Name of Applicant
Grade ____
Application for Admission
Pre-Kindergarten & Kindergarten
Pre-Kindergarten 3*
Pre-Kindergarten 4**
___ 8:00 – 11:30 am (M-F)
___ 8:00 – 3:00 pm (Full Day)
___ 8:00 – 3:00 pm (M-F)
___ 8:00 – 11:30 am (T-W-TH)
___ 8:00 – 3:00 pm (T-W-TH)
Kindergarten
___ 8:00 – 3:00 pm (Full Day)
*Children must be 3 years old by September 1st for our Pre-K3 program.
**Children must be 4 years old by September 1st for our Pre-K4 program.
The Visitation Academy
200 East 2nd Street
Frederick, MD 21701
Office: 301-662-2814 | Fax: 301-695-8549
www.thevisitationacademy.org
2015-2016 SCHOOL YEAR
The Visitation Academy admits students of any religion, belief, race, color, national and ethnic origin to all rights,
privileges, programs and activities generally accorded or made available to students at our school. We do not
discriminate on the basis of religion, belief, race, color, national or ethnic origin in administration of our educational
and admissions policies.
The Academy welcomes your application to our school. Please call the school office if you have any questions,
comments or concerns regarding the admissions process or any other aspect of the school.
Pre-Kindergarten and Kindergarten
New Student Registration Form
Student’s Name
Last
First
Address
M.I.
Home Phone
Street Address
City
State
Student’s Religion
Parish Registered
Zip
Baptism Date
Baptismal Cert. Attached?
Student’s Ethnic Background
Birth Date
(Caucasian, African American, Asian, Hispanic/Latino, Pacific Islander, American Indian, Multi)
Family Information
School Correspondence should be addressed to (Mr. & Mrs / Ms. / Dr. Name, etc.):
Family email address (for school announcements):
Student resides with (circle one):
both parents / father / mother / grandparent(s) /guardian
Legal status of child’s custody (if applicable):
Sibling(s) applying or in attendance? Yes / No
If yes, Name(s) / Grade(s):
Any family members who are alumnae? Yes / No
Name of Alumna:
Relationship:
Years attended:
Name of Alumna:
Relationship:
Years attended:
Name of Alumna:
Relationship:
Years attended:
Name of Alumna:
Relationship:
Years attended:
2015-2016 SCHOOL YEAR
Father’s Name
Last
First
M.I.
Father’s Email Address
Address*
Home Phone*
Cell Phone
Street Address
City
State
Zip
Father’s Employer
Work Phone
Father’s Religion
Job Title
Marital Status
Relationship to student (please circle one): biological father / step-father / adoptive father
*if different from student’s
Mother’s Name
Last
First
M.I.
Mother’s Email Address
Address*
Home Phone*
Cell Phone
Street Address
City
State
Zip
Mother’s Employer
Work Phone
Mother’s Religion
Job Title
Marital Status
Relationship to student (please circle one): biological mother / step-mother / adoptive mother
*if different from student’s
Legal Guardian’s Name
Last
First
M.I.
Guardian’s Email Address
Address*
Home Phone*
Cell Phone
Street Address
City
Guardian’s Employer
State
Zip
Work Phone
Guardian’s Religion
Job Title
Marital Status
Relationship to student
*if different from student’s
2015-2016 SCHOOL YEAR
Did anyone refer you to Visitation Academy?
Yes / No
If yes, please provide the name of who referred you to our school.
If no, how did you hear about Visitation (i.e. internet, parish bulletin, etc.)
I understand that by the time school begins, my child must be fully toilet trained to enroll in the Visitation
Academy Pre-K or Kindergarten program. The Academy cannot accommodate students who are not toilet
trained. Students are not permitted to wear pull-ups to school.
A Parent-Executive Director interview will be scheduled after the completed application is received. Final acceptance
is dependent upon completion of all admission requirements and a review by the Executive Director and Principal.
Please refer to the required materials and attach all necessary documents and fees, including the mandatory nonrefundable registration fee of $350* which holds your daughter’s place in her class.
*If received prior to February 15, 2015, the fee is $300.
The signature below indicates that you have read and understand the above policies and that the form has been filled
out truthfully to the best of your knowledge.
Signature
Date
FOR OFFICE USE ONLY
Documents Required with Application
___ Enrollment Contract
___ Physical Examination Form
___ Tuition Contract
___ Baptismal Certificate
___ Registration Fee
___ School Recommendation Form
___ Birth Certificate
___ Emergency/Medical Contact Form
___ Immunization Form
___ Current Photo of Daughter
FOR OFFICE USE ONLY
Application received on:
by:
Date
Initials
Enrollment Contract received on:
by:
Date
Registration Fee received on:
Initials
by:
Date
FACTS Enrollment received on:
Initials
by:
Date
Initials