Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
Enrollment Checklist
Thank you for your interest in registering your child at Our Lady of the Valley Catholic School.
We look forward to an exciting new school year. Each of the following documents must be on
file and the accompanying fees paid in order for your application to be considered complete.
Additionally, all applicants who are new to the school are required to have an interview with the
child’s potential teacher and the principal. Completed application packets may be returned to the
above address.
The following documents are required to complete the enrollment process for all returning and
new students:
 Enrollment Application (one per child)
 Health Registration Form (one per child)
 Permission Forms (SBA tests, use of student photos, directory) (one per child)
 Tuition Information Form (one per family)
 Share Hours Agreement (one per family)
 Family & Friends Information (one per family)
 Uniform Policy Acknowledgment (one per family)
 Copy of student’s immunization records and any TB test results (one per child)
 Signed TADS Tuition Agreement or Tuition Paid in Full
 $100 Non-Refundable Registration Fee (one per family)
The following documents are also required for each new student:
 Copy of student’s school records
 Copy of student’s birth certificate
 SBA/AIMS/MAP/ Terra Nova test results
 Work Samples
 Current Test Scores
 Sacrament documents
Any past fees such as registration fee, tuition, share hours etc., must be paid in full from
previous years in order for enrollment to be considered.
Our Lady of the Valley Catholic School
260 East Nelson Avenue
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
2012-2013 Enrollment Application (one per student)
Student Last Name:
First Name:
Middle Name:
Enrollment Date:
Date of Birth:
Age:______
Grade Entering:
Place of Birth:
Previous School (if any):
Street Address:
Home Telephone:
City:
Zip:
Mailing Address (if different)
City:
Zip:
Primary Email Address:
Student lives with:
Both parents
Mother
Father
Grandparent(s)
Legal Guardian/Other:
Father/Guardian Name:
Mother/Guardian Name:
Place of Business:
Place of Business:
Work Phone:
Cell Phone
Work Phone:
Cell Phone:
Address (if different than above):
Address (if different than above):
City:
State:
City:
State:
Zip:
Zip:____________
Emergency Contacts (other than parents):
Name:
Relationship to student:
Name:
Relationship to student:
Phone:
Phone:
Cell Phone:
Work Phone: __________________
Cell Phone:
Work Phone: _________________
People Who Are Authorized To Pick Up Your Child:
Name: ______________________________________________ Phone: _________________________
Name: ______________________________________________ Phone: _________________________
I am responsible for payment of tuition and fees for the above named student .
Signature of Parent/Guardian____________________________________________
Date _________________
Our Lady of the Valley Catholic School
260 East Nelson Avenue
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
Catholic Sacraments Received by Student (if applicable)
Baptism - Church/City/State
Eucharist - Church/City/State
Confirmation - Church/City/State
Parish Currently Attended - Church/City/State
NCEA Information
The following information is collected solely for purposes of completing paperwork for the National Catholic Educational
Association (NCEA). This organization compiles data annually on demographics of students who are enrolled in Catholic Schools.
Racial Background:
(Please check one box)
Ethnicity:
(Please check one box)
AK Native
Eskimo
American Indian
African-American
Asian
Native Hawaiian/Pacific Islander
Caucasian
Two or More
Hispanic
Aleut
Non-Hispanic
Special Services
What special services has your child received, or been referred for, while attending other schools?
Occupational Therapy
Physical Therapy
Title I
Modified Curriculum
Speech
Other _____________________________
_____________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Concerns of which classroom teachers should be aware?
Additional Information:
Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
Tuition Information
Our Lady of the Valley Catholic School (OLV) strives to set a tuition rate that is affordable for families
while ensuring the long-term financial health of the school. Ideally Catholic school tuition covers at least
50% of the actual education costs; currently tuition is covering 30%-40%. To bridge the gap between
tuition received and actual costs, we depend on the generosity of families, parishes, and friends through a
variety of fundraisers.
