REGISTRATION PACKAGE Our Lady Queen of Peace Catholic School
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Our Lady Queen of Peace Catholic School
REGISTRATION PACKAGE
1600 Highway 2004
Richwood, Texas 77531
979-265-3909
FAX 979-265-9780
www.olqpschool.org
2022-2023
Requirements at the time of Registration
Birth Certificate Copy from the County
Social Security Card Copy
Current Immunization Records
Baptismal Certificate (if applicable)
Authorization for School Records from previous school
Most Recent Report Card (if applicable)
Interview with the Principal
Screening of the enrolling student
Copies of Court Records regarding guardianship or parental custody (if applicable)
Registration Fee
Down payment is due April 12, 2022
Smart Tuition enrollment (if not paid in full)
Tuition Assistance (if applicable)
Extended Care paperwork completed if necessary
Uniforms are required for Kindergarten through 8th grade.
January 10, 2022
Dear OLQP Family,
Thank you for choosing Our Lady Queen of Peace Catholic School. You have given your child a priceless gift by bringing them to OLQP where they can learn
to love God and one another. In doing so, you are infusing the world with hope by helping us form loving and caring future citizens. This unprecedented
past year has shown us how important having positive, loving, and caring citizens is for our future. They will be tomorrow’s heroes.
All of us here feel very blessed to provide individualized attention in small loving classroom environments. We are very thankful that you will continue to be part of
our OLQP family and greatly appreciate how committed you are to working in partnership with us. I am so thankful to God, and to each of you, and the staff for
working to stay safe so we can provide uninterrupted face-to-face instruction. Let's all keep praying that God continues to bless us through the days ahead.
Why am I thankful OLQP is here as a choice for parents? When I look at the choices available in Southern Brazoria County, I am especially thankful that students here
are in a safe and respectful environment. I am glad OLQP is a place where you do not have to worry about your 5th to 8th graders witnessing daily fights among
students as is happening in other schools in this area. I am glad we have established the expectation of respect for God, for adults, and for each other at OLQP. This is
a place where students are not exposed to cursing and drugs like the schools in the area. This is a place where students, teachers, and parents work together to meet
the expectation of doing homework - again this expectation sets us apart from the schools around us. This is why we are the elementary and middle school that
graduates the most valedictorians and salutatorians of all the area high schools. The majority of our students will be in the top 8% of their high schools. OLQP helps
form students who are both caring and ready for meeting success in a high school or college setting.
The OLQP Board of Trustees, working with Administration, has decided in the midst of these difficult times there will be no increases in tuition or fees. We hope that
this will help our families and also allow more children to come to our wonderful school. What a blessing for our community if more children came here to build their
personal relationship with Jesus Christ and excel in academics. We are continuing our work on other ways to make Catholic education more affordable.
This year, the "Priority/Discounted Registration" for currently enrolled families will take place Tuesday January 18 through Wednesday January 19, 2022. There is a
discount from $240 to $135 for students in K – 8th grades. That is a $105 savings to you if you register by 6:00 pm on January 19, 2022. The fee for additional
students in K – 8th grades is also discounted from $160 to $90. As of January 20, 2022, the registration fee for K – 8th grades will be $240 and the registration fee for
Pre-K is $125.
Some important notes related to tuition cost and payments include:
• We offer a 3% discount on tuition balance after downpayment for prepaying your full annual tuition balance by May 3, 2022.
• The difference between the true cost of educating a child at OLQP and the tuition charged is approximately $4,037.00 .
• Donations, The Annual Giving Fund, and our two major fundraisers are the ways that we are able to cover this "gap" in order to keep tuition as low as
possible.
• If you would like to make a donation to help "close the gap," you may do so on-line at www.olqpschool.org/donate-here
• Electronic copies of these forms may be found on the school's website under the admissions tab.
TUITION ASSISTANCE IS AVAILABLE for K-8th grade. You must pay your non-refundable registration fee first and turn in registration package in order to apply for
tuition assistance. The tuition assistance application must be completed online. All information is confidential and handled by FACTS Tuition Assistance
Management. Tuition assistance is not guaranteed to all that apply.
The deadline for Tuition Assistance applications is February 11, 2022.
For your convenience, we will be "at the curb" during morning drop-off from 7:45am to 8:00am on January 18 and January 19, 2022 to collect your registration
paperwork. All accounts (tuition, extended care, library, and lunch) must be current before the finance office can begin processing your registration.
You may also complete your paperwork and submit it online to registrar@olqpschool.org and drop your registration check at morning arrival. Remember to print,
sign, and scan your registration packet before emailing to registrar. Please sign all pages.
Again, thank you for being part of Our Lady Queen of Peace Catholic School. Please contact us with any questions or concerns.
God bless,
Mrs. Nirm Thomas, M.S. (Engineering) ,M.Ed.
