Your email address (for confirmation email)

School Year

Entry Date (today's date):

Grade Level (K, 1st, 2nd, 3rd, 4th, 5th)

Catholic? NoYes

If yes, what is your home parish?

Student:

First Name Middle Name Last Name

Sex FemaleMale

Date of Birth (mm/dd/yyyy)

Address (number and street)

City

State (initials)

Zip Code

Special needs, allergies, etc.?

Place of Birth:

Legal/Custodial Parent

Fathers Name

Fathers Home Phone

Fathers Work Phone

If the Father's address is the same as the child's, check this box and skip to 'Father's Occupation' Fathers Address Same

Fathers Street Address

Fathers City

Fathers State

Fathers Zip Code

Fathers Occupation

Fathers Religious Denomination

Fathers Country of Birth

Fathers Email Address

Mothers Name

Mothers Maiden Name

Mothers Home Phone

Mothers Work Phone

If the Mother's address is the same as the child's, check this box and skip to 'Mother's Occupation' Mothers Address Same

Mothers Street Address

Mothers City

Mothers State

Mothers Zip Code

Mothers Occupation

Mothers Religious Denomination

Mothers Country of Birth

Mothers Email Address

Marital StatusMarriedSeparatedDivorced

Child's Baptism Date (mm/dd/yyyy)

Child's Baptism Church

Child's Baptism City

Child's Baptism State

Child's Eucharist Date (mm/dd/yyyy)

Child's Eucharist Church

Child's Eucharist City

Child's Eucharist State

Child's Penance Date (mm/dd/yyyy)

Child's Penance Church

Child's Penance City

Child's Penance State

Other Children

Child 1 Name

Child 1 Date of Birth (mm/dd/yyyy)

Child 2 Name

Child 2 Date of Birth (mm/dd/yyyy)

Child 3 Name

Child 3 Date of Birth (mm/dd/yyyy)

Schools Previously Attended:

School 1 Name

School 1 City

School 1 State

School 1 Date

School 1 Grade

School 2 Name

School 2 City

School 2 State

School 2 Date

School 2 Grade