2011/2012 Tuition
$4,200
K – 8th Grade
A 3% discount is offered to families paying full tuition prior to the start of school. The discounted one-time
payment is offered until August 15th, 2012 and must be made with check or cash. Full tuition may also be
made with credit card, prior to the first day of school, however credit card payments will not receive a
discount.
For those families with more than one child enrolled, a multi-child discount is offered. The net tuition is as
follows:
1 Child
$4,200
2 Children
$7,800
3 Children
$10,900
4 Children
$13,300
The actual cost to educate 1 child at OLV for the current school year is about $8,500. This means that the
school must raise an additional $4,300 per student through fundraising. Please see the following page for
details about our family volunteer and fundraising requirements.
Tuition Payment Terms For those families who would like payment terms, OLV has partnered with Tuition
Aid Data Services (TADS) for tuition collection. We offer several tuition payment options:
2 payments due in August 2012 and January 2013.
10 payments due monthly August 2012 through May 2013.
12 payments due monthly August 2012 through July 2013.
(There is a one-time processing fee of $45 paid to TADS for the 10 and 12 payment options)
If you are interested in a payment plan option you will need to set up an account with TADS at
www.tads.com You will receive a Tuition Payment Agreement directly from TADS, via email, during the
month of July, where you can select your payment option. If you choose a payment plan you must have a
Tuition Payment Agreement on file with the school before your child(ren) will be allowed to begin classes.
Tuition Assistance
The U.S. Catholic Conference of Bishops released a pastoral statement, Renewing Our Commitment to Catholic
Elementary and Secondary School in the Third Millennium. In this statement, the Bishops remind us that Catholic
schools must be financially accessible to all families that desire a Catholic education for their children.
For families requesting financial assistance, we have partnered with TADS to evaluate financial need through an easy
and confidential application process. Applications can be made online at www.tads.com. Simply click on the
“Financial Aid Assessment Login” button to begin and then follow the step by step instructions. Your complete
financial aid application MUST be received by TADS by May 10, 2012 to qualify. All families requesting financial aid
are required to pay a minimum of 33% of the total cost of tuition. Please contact the school if you have any questions
regarding tuition or tuition assistance.
Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
Fundraising & Share Hours Agreement
(please read carefully & initial where marked)
Tuition alone does not cover all of the necessary resources needed to operate Our Lady of the Valley Catholic
School (OLV). The actual cost to educate 1 child at OLV for a year is about $8,500. This means that the
school must raise an additional $4,300 per student. The success of OLV depends on the faithful involvement
of the school community. We rely on the parents of our students to provide resources which are not covered
by tuition. It is important for parents to be involved in the educational process, and to provide educational
assistance, fundraising and leadership help. _____(initials)
There are several major fundraising events that require participation from every family. In order for the
school to meet its annual fundraising goal, which is needed to support the daily operations of the school, each
family is required, at a minimum, to:
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Sell 40 raffle tickets for our Annual Cash Raffle – Tickets are $10 each
Sell 5 tickets for each of our 4 Steak Dinners (20 tickets total) – Tickets are $20 each
Sell 8 tickets for our Annual Dinner Auction – Tickets are $50 each
Volunteer for a minimum of 3 hours on the day of our Annual Auction (this may be done by a friend if the
parents are not available on this day)
Actively serve on ______________________ auction committee ____ (initials).
Families have the option of either selling their allotted number of tickets or paying for the tickets themselves.