Principal
OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL
Instilling Knowledge, Inspiring Faith
1600 Highway 2004
Richwood, Texas 77531
~~~~
OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL
REGISTRATION FORM
STUDENT INFORMATION
SCHOOL YEAR : 2022 - 2023 REGISTERING FOR GRADE:
LAST NAME: FIRST: MIDDLE:
Address: City Zip:
Birth Date: Pre-K Attendance All day or Half Day
Birth Place: 5 days M-F or 3 days M-W-F
Student lives with Both Parents Mother Father Guardian
Gender: Female Male
Other
Nick Name: Public School District: Baptism Date:
Language spoken at home: School transferring from: Baptism Church:
Social Security No. Ever attended OLQP? Religion:
Race---please check one: I WILL PRE-PAY THE ANNUAL
Present Parish:
TUITION
NATIVE AMERICAN I WILL SIGN UP FOR THE
SMART TUITION PAYMENT If Parents are separated or divorced, a copy of
ASIAN documentation as to who has custody of the
BLACK PROGRAM
child must be kept in the child’s file at the
NATIVE HI/PACIFIC ISLAND I am interested in applying for
school.
WHITE TUITION ASSISTANCE
MULTI-RACIAL
Ethnicity-please check one: Siblings Names and ages:
UNKNOWN
HISPANIC OR LATINO
YES NO
PARENT OR GUARDIAN INFORMATION
FATHER: MOTHER:
Home phone: Home phone:
Work phone: Ext: Work phone: Ext:
Cell phone: Cell phone:
Email: Email:
Occupation: Occupation:
Employer: Employer:
Religion: Religion:
Parish: Parish:
Race/Ethnicity: Race/Ethnicity:
Education: Education:
Marital Status: Maiden Name:
Address: (if different) Address: (if different):
STUDENT LAST NAME: FIRST NAME: MIDDLE NAME:
Grandparents: Grandparents:
Mailing Address: Mailing Address:
City, State, Zip: City, State, Zip:
Email Address: Email Address:
Home: Cell: Home: Cell:
approved to pick up my child approved to pick up my child
call in case of emergency call in case of emergency
add to schools mailing list add to schools mailing list
EMERGENCY CONTACT LIST THIS YEAR:
Students will not be released to anyone who is not on this list! Permission is given to the following people:
Please check all boxes that apply.
Name: Home ph:
Relationship: Work:
Address: Cell:
approved to pick up my child call in case of emergency add to schools mailing list
Name: Home ph:
Relationship: Work:
Address: Cell:
approved to pick up my child call in case of emergency add to schools mailing list
Name: Home ph:
Relationship: Work:
Address: Cell:
approved to pick up my child call in case of emergency add to schools mailing list
Name: Home ph:
Relationship: Work:
Address: Cell:
approved to pick up my child call in case of emergency add to schools mailing list
NEW FAMILIES ONLY: We were referred to Our Lady Queen of Peace by one of the
school families. That family is :
Our Lady Queen of Peace reserves the right to ask a student to withdraw if he/she cannot adjust to our program or environment. Preschoolers must be potty-trained tor
remain in the program. The Administration of OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL agrees to accept this student at OUR LADY QUEEN OF
PEACE CATHOLIC SCHOOL for a period of Six (6) Weeks. This conditional acceptance is granted to determine the student’s ability to meet the expectations of
the school program. The student must maintain passing grades and acceptable behavior as outlined in the current Our Lady Queen of Peace Family Handbook. The
Administration of Our Lady Queen of Peace will determine the status of continued enrollment at the end of the designated time. I read and understand the terms of
the above. I do accept these terms and choose to enroll my son/daughter at Our Lady Queen of Peace under the above terms. I am fully aware that there is no
guarantee of re-enrollment if these terms are not satisfactorily met.
I/we have included the non-refundable registration fee per student with this registration.
Parents’ Signature * x____________________________________________________________________________________________________
Date of Registration_______________________________________________________________________________________________________
* Electronic Signature agreement: By typing in the Parent/Guardian/Student signature fields you are electronically signing the page in this Registration packet
Agreement. You agree your electronic signature is the equivalent of your manual signature on the pages where you type in the Signature box of this Registration
packet Agreement. By typing in your name, you consent to be legally bound by this Agreement's terms and conditions.
By checking this box I accept this electronic signature agreement. If you do not accept, please print and sign each page manually.SCHOOL YEAR 2022 - 2023 SPECIAL NEEDS INFORMATION DISCLOSURE FORM
We at Our Lady Queen of Peace Catholic School enter into partnership with you, the
parent(s)/guardian(s), to provide the best education for your child/our student. To make
appropriate decisions for your child's benefit, it is necessary that all pertinent data concerning
your child's medical, psychological, behavioral, emotional or educational history that may affect
the learning environment or the educational progress of the child be disclosed. Failure to
provide this information may prohibit the staff of Our Lady Queen of Peace Catholic School
from meeting the individual needs of your child, and consequently, present reason to request
that your child not continues at this school.
