Enrollment Form
______________________________________________________ ___________
Child’s
Last Name, First, Middle Entering
Grade
Session
Choice (PreK only-circle all that apply)
Ethnic
Origin (circle one)
M/W T/Th F M-F African
American Caucasian
Asian
American
Hispanic
__________________________________________ Native
American Other
Address
__________________________________________ __________________________
City,
State, Zip Phone
Number
__________________________________________ __________________________
Birthplace,
City, State Birth
date
__________________________________________ __________________________
School
last attended, City, State Phone
Number
Has your child ever received special education
services? Reading___________ Math___________
Has your child ever received speech services? ___________
__________________________________________ __________________________
Mother’s
Last Name, First Email
__________________________________________ __________________________
Mother’s
Employer Phone
Number
__________________________________________ __________________________
Father’s
Last Name, First Email
__________________________________________ __________________________
Father’s
Employer Phone
Number
Legal Guardian of
Child______________________________________________________________
Number of children in family___________
Name of parish/church your family most often
attends______________________________________
________________________________________________________________________________
Child’s Baptism Date, Church, City, State
Has your child received the sacrament of
Reconciliation? ___________
Has your child received the sacrament of First
Communion? ___________
Updated 2/17/11 (please turn over)
Please
circle how your child will get to and from school:
Drop
Off Pick
Up
Walk/Ride
Bike Walk/Ride
Bike
Parent Parent
Proctor
Bus (ISD 704 only)* Proctor
Bus*
St.
Rose Bus (outside ISD 704 only) St.
Rose Bus
Other____________________________ Other____________________________
________________________________ ________________________________
If
the bus pick up or drop off address is different from the home address, please
list below:
Pick up
address___________________________________________________
Drop off address___________________________________________________
*We
do not recommend putting PreK students on the Proctor bus unless they have an
older sibling to help them.
Please indicate anything else you’d like us to know
about your child/family______________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Students are
not considered enrolled until:
- this Enrollment Form has been completed and
turned in
- the Tuition Agreement has been completed and
turned in
- a $50, non-refundable, deposit has been paid
_____________________________________________________ ___________
Parent
Signature Date
