Saint Aidan SchoolTogether in Learning, Together in Christ

Registration Checklist

The following items are required for all new applicants at registration:

Application form completely filled out (both sides) and signed by parent

Copy of your child’s Birth Certificate

Copy of your child’s Baptism Certificate (if baptized)

Copy of your child’s most recent report card (Grades 1-8 only)

Your child’s immunization records from their health care provider

Signed Letter of Probation form

Blue Health Record form (completed by parent)

The white required NYS Health Examination Form must be completed by

your child’s health care provider. This form along with the Dental Health

Certificate must be returned when your child starts school.

Registration fee (non-refundable) is $150 per family.

Please make check payable to St. Aidan School.

ST. AIDAN SCHOOL Tuition Rates 2020-2021

Program 2020-2021 10 Monthly Payments Grades K-8

1 Child $5870 $587.00 2 Children 9380 938.00 3 or more Children 12070 1207.00

Pre-K 5 Full Days With Sibling $7140 $714.00 Without Sibling 7750 775.00

Pre-K 3 Full Days With Sibling $4490 $449.00 Without Sibling 5700 570.00

Nursery 5 Day-Extended (8:30-2:30) With Sibling $5100 $510.00 Without Sibling 5400 540.00

Nursery 3 Day – Extended (8:30-2:30) With Sibling $4080 $408.00 Without Sibling 4340 434.00

Nursery 3 Day (8:30-11:30) With Sibling $3470 $347.00 Without Sibling 3770 377.00

Nursery 5 Day (8:30-11:30) With Sibling $3780 $378.00 Without Sibling 4030 403.00

Nursery 2 Day – Extended (8:30-2:30) With Sibling $2720 $272.00 Without Sibling 2895 289.50

Nursery 2 Day – (8:30-11:30) With Sibling $2315 $231.50 Without Sibling 2515 251.50

=============================================================== In order to help with your budgetary needs, tuition is paid in 10 monthly payments from September through June. It is imperative that tuition payments be kept current. A late fee of $50 will be charged for all late payments.

**A technology fee of $75 per student in grades PreK-8 is billed with your first tuition payment. This annual fee is strictly utilized to maintain and upgrade our technology program. It includes, but is not limited to, upgrading and replacing SMARTBoards and iPads, Internet improvements, Wi-Fi connections and classroom computers for teacher and student use. It is our intent that St. Aidan School remains current with the latest technology available.

***Each family with children in grades K through 8 will contribute $150.00 which will go toward PACE’s mandatory fundraising goal.

(Sept.)____________ Public School District __________________________________ Date _____________

SAINT AIDAN SCHOOL – APPLICATION FORM Grade

Child’s First Place of Date of Last Name: ______________________Name_______________ Birth: ________________ Birth:____________ Address: ___________________________________City:_____________________________Zip:_____________ Male Female Home phone number ________________________________

Mother’s Email Address: _____________________________Mother’s cell phone # _______________________

Father’s Email Address: ______________________________Father’s cell phone # ________________________

School Presently Attending: ____________________________ Location: ______________________ Grade: ______________ Church of Baptism: ____________________________ Location: ______________________ Date: _______________ Church of First Penance: _________________________ Location: ______________________ Date: ________________ Church of Communion: __________________________ Location: ______________________ Date: ________________ Father’s Name: ________________________ Occupation: ___________________________________________

Business Name, Add., Tel. #_____________________________________________________________________

____________________________________________________________________________________________

Mother’s Name: ____________________________________________Occupation:________________________ (First) (Maiden) Business Name, Add., Tel. #_____________________________________________________________________

____________________________________________________________________________________________ Father’s Place of Living Religion: _____________________________ Birth: _______________________ Deceased Mother’s Place of Living Religion: _____________________________ Birth: _______________________ Deceased Is parent or relative an alumnus of St. Aidan? Yes No If yes, Name___________________Year_________ Names of Brothers and Sisters: (Oldest Child First) Date of Birth School Attending Grade ________________________________ _______________ ______________________________ _________

________________________________ _______________ ______________________________ _________ ______________________________________ __________________ ____________________________________ ___________

Home Parish: ___________________________________ Location:_____________________________________ Language(s) Spoken in Home:__________________________ Weekly Envelope #

(St. Aidan Church) _____________________ Parents Living Together? Yes No Name of Person to be Emergency Telephone Number called in emergency:__________________________________ if parents not home:____________________

Educational, Behavioral and Medical Needs Survey

My child, ___________________________________, is registering for St. Aidan School for grade_______.

