New Student 1st-11th

Family Last Name (To keep members of the same family together) REQUIRED Please fill out this field. Please enter valid data.

Student First Name REQUIRED Please fill out this field. Please enter valid data.

Student Last Name REQUIRED Please fill out this field. Please enter valid data.

Student Gender Male Female

Home Address REQUIRED Please fill out this field. Please enter valid data.

City and State REQUIRED Please fill out this field. Please enter valid data.

Zip Code REQUIRED Please fill out this field. Please enter valid data.

Student Birth Date REQUIRED Please fill out this field. Please enter a date.

Student Birth Place (City, State) REQUIRED Please fill out this field. Please enter valid data.

Grade in School in 2021-2022 REQUIRED Please fill out this field.

School Attending Please enter valid data.

Who does the student live with?

If Other, please explain Please enter valid data.

Mother's Name Please enter valid data.

Mother's Occupation Please enter valid data.

Mother's Preferred Language

Mother's Work Phone Number Please enter a phone number.

Mother's Cell Phone Number Please enter a phone number.

Mother's Email Please enter an email address.

Is this the student's birth mother? Yes No

If no, please give the following information of the student's birth mother Please enter valid data.

Father's Name Please enter valid data.

Father's Occupation Please enter valid data.

Father's Preferred Language

Father's Work Phone Number Please enter a phone number.

Father's Cell Phone Number Please enter a phone number.

Father's Email Please enter an email address.

Is this the student's birth father? Yes No

If no, please give the following information of the student's birth father: Please enter valid data.

Has the Student been Baptized? REQUIRED Yes No Please fill out this field.

If yes, please provide the date of baptism Please enter a date.

Baptismal Information Please enter valid data.

Is this church Catholic? REQUIRED Yes No Please fill out this field.

If no, what faith? Please enter valid data.

Has the student received First Holy Communion? REQUIRED Yes No Please fill out this field.

If yes, please provide the date of FHC Please enter a date.

FHC Information Please enter valid data.

Has the student been Confirmed? REQUIRED Yes No Please fill out this field.

if yes, please provide the date of Confirmation Please enter a date.

Confirmation Information Please enter valid data.

Emergency Contact's Name (Other than Parent) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergency Contact's Relationship to Student REQUIRED Please fill out this field. Please enter valid data.

Any medical conditions we should be aware of (allergies, learning or physical disabilities, etc.)? Please enter valid data.

Please provide preferred phone number to receive text message notifications through our flock note system: REQUIRED Please fill out this field. Please enter a phone number.

Please provide preferred email to receive notifications through our flock note system: REQUIRED Please fill out this field. Please enter an email address.