All ticket stubs and monies must be accounted for at the conclusion of each fundraiser. The school will secure
selling locations for each fundraiser so that all parents have an opportunity to sell their tickets. Families not
completing their auction obligations will be billed $400. ________(initials)
Additionally, each family at OLV is required to perform at least 35 hours of service to the school in addition
to the 3 hrs required at the auction. The hours spent in performing the following types of activities qualify as
meeting the mandatory “Share Hours” requirement. It is recommended that families participate in several
different activities. Being active in the school is a great way to meet other families and establish lifelong
friendships. _____(initial) A few examples of the many ways to serve are:
*Room Parent
*Helping in the library
*Active participation in the PVO
*Recess Monitor
*Serving as fundraiser chair / co-chair
*Actively volunteering at a fundraiser
*Helping with building and grounds maintenance
*Driving for field trips
*Assisting a teacher in the classroom
*Helping with “Friday Lunches”
*Cleaning / organizing areas of the school
*Shopping for school supplies/needs etc
A “Share Hours Register” is located in the administration office for logging your hours. Keeping track of
share hours beyond the expected 35 is important. It demonstrates the commitment of families to the success
of the school. This is important information for the community and for potential donors. Please log all your
share hours!!
If you are unable to fulfill your obligation of 35 Share Hours, you will be required to pay for the remaining
hours at the rate of $25 per hour. _____(initials)
I understand and agree to the requirements of this, Our Lady of the Valley Catholic School, Fundraising and
Share Hours Agreement.
Family Name: _______________________________________________________
Parent Signature: _____________________________________________________
Date: _____________________
AUCTION COMMITTEES: By being on a team, you commit to the success of the school.
Procurement: Choose one: Phone call soliciting, on foot soliciting, on-line soliciting
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Silent Auction: Set up & organization of silent auction items with bid sheets
Live Auction: Display live auction items (may require some work ahead of the auction)
Baskets: Gather, sort, compile, fill, seal & label baskets, deliver list of labels to chair
Set Up: Load trucks night before, unload truck at event, set up tables, chairs, linens & silverware
Breakdown/Clean Up: After event, cleanup, load and unload vehicles to take back to OLV
Advertising: Soliciting business for advertising, promoting the auction
Hostess/Greeters: Greet guests as they arrive, assist with coats and answer any questions about event
Table Workers: fill water pitchers, clear plates off tables, empty trash, etc.
Entertainment: Assist chairperson with getting entertainment (music) for event etc
Special Items: choose one: Heads & Tails, $1 Raffle, Mystery Wine, 1 in 100 raffle etc.,
Main Food: Assit food chairperson in kitchen, including prep work and clean up, acquire utensils etc.
Appetizers: Acquire food, plates, napking and utensils, creating, displaying & replenishing appetizers
Desserts: Acquire food, plates, napkins & utensils, creating and displaying
Beverages/Bartending: Assist Chairperson, must have TAM training (will be provided at no cost)
Decorations: Assist chairperson in getting linens on tables and decorating room
Spotters: Assist with live auction by making sure that no bids are missed
Audio/Video: Assist with acquisition, set-up and running of sound system and slide show
Runners: Many needed throughout the event to organize and deliver items
Equipment & Supplies: Acquire all necessary items for auction event, i.e., power cords, pens, etc.
Wishing Well: Wishing well is an opportunity for attendees to donate to a specified teachers “wish” for
their classroom or for the school’s wish. This person(s) need to be available if any questions arise.
Public Relations: Assist and help inform auctioneer, spotters, emcee and special guests of activities
Health Registration Form
___________________
Date of Enrollment
___________________
Last School Attended
_______________________________
School
Previously attended a Mat-Su School?
No_____ Yes______When_________
Where:_________________________
Student’s Name:__________________________________M_____F______Birthdate:______________Age:_________Grade____________
Parent/Guardian (Both):_______________________________Mailing Address:__________________________________Location of Home__________________
Lives with(if other than parent)________________________________Home Phone________________Work Phone______________Cell Phone______________
STUDENT’S MEDICAL HISTORY (Please check all that apply at right of each item) Has your child ever had or has now?...