My child may have special educational, behavioral, medical needs as suggested by

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

My child has been identified as having special needs in these areas and is currently receiving them. Services include______________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

My child has been identified as having special needs but is currently not receiving any support services. Please explain:______________________________________________________

________________________________________________________________________________

________________________________________________________________________________

My child has no special needs in these areas.

I verify that all statements on this application form are correct.

___________________________________________ Parent’s Signature

At this time, I plan to have my child continue in St. Aidan School in the future.

Yes No Undecided For state reporting purposes only: Ethnicity: Is the student Hispanic or Latino? Yes No What is the student’s race? Please check all that apply.

American Indian or Alaska Native Asian Black or African American Native Hawaiian/ Other Pacific Islander White

Please Note: Admission is conditional and based upon the receipt and review of your child’s records. There is a $150 application fee (per family) payable at the time of registration.

Rev. 11/20

chuQch o� saint a1ban paQJSh school (nURS€RY thRU sth CjRab€J www.sta1banscho0L0Rq

Lower School • 525 Willis Avenue • Williston Park • New York 11596-1727 • 516-7 46-6585 ext.202 • Fax 516-7 46-8817 Upper School • 51 0 Willis Avenue • Williston Park • New York 11596-1728 • 516-7 46-6585 ext.302 • Fax 516-7 46-3086

Student's Name ---------------

Present Grade -------

The above-named student has enrolled in our school. In order to avoid subjecting the student to unnecessary testing, would you please send the following data to us:

Cumulative Folder including testing data

Grades (up to the time of withdrawal)

Psychological Reports

Individualized Educational Program (IEP)

Sincerely,

Mrs. Juhe A. O'Connell Principal

Permission is hereby granted to release to St. Aidan Scho0l any information relating to my child.

Date Parent/Guardian

Immunization and Health Records

Thank you for your promp attention to this matter.

Nursery/Pre-K

Please select your 1st choice for registration.

Student’s Name: ___________________________ Date of Birth: ____________

NURSERY (must be 3 by November 30)

2 day (Tuesday, Thursday) 8:30 AM - 11:30 AM

2 day (Tuesday, Thursday) 8:30 AM - 2:30 PM

3 day (Monday, Wednesday, Friday) 8:30 AM - 11:30 AM

3 day (Monday, Wednesday, Friday) 8:30 AM - 2:30 PM

5 day (Monday through Friday) 8:30 AM - 11:30 AM

5 day (Monday through Friday) 8:30 AM - 2:30 PM

PRE-K (must be 4 by November 30)

3 day (Monday, Wednesday, Friday) 8:00 AM - 2:30 PM

5 day (Monday through Friday) 8:00 AM - 2:30 PM

Parent Signature:______________________________ Date:______________

SAINT AIDAN SCHOOL WILLISTON PARK, NEW YORK

HEALTH RECORD REGISTRATION FORM (Blue Form)

CHILD’S NAME: ____________________________________ DATE OF BIRTH:______________________

GRADE (Sept.): ___________________ SEX:_____________ TODAY’S DATE:_______________________

STREET ADDRESS:_____________________________________TOWN_____________________________

HOME PHONE NUMBER: _______________________ CITY/STATE OF BIRTH______________________

FATHER’S NAME:______________________________ BUS. PHONE/CELL:_________________________

MOTHER’S NAME:_____________________________ BUS. PHONE/CELL:_________________________

EMAIL ADDRESS: ________________________________________________________________________

NAME AND PHONE NUMBER OF TWO PEOPLE WHO CAN BE REACHED IN THE EVENT OF AN EMERGENCY IF THE PARENTS ARE UNAVAILABLE:

1. NAME: ________________________________________ PHONE:____________________________

2. NAME: ________________________________________ PHONE:____________________________

FAMILY PHYSICIAN: _________________________________ PHONE: ____________________________

FAMILY HEALTH HISTORY (parents, siblings, grandparents)

Food Allergies Yes No Scoliosis Yes No Insect/bee sting allergy Yes No Vision problems Yes No Learning Disability Yes No Color deficiency Yes No ADHD Yes No Hearing problems Yes No Diabetes Yes No Other : _____________________________________

If yes, please explain: ________________________________________________________________________

__________________________________________________________________________________________

CHILD’S HEALTH HISTORY 1. Was your child born prematurely? Yes No Birth Weight __________________

2. Any complications/congenital defects? _______________________________________________________

3. Was your child in neonatal intensive care for any period of time? Yes No

Reason ____________________________________________ Length of time_____________

4. Did you child leave the hospital with you? Yes No 5. Does your child have an ongoing health concern? (asthma, diabetes etc.) Yes No

