’s medical-care provider information below: Doctor: Name:_________________________________________

Address:_______________________________________

Phone No.: ( )_______________________________

Dentist: Name:_________________________________________

Address:_______________________________________

Phone No.: ( )______________________________

PRIVACY ACT: It is understood that no student information will be given out without parental consent. However, we wish to inform you that your name and home phone number will be given

to selected adults who will keep the information confidential and will use it only to inform you of emergency situations. This procedure will replace our old method of informing parents of an

emergency school closing. If you have any problem with this policy, please call me in the school office at

(440) 449-4242. I have read the above statement regarding the Privacy of Student Information.

Date:_____________ Signature:_________________________________

PART I OR II MUST BE COMPLETED

PART I (TO GRANT CONSENT) In the event reasonable attempts to contact me at: ( )__________________ or _______________________ (phone) (other parent) at ( )_____________________ have been unsuccessful, I hereby give my consent for:(1) the administration of any treatment deemed necessary by Dr._____________________, or Dr.______________________ or in the (dentist) (physician) event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to:____________________________________ hospital or any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentist, concurring in the necessity for such surgery, are obtained before surgery is performed.

Date:_______ Signature of Parent or Guardian:___________________________________

PART II (REFUSAL TO CONSENT)

DO NOT COMPLETE PART II IF YOU COMPLETED PART I

I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the school authorities to take no action

or:to:_____________________________________________________________________________________ _________________________________________________________________________________________

Date:_________ Signature of Parent or Guardian:_________________________________

CORPUS CHRISTI ACADEMY

2020-2021

INFORMATION REGARDING LEGAL CUSTODY

Date:_______________________

Student Name(s):________________________________________________ Grade:________

_________________________________________________Grade:________

_________________________________________________Grade:________

_________________________________________________Grade:________

Address of student residence:_________________________________________________

_________________________________________________

Student lives with: _____ both parents

_____ mother as residential parent

_____ father as residential parent

_____ grandparent(s) (with legal custody)

_____ other - Please explain:________________________________

Residential parent/guardian:

Name: _____________________________________________________________

Address:_____________________________________________________________

City, Zip: _____________________________________________________________

Phone: _____________________________________________________________

Is there a court order (or pending order) affecting the custody and/or residency of the student(s)?

_____YES* _____ NO

*If yes, please attach a certified copy of the entire court order including the case number and

those sections referring to visitation rights and contact with the school. Also include the page

bearing the judge’s signature and court seal. This copy should include any and all modifications

made as of the date of registration of the student(s) in this school. It is also the responsibility of

the parents to inform the principal of any subsequent modifications during the student(s) tenure

at the school.

Non-residential parent:

Name: ______________________________________________________________

Address: ______________________________________________________________

City, Zip: ______________________________________________________________

Phone: ______________________________________________________________

Does the non-residential parent have visitation rights?_____YES _____NO

Is there a court decision that states that the non-residential parent should NOT receive school

information or attend school activities?

_____YES _____NO

Is the non-residential parent responsible for paying tuition? _____YES _____NO

PreSchool Entrance Medical Record & Physical Form Child’s Name Date of birth

___This above named child has been examined, the immunization status recorded, and the child is in suitable condition for participation in group care. ___This above named child has been immunized in accordance with the requirements of section 5104.014 of the Ohio Revised Code (please note any exceptions below Signature of examining Physician/Physician’s Assistant/Advanced Practice Registered Nurse/Certified Nurse Practitioner

Date of Examination

Name of Physician/Physician’s Assistant/Advanced Practice Registered Nurse/Certified Nurse Practitioner

Telephone Number

Street Address City, State and Zip Code

ATTACH A COPY OF THE CHILD’S IMMUNIZATION RECORD WITH DATES OF DOSES OF

ALL IMMUNIZATIONS

Exceptions to immunization requirements pursuant to 5104.014 ORC (please include names of requirements diseases against which the child has not been immunized and whether it is because the immunization is medically contraindicated, not medically appropriate for the child’s age, or declined by the parent). ____I have declined to have my child immunized against one or more of the diseases required by 5104.014 of the Ohio Revised Code. Please note above and sign Signature of Parent

Date of Signature

OPTIONAL Recommended Assessments/Screenings Vision ___Yes ___No Lead ___Yes ___No Hearing ___Yes ___No Hemoglobin ___Yes ___No Dental ___Yes ___No Other Measurements Notes Height Weight BMI