STUDENT NAME: ___________________________________ENTERING GRADE: ___________
ALL INFORMATION IS HELD IN CONFIDENCE
Has your child...
yes __ no __ been tested for any special concerns academic, attention deficit, learning
problems, behavior or other?
yes __ no __ been referred for Special Education Services (testing or classes)?
If so, please describe. ________________________________________________
_________________________________________________________________
yes __ no __ ever been on medication for educational purposes? This would include
attention deficit, hyperactivity, and learning disability.
If so, please describe. ________________________________________________
_________________________________________________________________
yes __ no __ ever needed medication for his/her emotional health in order to function in a
school setting?
If so, please describe. ________________________________________________
_________________________________________________________________
yes __ no __ ever had special services provided?
If so, please describe. ________________________________________________
__________________________________________________________________
yes __ no __ Are you willing to share the test results with the administration of this school?
Would you allow a copy of these test results to be placed in a confidential
yes __ no __ student file at this school?
Parent/Guardian Signature: _____________________________________ Date: ___________OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL, RICHWOOD, TEXAS 77531
DATE _____________ ARCHDIOCESE OF GALVESTON HOUSTON
ANNUAL INCOME ELIGIBILITY PARENT SURVEY
Erate Funding Year 25 - School Year 2022- 2023
Please complete and return the survey below. In order for this survey to be considered a valid measure, the survey must be returned
to the principal even if your income does not meet any of the criteria. The purpose of this survey is to collect data that will be
used to determine the school’s federal funding allocation. Use the chart below to find your family size. Family size may include a foster
child, an emancipated youth or a special education student over age 18. If you are paid on a weekly or monthly basis, please multiply
that amount by the number of weeks or months actually worked each year to determine your “Annual Gross Income.”
PLEASE CHECK HOUSEHOLD SIZE IN TABLE BELOW:
Household Size Annual Month Twice Per Month Every Two Weeks Week
1 $ 23,828 $ 1,986 $963 $ 917 $459
2 32,227 2,686 1,304 1,240 620
3 40,626 3,386 1,645 1,563 782
4 49,025 4,086 1,985 1,886 943
5 57,424 4,786 2,326 2,209 1,105
6 65,823 5,486 2,667 2,532 1,266
7 74,222 6,186 3,008 2,855 1,428
8 82,621 6,886 3,348 3,178 1,589
For each additional family
+8,399 + 700 + 350 + 324 + 162
member, add:
Example: Family Size Annual Income
4 $49,025
8 $82,621
Please circle your answer
1. If your family income is the same or less than the amount shown on the chart beside your family size,
circle yes. If more than the amount shown, circle NO and move to the bottom portion. YES NO
2. Is your family eligible for food stamps? YES NO
3. Are you receiving public assistance? Food stamps, or TANF (formerly AFDC) YES NO
4. Are any of your children eligible for the "Medicaid" program? YES NO
5. Are you receiving full scholarship based on need for your child/children? YES NO
6. Are you receiving free or reduced tuition for your child/children? YES NO
7. Does your family live in a housing project or have poor housing conditions? YES NO
8. Do you have an unusual financial burden? If yes, please explain: (If necessary use back of page) YES NO
FAMILY NAME (PRINT): ____________________________________________________________________
FAMILY ADDRESS:
______________________________________________________________________________________________________
PUBLIC SCHOOL DISTRICT IN WHICH YOU RESIDE: _________________________________________
List the name of all school age children living in your home, including which school they attend and their grade level.