If yes, please explain:____________________________________________________________ _____________________________________________________________________________

6. Is there a history of any hospitalizations, ER visits, significant injuries or surgery? Yes No If yes, please explain: ___________________________________________________________ _____________________________________________________________________________

7. Does your child have any food allergies? Yes No (Please list) _______________________________ If yes, describe the reaction: ______________________________________________________

8. Does your child have any other allergies? Yes No (Please list) _______________________________ If yes, describe the reaction: ______________________________________________________

9. Has your child ever been stung by a bee? Yes No If yes, describe the reaction: ______________________________________________________

10. Are there any current or past medical concerns/injuries? Yes No

Anemia Yes No Bleeding disorder Yes NoDevelopmental delays Yes No Digestive disorder (constipation, colitis, Crohn’s) Yes NoEar infections Yes No Emotional problems (nervous habits, anxiety etc.) Yes NoHeart problems Yes No Kidney problems Yes NoOrthopedic problems Yes No Neurological problems(migraines, seizures, ADHD) Yes NoSore throats/tonsillitis Yes No Serious injuries/fractures Yes No

If yes, Please explain: _________________________________________________________________ _________________________________________________________________________________________

11. Does your child take any medication regularly at home? Yes No

If yes, please explain: ___________________________________________________________

12. Does your child require medication in school? Yes No

If yes, please explain: ___________________________________________________________

13. Has your child ever needed an inhaler or a nebulizer treatment? Yes No

If yes, please explain: ____________________________________________________________

14. Does your child have any difficulty with: Vision? Yes No Hearing? Yes No Speech? Yes No Gait? Yes No Muscle tone? Yes No

15. Does your child receive any special services? (Speech, OT, PT, vision therapy etc.) Yes No

If yes, please explain: ____________________________________________________________

Do you have any additional concerns or pertinent information that will assist us in caring for your child?

__________________________________________________________________________________________

__________________________________________________________________________________________

Parent/Guardian authorization to release any information on this form to the faculty/staff on a need-to-know basis:

Signature: __________________________________________ Date: _________________________________

Rev. 11/20

Welcome to Saint Aidan School

Health Requirements for School Entrance Lower School

No child is to be admitted unless immunized as follows:

Vaccines Nursery/Pre-K Kindergarten DTaP/DTP/Tdap 4 doses 5 doses or 4 doses

if the 4th dose was received at age 4 or older

Polio 3 doses 4 doses or 3 doses if the 3rd dose was received at

age 4 or older MMR 1 dose

(on or after 1st birthday) 2 doses

Hepatitis B 3 doses 3 doses Varicella

(Chicken Pox) 1 dose

(on or after 1st birthday) 2 doses

HIB (Haemophilus influenza type B)

1 to 4 doses (depends on when the series

was started)

N/A

Pneumococcal 1 to 4 doses (depends on when the series

was started)

N/A

All of the above immunizations must be documented by your child’s pediatrician. The immunization record must specify the exact date each immunization was administered. The physician’s signature is required on the immunization record.

ALL NEW ENTRANTS must have a physical exam by their physician before entering school. Physicals must be submitted to the Health Office no later than October 1. The physical exam is acceptable if it was done anytime within one year of the first day of school. Lead screening is required of Nursery and Pre-K students.

A physical (health examination) form is included with your application forms at registration. This is the required New York State school health examination form. This form must be completed by your child’s pediatrician.

9/2020

REQUIRED NYS SCHOOL HEALTH EXAMINATION FORM TO BE COMPLETED BY PRIVATE HEALTH CARE PROVIDER OR SCHOOL MEDICAL DIRECTOR

IF AN AREA IS NOT ASSESSED INDICATE NOT DONE Note: NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for

interscholastic sports; and working papers as needed; or as required by the Committee on Special Education (CSE) or Committee on Pre-School Special education (CPSE).

STUDENT INFORMATION Name Sex: M F DOB:

School: Grade: Exam Date:

HEALTH HISTORY

Allergies ☐ No

☐ Yes, indicate type

Type:

☐ Medication/Treatment Order Attached ☐ Anaphylaxis Care Plan Attached

Asthma ☐ No

☐ Yes, indicate type

☐ Intermittent ☐ Persistent ☐ Other :

☐ Medication/Treatment Order Attached ☐ Asthma Care Plan Attached

Seizures ☐ No

☐ Yes, indicate type Type:

☐ Medication/Treatment Order Attached

Date of last seizure:

☐ Seizure Care Plan Attached

Diabetes ☐ No

☐ Yes, indicate type

Type: ☐ 1 ☐ 2

☐ Medication/Treatment Order Attached

☐ Diabetes Medical Mgmt. Plan Attached

Risk Factors for Diabetes or Pre-Diabetes: Consider screening for T2DM if BMI% > 85% and has 2 or more risk factors: Family Hx T2DM, Ethnicity, Sx Insulin Resistance, Gestational Hx of Mother, and/or pre-diabetes.

