K-8 Registration 2008-2009

Please Print

Student’s Last Name_____________________________________________

First Name________________________Middle Name__________________ Entering Grade _____

Date of birth___/____/___ M___F___ Social Security #________________________

First Name________________________Middle Name__________________ Entering Grade _____

Date of birth___/____/___ M___F___ Social Security #________________________

First Name________________________Middle Name__________________ Entering Grade _____

Date of birth___/____/___ M___F___ Social Security #________________________

Student lives with: (Circle) Both parents, Mother, Father, Other__________________________

(relationship)

Student’s Address_____________________________________________________________________

City___________________________________State________Zip_______Phone___________________

School District__________________________________________ New Student______ Returning ____

Father’s Name________________________________________________________________________

Address (if different)___________________________________________________________________

City____________________________________________State_______________________Zip_______

Home Phone________________________________Cell______________________________________

Employer____________________________________________________________________________

Daytime Phone___________________________________Ext________Email_____________________

Mother’s Name_______________________________________________________________________

Address (if different)___________________________________________________________________

City____________________________________________State_______________________Zip_______

Home Phone________________________________Cell______________________________________

Employer____________________________________________________________________________

Daytime Phone___________________________________Ext________Email_____________________

Since Sacramental preparation is part of our curriculum, we may need to contact your parish. Please provide the following:

Catholic____Non-Catholic______Registered in _________________________Parish_________(city)

Ethnicity (Circle) White, Asian, Black, Hispanic, Native American, Multi-Racial

Are there court orders pertaining to any of these children we need to be aware of? (If so, please provide most recent official court documentation.)

Does your child have an existing IEP? No___ Yes___ Name ____________________Grade entering___

(Please provide a copy of the most current IEP, new students only.)

Will you be using the After School Care Program? No___ Yes ___ Occasionally____ Everyday_____

Please list all other siblings living at home, grades and the schools they will attend in the fall. Please include preschoolers.

Name_________________________________Age______Grade______School____________________

Name_________________________________Age______Grade______School____________________

Name_________________________________Age______Grade______School____________________

Our primary means of communication will be e-mail. Please provide your e-mail address_________________________________________________.

We do not have email; please send paper copies of all correspondence.

I understand my child’s records must be received and reviewed, and other admittance requirements met before official acceptance (for new applicants).

I have read the new tuition guidelines and agree to the conditions.

Date Registration received_________________

___ $50.00 Registration fee ___Birth Certificate

___$40.00 Tuition fee ___Baptismal Certificate

___Records ___Request ___Transportation Form

___Sample of work ___Book Form

___Health Packet ___ASP Form