NAME OF CHILD NAME OF SCHOOL GRADE LEVELTuition & Fee Schedule
1600 HWY 2004 | Richwood, TX 77531
979-265-3909
www.olqpschool.org
2022-2023 Annual Tuition
10 Monthly PREPAYMENT
Payments BALANCE
PK3-PK4 Half Day Tuition Annual Fees Down Payment (assumes down payment & fees
(after down payment and already paid; 3% discount applied
annual fees are paid) after down payment)
5 Days M-F $3,066.00 $680.00 $306.60 $275.94 $2,676.62
3 Days M-W-F $2,446.00 $680.00 $244.60 $220.14 $2,135.36
10 Monthly PREPAYMENT
Payments BALANCE
PK3-PK4 Full Day Tuition Annual Fees Down Payment (assumes down payment & fees
(after down payment and already paid; 3% discount applied
annual fees are paid) after down payment)
5 Days M-F $4,995.00 $680.00 $499.50 $449.55 $4,360.64
3 Days M-W-F $3,395.00 $680.00 $339.50 $305.55 $2,963.84
10 Monthly PREPAYMENT
Payments BALANCE
Kindergarten Tuition Annual Fees Down Payment (assumes down payment & fees
(after down payment and already paid; 3% discount applied
annual fees are paid) after down payment)
1st Child $6,200.00 $795.00 $620.00 $558.00 $5,412.60
2nd Child $6,200.00 $390.00 $620.00 $558.00 $5,412.60
3 Children (15%) $5,270.00 $390.00 $527.00 $465.00
4 Children (20%) $4,960.00 $390.00 $496.00 $434.00
10 Monthly PREPAYMENT
Payments BALANCE
1st-5th Grade Tuition Annual Fees Down Payment (assumes down payment & fees
(after down payment and already paid; 3% discount applied
annual fees are paid) after down payment)
1st Child $7,500.00 $795.00 $750.00 $675.00 $6,547.50
2nd Child $7,500.00 $390.00 $750.00 $675.00 $6,547.50
3 Children (15%) $6,375.00 $390.00 $637.50 $562.50
4 Children (20%) $6,000.00 $390.00 $600.00 $525.00
10 Monthly PREPAYMENT
Payments BALANCE
6th-8th Grade Tuition Annual Fees Down Payment (assumes down payment & fees
(after down payment and already paid; 3% discount applied
annual fees are paid) after down payment)
1st Child $7,995.00 $795.00 $799.50 $719.55 $6,979.64
2nd Child $7,995.00 $390.00 $799.50 $719.55 $6,979.64
3 Children (15%) $6,795.75 $390.00 $679.58 $599.63
4 Children (20%) $6,396.00 $390.00 $639.60 $559.65
Annual Fees
Registration Fee : Preschool ($125); Kinder to 8th ($240)
$150 Technology Fee Per Student
$20 Home and School Fee Per Family
$10 Booster Fee Per Family
$375 Staff Bonus Fee Per Family
Installment Plan
Non-refundable Registration fee is due on date of registration. A nonrefundable down payment and annual fees are due April 12, 2022 or the date of registration whichever is later.
Down payment consist of 10% of tuition total.
The balance is payable in 10 monthly installments due July 1, 2022 through April 1, 2023 and is made through SMART Tuition
Prepayment
Non-refundable Registration fee is due on date of registration. A nonrefundable down payment and all fees are due April 12, 2022 or date of registration, whichever is later. Down
payment consist of 10% of tuition and all annual fees.
If the balance is paid in full May 3, 2022, family will receive a 3% discount on tuition after the 10% downpayment is taken out
Tuition Assistance is available via online application for K-8th grades. Deadline for submission is February 11, 2022. Non-refundable
Registration fee must be paid in order to be eligible to receive tuition assistance information.
Extracurricular athletics participation fee is $175 per sport. Fees are mandatory for participation and are nonrefundable. They are due when billed.
Please see tuition notes in registration packet for additional details REVISED 1/11/2022Tuition
Tuition may be paid in installments or prepaid in full
• Tuition Refunds- Tuition payments are not refundable
• Tuition Assistance- Online tuition assistance applications are available for K-8th grade. The deadline for this
paperwork is February 11, 2022. Annual fees must be paid in order to be eligible to receive tuition assistance
information
Installment Plan
• A nonrefundable down payment and annual fees are due April 12, 2022 or date of registration, whichever is
later
• The balance is payable in 10 monthly installments due July 1, 2022 through April 1, 2023. These installments will
be paid to SMART Tuition Management
• The installment plan is subject to a nonrefundable setup fee paid to SMART and due with the first installment
• Monthly installments will be drafted by EFT from your bank account or charged to your credit card. Credit card
payments are subject to a convenience fee charged by SMART
• OLQP will charge a $25 handling fee per incident on any payments due SMART that are made to the school.
• For later enrollments, installments whose due dates cannot be scheduled with SMART are due at registration.
For example, for a late July enrollment the down payment and the July and August installments are due at
registration.
Prepayment Plan
• A nonrefundable down payment and annual fees are due April 12, 2022 or date of registration, whichever is
later. A $25.00 late fee will be charged after May 1, 2022
• The balance of prepayment of tuition is due May 3, 2022 and will receive a 3% discount. Please note that the 3%
discount is applied to the balance after the down payment is taken out.
• If the balance is not paid in full by May 3, 2022, the prepayment discount will decrease 0.5% every half month
thereafter until the balance is paid in full
• If the installment plan is initially selected, but payment in full is subsequently made, the prepayment discount
will be the discount applicable to the date when payment in full is received. The discount will be applied to the
entire balance amount and not just the remainder then due. However, the SMART setup fee will not be
refunded, nor any late fees charged
Multi Child Discount
The following discounts apply for students enrolled in K-8th grade and in Pre-K full time - 5 days. The discounts apply to
the balance but not the down payment.
