Re-Enroll Now Name* First Last Phone*Email* Re-Enrollment PreferenceAll families, except those whose oldest/only is graduating, must complete this form whether your student(s) will or will not be returning to Lourdes for the 2021-2022 school year. Re-Enrollment ensures your student(s)’s place in the classroom for the coming year.Will your family be returning to Our Lady of Lourdes School?*Yes, we will be returningNo, we will not be returningStudents ReturningPlease list the children in your family that will be returning to Our Lady of Lourdes School (List oldest child first).Name* First Last Do you have any other children that will be RETURNING to Our Lady of Lourdes School?*None1 Additional Child2 Additional Children3 Additional Children4 Additional ChildrenName* First Last Name* First Last Name* First Last Name* First Last New Applicant (optional) I also wish to register another child NOT PRESENTLY attending Our Lady of Lourdes School.Please complete an application by visiting the admissions page on our-lady-of-lourdes-school.org. Please note, there will be a $50.00 application fee due at the time the application is presented. • For Kindergarten Application, Student should be 5 yrs. of age by Sept. 1, 2021 • For 1st Grade Application, Student should be 6 yrs. of age by Sept. 1, 2021Name* First Last Student's Birthday* Date Format: MM slash DD slash YYYY Grade applying for:*Please select the grade level the student will enter.TKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeNotes/MessageCheckoutRe-Enrollment Fee (1 Student) Price: $150.00 Re-Enrollment Fee (2 Students) Price: $300.00 Re-Enrollment Fee (3 Students) Price: $450.00 Re-Enrollment Fee (4 Students) Price: $600.00 Re-Enrollment Fee (5 Students) Price: $750.00 Coupon Billing Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How would you like to make your payment?Bank Account/ACHDebit/Credit CardTotal $0.00 Pay by Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Pay by ACH - Bank Check Account Number SelectSavingsChecking Account Type Routing Number Bank Name Consent I agree to the payment policy below.I authorize the company named on this web form to debit the bank account or credit card indicated in this web form, for the noted amount on today's date. This payment is for the goods and services noted on the web payment form. I understand that returns, refunds and cancellations are not permitted, however exceptions may be made on a case-by-case basis. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted transaction date. I agree that payments for billing schedules with common bill dates may be consolidated into a single payment. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that the company named on this web form may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card or bank account, and that I will not dispute the payment with my Credit Card Company or Bank, so long as the transaction corresponds to the terms indicated in this web form.