Up & Over Registration if paying with check

Student Information
Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
Gender*
- Male
- Female
Grade Level (2024 - 2025 School Year)*
Parish
Dieterary Needs/Allergies/Medical Restrictions
Parent/Guardian Information
Name*
Relationship to Student
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Up & Over Registration Total Cost: $170 (which includes a $75.00 non-refundable deposit)
- Up & Over Fee: $170 (which includes a $75 non-refundable deposit)
- Up & Over Deposit: $75 (non-refundable)
Up & Over Total
$0.00
Please make your check payable to Diocese of Scranton and mail it to the Office for Parish Life, Attn: Tommy Flynn, Diocesan Pastoral Center 330 Wyoming Avenue Scranton, PA 18503

Student Information