• 3 students enrolled- 15%
• 4 students enrolled- 20%
• 5 or more students enrolled- 25%
Miscellaneous Fees
• Annual fees per student that are due with the down payment include: $20.00 to Home and School, $10.00 to
Booster Club and $150.00 for Technology. The $375 Staff Bonus Fee is a per family annual fee due with the
down payment as well. Annual fees are nonrefundable.
• Extracurricular Athletics Participation Fee: $175 per sport and are due when billed
• Pre-K schedule change fee- $75 per change per student per incident
• Return check fee- $25
• A 3.0% service fee for all credit card charges made payable to OLQP will be assessed
• Fees mentioned above are nonrefundableTECHNOLOGY / TELECOMMUNICATIONS ACCEPTABLE USE POLICY Our Lady Queen of Peace Catholic School is pleased to offer students access to a computer network and the Internet on the server owned by the school. To gain access to the Internet, and to use school computers all students must obtain parental permission as verified by the signatures on the technology agreement form. Should a parent prefer that a student not have Internet access, computer access will still be granted for software-based applications such as word processing. Acceptance of the technology agreement for this computer access is still required. These rules apply to both school and personally owned technology devices used on OLQP premises. Personally owned technology devices may be utilized for educational purposes during the school day as directed by a student’s classroom teacher. A completed technology agreement form is required as well as compliance with additional guidelines as may be requested by the teacher allowing such devices to be used. What is possible? Network and Internet access will enable students to explore thousands of libraries, databases, museums, and other repositories of information around the world. Families should be aware that some material accessible via the Internet might contain items that are illegal, defamatory, inaccurate, or potentially offensive. All computers at Our Lady Queen of Peace have content filtering software installed. While the purposes of the school are to use Internet resources for constructive educational goals, students may find ways to access other materials. We believe that the benefits to students from access to the Internet justify its availability. Ultimately, however, parents and guardians of minors are responsible for setting and conveying the standards that their children should follow when using media and information sources. Therefore, we support and respect each family’s right to decide whether or not to apply for access. What is expected? Students are responsible for appropriate behavior on the school’s computer network just as they are in a classroom or on a school playground. Individual student e-mail accounts will not be established for the students at school and accessing personal e- mail accounts is not acceptable. Communications on the network are often public in nature. General school rules for behavior and communications apply. It is expected that users will comply with school standards and the specific rules set forth below and by their supervising teacher. Cheating on digital assessments or assignments is not allowed. The use of computers is a privilege, not a right, and may be revoked if abused. The user is personally responsible for his/her actions in accessing and utilizing the school’s computer resources. The students are required never to
access personal e-mail accounts, go to restricted sites or keep, or send anything that
they would not want their parents or teachers to see.
What are the rules?
Personal Safety and Personal Privacy: Students will not post personal contact
information about themselves or others. Personal contact information includes
addresses, telephone numbers, school addresses, etc. This information may not be
provided to an individual, organization, or company, including web sites that solicit
personal information. Use of personal or school owned electronic devices for
commercial activities, product advertisement, political lobbying, game playing,
gambling, unauthorized chat, blogging or chain letter communication, information on
bombs, pornography, and inappropriate language, content, and communications is
strictly prohibited.
Illegal copying – Students should never download or install any commercial
software, shareware, or freeware onto network drives or disks, unless they have
written permission from the teacher. Nor should students copy other people’s work
or intrude into other people’s files.
Social networking Websites such as, but not limited to Facebook, Twitter,
Instagram, et al.) are off-limits on school property whether accessed on school
owned or personal devices.
Inappropriate materials or language – No profane, abusive or impolite language
should be used in electronic communications nor should materials be accessed
which are not in line with the rules of school behavior. Students and other utilizing
the school provided computer network should never view, send, or access materials,
which you would not want made public. Should a student encounter such materials
generated by others, he/she should report it to their teacher immediately.
In order to maintain access to the school computer network, a student:
1. Must not use a computer to harm other people or their work.
2. Must not damage the computer or the network in any way.
3. Must not interfere with the operation of the computer by installing
illegal software, shareware, or freeware.
4. Must not violate copyright laws.
5. Must not view, send or display offensive messages or pictures.
6. Must not share password(s) with another person.
7. Must not waste limited resources such as disk space or printing
capacity.
8. Must not trespass in another’s folders, work or files.
9. Must turn off the monitor and notify an adult immediately, when
encountering materials which violate the rules of use.
10. Must not access personal e-mail accounts, Instant messaging sites or
other unapproved websites.Digital and Distance Learning Policy (Part of Technology Acceptable Use
Guidelines)
Parents consent to Our Lady Queen of Peace Catholic School's (OLQP)
collection, use, and/or disclosure of information about my children through video
conferencing, online classes and recording applications and other procedures used
with course instruction.