BMI________kg/m2

Percentile (Weight Status Category): <5th 5th-49th 50th-84th 85th-94th 95th-98th 99th and>

Hyperlipidemia: ☐ No ☐ Yes ☐ Not Done Hypertension: ☐ No ☐ Yes ☐ Not Done

PHYSICAL EXAMINATION/ASSESSMENT

Height: Weight: BP: Pulse: Respirations:

Laboratory Testing Positive Negative Date List Other Pertinent Medical Concerns (e.g. concussion, mental health, one functioning organ)

TB- PRN ☐ ☐ Sickle Cell Screen-PRN ☐ ☐ Lead Level Required Grades Pre- K & K Date

☐ Test Done ☐ Lead Elevated > 5 µg/dL ☐ System Review and Abnormal Findings Listed Below

☐ HEENT ☐ Lymph nodes ☐ Abdomen ☐ Extremities ☐ Speech ☐ Dental ☐ Cardiovascular ☐ Back/Spine ☐ Skin ☐ Social Emotional ☐ Neck ☐ Lungs ☐ Genitourinary ☐ Neurological ☐ Musculoskeletal ☐ Assessment/Abnormalities Noted/Recommendations: Diagnoses/Problems (list) ICD-10 Code*

☐ Additional Information Attached *Required only for students with an IEP receiving Medicaid

2020 Page 1 of 2

Name: DOB:

SCREENINGS Vision (w/correction if prescribed) Right Left Referral Not Done Distance Acuity 20/ 20/ ☐ Yes ☐ No ☐ Near Vision Acuity 20/ 20/ ☐ Color Perception Screening ☐ Pass ☐ Fail ☐ Notes Hearing Passing indicates student can hear 20dB at all frequencies: 500, 1000, 2000, 3000, 4000 Hz; for grades 7 & 11 also test at 6000 & 8000 Hz. Not Done

Pure Tone Screening Right ☐ Pass ☐ Fail Left ☐ Pass ☐ Fail Referral ☐ Yes ☐ No ☐

Notes

Scoliosis Screen Boys in grade 9, and Girls in grades 5 & 7

Negative Positive Referral Not Done ☐ ☐ ☐ Yes ☐ No ☐

RECOMMENDATIONS FOR PARTICIPATION IN PHYSICAL EDUCATION/SPORTS/PLAYGROUND/WORK

☐ Student may participate in all activities without restrictions. ☐ Student is restricted from participation in: ☐ Contact Sports: Basketball, Competitive Cheerleading, Diving, Downhill Skiing, Field Hockey, Football, Gymnastics, Ice

Hockey, Lacrosse, Soccer, and Wrestling. ☐ Limited Contact Sports: Baseball, Fencing, Softball, and Volleyball. ☐ Non-Contact Sports: Archery, Badminton, Bowling, Cross-Country, Golf, Riflery, Swimming, Tennis, and Track & Field. ☐ Other Restrictions:

Developmental Stage for Athletic Placement Process ONLY required for students in Grades 7 & 8 who wish to play at the high school interscholastic sports level OR Grades 9-12 who wish to play at the modified interscholastic sports level.

Tanner Stage: ☐ I ☐ II ☐ III ☐ IV ☐ V Age of First Menses (if applicable) : ____________

☐ Other Accommodations*: (e.g. Brace, orthotics, insulin pump, prostectic, sports goggle, etc.) Use additional space below to explain. *Check with athletic governing body if prior approval/form completion required for use of device at athletic competitions.

MEDICATIONS ☐ Order Form for Medication(s) Needed at School Attached

IMMUNIZATIONS ☐ Record Attached ☐ Reported in NYSIIS

HEALTH CARE PROVIDER Medical Provider Signature:

Provider Name: (please print)

Provider Address:

Phone: Fax:

Please Return This Form To Your Child’s School When Completed.

2020 Page 2 of 2

…for a lifetime of learning

Dental Health Certificate

Name of Student ____________________________ Date ___________

School _______________________ Grade ________

Treatment has been completed.

Treatment is in progress.

No treatment is indicated.

________________________________________________________________ Dentist Signature and Stamp Date of Exam