Yes
Head Injury/Concussion
Epilepsy/Seizures
Hearing Problems
Frequent ear infections
Ear Tubes
Vision Problems
Glasses
Asthma
Pneumonia
Tuberculosis
Year
Yes Year
Heart Problems
Rheumatic Fever
Diabetes
Leukemia/Cancer
Thyroid problems
Kidney/Bladder problems
Ulcer
Mononucleosis
Chicken Pox
Skin Disease/Eczema
Yes Year
Bone/Joint Problems
Scoliosis/Back Curvature
Others:
Behavior/Emotional problems
Substance Abuse Treatment
Depression
Eating Disorder
Hyperactivity/ADD
Coordination Problems
Frequent Bedwetting
My child has allergies to:____________________________________Reaction:________________________________
My child has had surgery for:______________________________________________________________Date:______________________________
My child has been hospitalized for:_________________________________________________________Date:______________________________
Does your child take medication regularly?_____No_____Yes If so please for what please explain:________________________________________
Do you have specific concerns not covered above? If so, please explain: _____________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Health Form 812
Immunizations: You will be notified when your child needs additional immunizations as required by Alaska Law 4AAC 06.055.
Release of Health Information: I give the Administrative Secretary permission to share health related information regarding my child to other School District
personnel on a need to know basis, i.e., teacher, bus/transportation driver, etc.
TB Skin Test: I understand that my child will need a TB Skin test at intervals, as required by State Law 7AAC27.213, during the period they are enrolled in school
in the Matanuska-Susitna Borough School District unless documentation is provided showing negative results in the previous six months or positive results from a
PPD test.
Has your child ever had a positive reaction to a TB Skin Test? ____NO____YES
Date of last Chest X-Ray:_______________________
DATE:_________________
I give permission for the classroom teacher or office personnel to give my child acetaminophen (Tylenol) and/or ibuprofen (Motrin, Advil) antacid (Tums, Rolaids) if
needed. ______YES________NO
IN CASE OF EMERGENCY NOTIFY:
Father’s Home Phone:__________________________Father’s Work/Cell Phone:_______________________________Where Employed:____________________
Mother’s Home Phone:_________________________Mother’s Work/Cell Phone:_______________________________Where Employed:___________________
If unable to contact parents: (local numbers preferred)
___________________________________________
Relative/Neighbor Name & Contact phone
_____________________________________________
Relative/Neighbor Name & Contact phone
______________________________________
Relative/Neighbor Name & Contact phone
Family Doctor:____________________________________Phone:_______________________________________
I give permission for my child to be transported by ambulance if I cannot be located and immediate medical attention is necessary. I give permission for my family
doctor or the physician on call to treat my child. I will assume financial responsibility. ____YES_____NO
COMMENTS OR INSTRUCTIONS:
_____________________________________________________________________________________________
Date
SIGNATURE OF PARENT OR LEGAL GUARDIAN
Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
I give Our Lady of the Valley Catholic School permission to use video/pictures of my child
______________________________ in: (Please check all that apply)
____OLV webpage
____Facebook/You tube
____Newsletter and newspaper articles that are used to promote the school
____Other uses such as calendars, slide shows at auction/fundraisers etc.
____I decline permission to allow use of videos/pictures of my child.
Parent/Guardian Signature
Date
Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
907-376-0883 907-376-0853 fax
School Year 2012-2013
Dear Parents,
Students in K-8 who are enrolled at Our Lady of the Valley Catholic School are required to take
the following tests throughout the school year:
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K-3rd grades AIMS web Reading Assessment
Grades 3-9 SBAs (Standard Based Assessments)
Grades 5 & 7th Terra Nova
K-12 MAP Tests (Fall/Winter & Spring)
Classroom teachers use the results of these tests to plan their lessons and direct instruction
more efficiently. By signing the statement below the advisory teachers at MSCS/Twindly Bridge
will be able to share testing results with your student’s private school teacher(s)
I give Mat-Su Central School/Twindly Bridge permission to release copies of
______________________________________________’s AIMSweb, SBA, Terra Nova,
Student Name
and/or MAP scores to :
Parent Signature
Our Lady of the Valley Catholic School
1201 Bogard Road
Wasilla, AK 99654
Fax (907) 376-0853
Date