Parents understand that their child may be participating in a virtual academic
setting. A child's name, image, speech, typed content, and segments of video may
be transmitted during remote learning and online instruction. The information
shared with the teacher, OLQP, and/or learning platform companies is meant solely
for educational/class use.
Any use of this academic material outside OLQP's coursework by the student or
parent, such as sharing video content to a third party website, personal website, or
a social media account is strictly prohibited.
Parent and student will abide by the conditions stated in the Technology
Acceptable Use Agreement and Family Handbook that was signed at the start of
school for proper etiquette via media.
Parents are responsible for ensuring that their child has read, understands and
abides by these terms as well.
Parents are responsible to read the privacy policies of the learning platforms used,
specifically SeeSaw, Google Classroom, Google Hangout, and Google Meet. If
any others are added, the school will inform me and I will read the privacy policies
at that time.
It is the responsibility of the student and the parent to see that work is turned in on
a timely basis in the proper digital format.
Parent understands that their child can receive a failing grade for hitting the
“submit” button to change the status to “turned in” but not actually have turned in
any work. It is the responsibility of the student to show what the digital work looks
like to the parent/guardian to show it is actually done.Our Lady Queen of Peace Catholic School
2022-2023
Students will have many opportunities to access technology resources at Our Lady Queen of Peace
Catholic School. Students are expected to use technology in a safe and responsible manner. Refer to the
Family Handbook for the full requirements of Technology Acceptable Use Policy that includes the Digital &
Distance Learning Policy.
All students need access to the internet for academic success. Students in grades 1-8 will be issued
Google accounts and restricted email for academic use only in Google Classroom. Google Classroom
can be accessed from home. The Google account will also be used to sign in to other accounts such as
Typing.com, Tynker, Quizlet, Khan Academy, Canva, Lucid Press, and other academic sites as directed
by teachers.
Students will be using Google Classroom with assigned internal Gmail accounts for school use only.
OLQP makes no warranties of any kind, whether expressed or implied, for the service it is providing.
OLQP will not be responsible for any damages suffered while on this system. These damages include,
but are not limited to, loss of data as a result of delays, non-deliveries, mis-deliveries, or service
interruptions caused by the system or user’s errors or omissions. Use of any information obtained via the
information system is at your own risk. OLQP specifically disclaims any responsibility for the accuracy of
information obtained through it service. All users need to consider the source of any information they
obtain and consider how valid that information may be. (BOT# Revision:2014 Policy# 190)
As parent/guardian and student of Our Lady Queen of Peace, we have read and discussed the
Technology Acceptable Use Policy found in the OLQP Family Handbook. We agree to abide with the
terms and conditions of both these policies. We understand that this agreement will be kept on file at
school for the 2022-2023 school year.
_ _ _
Student Name - Printed Grade
_ _ _
Student Signature Date
_ _
Parent or Guardian Name - Printed
_ _ _
Parent or Guardian Signature DateAssumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19/viral mutations
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.
COVID-19 is a contagious disease believed to spread mainly through person-to-person contact. As a result, federal,
state, and local governments and federal and state health agencies recommend social spacing and have, in many
locations, prohibited the congregation of groups of people.
Our Lady Queen of Peace Catholic School (OLQP) has put in place several protective measures to reduce the
spread of COVID-19; however, OLQP cannot guarantee that you or your child(ren) will not become infected with
COVID-19 or viral mutations. Further, attending activities or class on the campus of OLQP could increase your risk
and your child(ren)’s risk of contracting COVID-19 and any viral mutations. A group of students is likely to
occasionally disregard social-distancing guidelines, notwithstanding supervision and appropriate sanctions. Parents
and guardians should monitor the health of their child. Parents and guardians agree that they will not take their child
to OLQP if their child displays any symptoms of COVID-19/viral mutations or has been exposed to anyone with
COVID-19/viral mutations. Parent or guardian will notify OLQP immediately if their child is exposed or develops
symptoms. Parent and guardian agrees to comply with rules and directives of OLQP and the Archdiocese, and will
actively encourage their child to do the same. OLQP has shared their Returning to Learning Plan and Instructional
Continuity Plan in their Family Handbook with me which outlines the steps the school takes to help mitigate the
exposure to and the spread of the COVID-19 virus. I have read both plans and I agree to abide by the plans as it
pertains to me or my child(ren).
By signing this agreement, I acknowledge the contagious nature of COVID-19 and other viral mutations and on
behalf of myself, my child(ren), my spouse/co-parent of child(ren) voluntarily assume the risk that my child(ren) and I,
and any member of my family, may be exposed to or infected by COVID-19 or viral mutations by attending activities or
class on the OLQP campus and that such exposure or infection may result in personal injury, illness, permanent
disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 or viral mutations
while on the OLQP campus may result from the actions, omissions, or negligence of myself and others, including, but
not limited to, OLQP employees, agents and representatives, volunteers, program participants and their families
and/or any other individual who may be present upon school property or in attendance at any school activity.
