Page 16 - 2019-20 BOOK

ST. ANDREW THE APOSTLE SCHOOL REGISTRATION FORM

FAMILY LAST NAME_____________________________________________________________________

RESIDENTIAL ADDRESS_____________________________________________________________________________

____________________________________________________________

1) STUDENT LAST NAME FIRST NAME MIDDLE GENDER DATE OF BIRTH CATHOLIC? ENTERING
MM/DD/YYYY YES GRADE
M F
NO

2) STUDENT LAST NAME FIRST NAME MIDDLE GENDER DATE OF BIRTH CATHOLIC? ENTERING
MM/DD/YYYY YES GRADE
M F
NO
3) STUDENT LAST NAME FIRST NAME MIDDLE GENDER DATE OF BIRTH CATHOLIC? ENTERING
MM/DD/YYYY YES GRADE
M F
NO

DO ANY OF YOUR CHILDREN HAVE ANY MEDICAL ISSUES WE SHOULD BE AWARE OF? PLEASE REMEMBER EMERGENCY ACTION PLANS
ARE REQUIRED TO BE UPDATED YEARLY. CONTACT THE SCHOOL OFFICE IF YOUR CHILD IS ON MEDICATION OR HAS A LIFE-
THREATENING ALLERGY. ADDITIONAL PAPERWORK IS REQUIRED. YES ______ NO _______ (for example asthma, allergies, wears
glasses, etc.) Please list below.

_____________________________________________________________________________________________________________

DO ANY OF YOUR CHILDREN HAVE ANY SPECIAL ACADEMIC NEEDS (for example they have an IEP, they have diagnosed ADHD, etc.)
YES ______ NO _______ If they do, please list below.
_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________
FEMALE Parent/Guardian/Other
FIRST NAME LAST NAME MAILING ADDRESS CITY, ZIP (IF DIFFERENT THEN ABOVE)

CATHOLIC? SOCIAL SECURITY OCCUPATION HOME PHONE CELL PHONE

Please pick one

YES NO
MALE Parent/Guardian/Other
FIRST NAME LAST NAME MAILING ADDRESS CITY, ZIP (IF DIFFERENT THEN ABOVE)

CATHOLIC? SOCIAL SECURITY OCCUPATION HOME PHONE CELL PHONE
Please pick one

YES NO
Please list your email(s) below and circle who it belongs to

___________________________________________ MOM/DAD __________________________________________
MOM/DAD

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FOR SCHOOL USE ONLY: Accepted on ___________________ Verified by ____________________