I voluntarily agree to assume, on behalf of myself, my child(ren), and my spouse/co-parent of child(ren) all risks
and accept sole responsibility for any injury to my child(ren),myself and any member of my family, (including, but not
limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I,
my child(ren) and/or members of my family may experience or incur in connection with my child(ren)’s attendance in
activities or participation in OLQP programming (“Claims”).
On my behalf, and on behalf of my children and/or members of my family, I will advance no claim and I hereby
release, covenant not to sue, discharge, defend, indemnify and hold harmless Our Lady Queen of Peace Catholic
School, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions,
damages, costs or expenses of any kind arising out of COVID or viral related claims, illness, death. I understand and
agree that this release includes any Claims based on the actions, omissions, or negligence of OLQP, its employees,
agents, and representatives, whether a COVID-19 infection or any viral infection occurs before, during, or after
participation in any OLQP activity, class, or programming.
Additionally, it should be noted that the laws of the State of Texas provide for numerous immunities for schools
should something occur to a student or to the family of a student as a result of activities on school property. In addition
to this Agreement, these immunities remain intact.
Signature of Parent/Guardian/ Staff Member Date
Print Name of Parent/Guardian/ Staff Member Name of Children/Participant(s)
Signature of 2nd Parent/Guardian Date
Print Name of 2nd Parent/Guardian Name of Children/Participant(s)FAMILY HANDBOOK ACKNOWLEDGEMENT FORM
The school and principal retain the right to amend the Family Handbook for just cause.
Parents will be given prompt notification if changes are made.
We have viewed and read the Family Handbook for Our Lady Queen of Peace Catholic School,
which is posted on the schools web site www.olqpschool.org.
We have discussed the rules and regulations stated therein with our student/s. We agree to
follow the school procedures, regulations, and policies covered in this handbook.
We agree to the statements on the Distance Learning Consent included in the Family Handbook
and also agree to the use of SeeSaw, Google Classroom, Google Suites, Google Meet, and
Google Hangout in the classroom as well.
We have understood and signed the Assumption of Risk and Waiver of Liability Relating to
coronavirus/COVID-19/other viruses. This form has been returned to school on the first day of
school.
Parent/Guardian Signature Date
Student 1 Signature Student 2 Signature Student 3 Signature Date
MEDIA PERMISSION RELEASE
__________________________________________ ________________
STUDENT’S NAME GRADE
Media Permission Release for School Year 2022 2023
I authorize the use of my child's photograph in promotional material provided by Our Lady Queen of Peace Catholic School
including social media. This includes the school website, YouTube, Facebook, and Instagram. I understand that if my child
does not have permission there is a possibility my child will not be able to participate in activities that are being videotaped or
live streamed including but not limited to Veteran’s Day Program, Christmas Show, and Spring Play.
YES NO
________________________________________________ ________________
Parent’s Signature Date
________________________________________________
Parent’s PRINTED NAMEOUR LADY QUEEN OF PEACE CATHOLIC SCHOOL
To Cover The School Year 2022 - 2023
Dear Parents/Guardians,
If you would like our staff to treat your child with insect repellent, please
complete the bottom portion of this form giving us permission to administer
this treatment.
You must also provide the repellent marked with your student’s
name.
The insect repellent will be given to the homeroom teacher
_______________________________________
____ YES, please treat my child with the insect repellent I have provided.
____ NO, do not treat my child with insect repellent.
Student:_________________________________________________________
Grade____________Teacher:________________________________________
Parent/Guardian Signature:_________________________________________
Date:____________________________________________________________School Year 2022 - 2023
OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL
CLINIC COPY Student Emergency Card
Student
Name: Grade: Birth Date: / /
Address: City: TX Zip:
To serve your child IN CASE OF EMERGENCY, accident or sudden illness,
it is necessary that you furnish the following information for emergency calls:
MOTHER: FATHER:
Occupation Occupation
Home # Home #
Work # Work #
Cell # Cell #
Pager # Pager #
LIST TWO NEIGHBORS OR NEARBY RELATIVES WHO WILL ASSUME TEMPORARY
CARE OF YOUR CHILD IF YOU CANNOT BE REACHED:
NAME: NAME:
ADDRESS ADDRESS
Home # Home #
Work # Work #
Cell # Cell #
ALLERGIES: (drug food etc.)
MEDICATION TAKEN DAILY OR AS NEEDED (please include name of medication, dosage and frequency)
DAILY MONITORING REQUIRED (glucose + monitoring)
HEALTH INFORMATION: List any health conditions (heart disease, diabetes, epilepsy, eye/ear problems, or chronic condition):
Doctor’s Name: Office #
Dentist’s Name: Office #
I, the undersigned, do hereby authorize officials of OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL to contact
directly the persons named on this card, and do authorize the named physician/dentist to render such treatment as may be
deemed necessary in an emergency, for the health of said child. In the event physician/dentist, other persons named on this
card, or parents cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in
their judgment, for the health of the aforesaid child. I will not hold the school financially responsible for the emergency care
and/or transportation for said child.
Signature Date
1/10/2022SCHOOL YEAR 2022 - 2023
OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL
ADMINISTRATION OF EXCLUDED
OVER THE COUNTER PRODUCTS
NAME OF CHILD
GRADE DATE OF BIRTH
LIMITED TO: (check all that apply)
☐ INSECT REPELLENT
☐ LIP BALM (Chap Stick)
☐ CONTACT LENS SOLUTION
☐ THROAT SOOTHERS (cannot contain menthol, if present needs physician signature)
I agree to be responsible for maintaining an adequate supply of the above products at school to meet
the needs of my child.
Consent
I hereby request that the medication specified above be given to the above named student. I understand that the school
personnel who give the medication may not be a medically trained person.
I realize that the school does not have to agree to allow medication to be given to a student by school personnel. I
understand that the school’s agreeing to allow the medication to be given is for my benefit and the student’s benefit. Such
agreement by the school is adequate consideration of my agreements contained herein. In consideration for the school
agreeing to allow the medication to be given to the student as requested herein, I agree to indemnify and hold harmless
the Archdiocese of Galveston – Houston, its servants, agents, and employees including, but not limited to the parish, the
school, the principal, and the individuals giving the medication of and from any and all claims, demands, or causes of
action arising out of or in any way connected with the giving of the medication or failing to give the medication to the
student. Further, for said consideration, I, on behalf of myself and the other parent of the student, hereby release and
waive any and all claims, demands, or causes of action against the Archdiocese of Galveston – Houston, its agents,
servants, or employees, including, but not limited to the parish, the school, the principal, and the individual giving or failing
to give the medication.
Parent/ Guardian Signature Date
Printed name Relation to the child
2017SCHOOL YEAR 2022-2023
TB QUESTIONNAIRE: STUDENTS
Catholic Schools Office
Archdiocese of Galveston-Houston
Name of Child: Date of Birth:
School: Date:
Tuberculosis (TB) is a disease caused by TB germs and is usually transmitted by an adult person with active
TB lung disease. It is spread to another person by coughing or sneezing TB germs into the air. These germs
may be breathed in by the child. Children who have active TB disease usually have many of the following
symptoms: cough for more than two weeks duration, loss of appetite, weight loss of ten or more pounds over a
short period of time, fever, chills and night sweats. A person can have TB germs in his or her body but not
have active TB disease (this is called latent TB infection or LTBI). Tuberculosis is preventable and treatable.
TB skin testing (often called the PPD or Mantoux test) is used to see if your child has been infected with TB
germs. No vaccine is recommended for use in the United States to prevent tuberculosis. The skin test is not a
vaccination against TB. We need your help to find out if your child has been exposed to tuberculosis.
All information obtained herein will be kept in confidence
Place a mark in the appropriate box: Yes No Don't
Know
TB can cause fever of long duration, unexplained weight loss, a bad cough (lasting over two
weeks), or coughing up blood. As far as you know:
Has your child been around anyone with any of these symptoms or problems? or
Has your child had any of these symptoms or problems? or
Has your child been around anyone sick with TB?
Was your child born in Mexico or any other country in Latin America, the Caribbean,
Africa, Eastern Europe or Asia?
Has your child traveled in the past year to Mexico or any other country in Latin America, the
Caribbean, Africa, Eastern Europe or Asia for longer than 3 weeks?
If so, specify which country/countries? ______________________________________
To your knowledge, has your child spent time (longer than 3 weeks) with anyone who is/has
been an intravenous (IV) drug user, HIV-infected, in jail or prison or recently came to the United
States from another country?
Has your child been tested for TB? Yes___ (if yes, specify date ____/____) No___
Has your child ever had a positive TB skin test? Yes___ (if yes, specify date ____/____) No___
Parent signature Date
**********************************************************************************************************
For Physician use only- (Must be a practicing physician/provider in the state of Texas per Texas Department of State Health Services guidelines)
PPD administered No___ Yes___ If YES:
Date administered: _____/_____/______ Date read: ______/______/_______ Result of PPD test: __________ mm response
PPD provider signature printed name
City: County:
Type of service provider (i.e. school, Health Steps, other clinics)
If positive, referral to physician No____ Yes____ If yes, name of provider:
Archdiocese of Galveston-Houston | Catholic Schools Office, 2018 62dYou can also read
