SAINTS PETER AND PAUL CATHOLIC SCHOOL

Registration Form 200___-200___

To the Parent/Guardian: The information asked for below is needed for school files. Kindly fill in the required data (IN BLUE OR BLACK INK) and return this form to the office.

Catholic __ Non-Catholic_____

PUPIL’S NAME ( M / F ) GRADE _

LAST FIRST MIDDLE CIRCLE ONE

ADDRESS_____________________________________________________PHONE____________________

(STREET)

CITY__________________________________________STATE________________________ZIP_________

E-MAIL ADDRESS________________________________________________________________________

PUPIL’S SOCIAL SECURITY NUMBER_____________________________________________________

BIRTHDATE PLACE

MONTH DAY YEAR CITY STATE

BAPTISM CHURCH

MONTH DAY YEAR CITY STATE

FIRST

COMMUNION CHURCH

MONTH DAY YEAR CITY STATE

SCHOOL PREVIOUSLY ATTENDED (if any) GRADE

Number of Brothers Number of Sisters Number Older Number Younger

Guardian/Person Child Lives With Relationship Language Spoken in Home

MEDICAL INFORMATION

DOCTOR TO BE CALLED IN THE EVENT OF AN EMERGENCY PHONE

ALLERGIES LIFE THREATENING?______________________

ASTHMA ? ___________ INHALER USED?___________

MEDICATION?_______________________ HEART CONDITION? ___________________________

ANY OTHER MEDICAL CONDITIONS?_____________________________________________________

Please fill out other side→

PARENT INFORMATION

FATHER RELIGION

HOME PHONE SOCIAL SECURITY NUMBER

ADDRESS

STREET CITY STATE ZIP CODE

EMPLOYER BUSINESS PHONE

ADDRESS

Married_____ Divorced_____ Remarried_____ Widowed_____ Single_____ Deceased_____

CELL/OTHER PHONE NUMBERS

MOTHER RELIGION

HOME PHONE SOCIAL SECURITY NUMBER

ADDRESS

STREET CITY STATE ZIP CODE

EMPLOYER BUSINESS PHONE

ADDRESS

Married_____ Divorced_____ Remarried_____ Widowed______ Single_____ Deceased_____

CELL/OTHER PHONE NUMBERS

Transportation Authorization Form I authorize the following people to pick up _____________________________ from Sts. Peter & Paul School: Child’s Name
Name	RELATIONSHIP TO STUDENT
1.
2.
3.
4.

No child will be released to anyone other than the names listed above. If anyone other than those listed above are to pick up a student, a note must be sent from the parent/guardian.

Date Signature of Parent or Guardian

FOR OFFICE USE ONLY

Registration Fee Date Paid Check/Cash Entry date Withdrawal Date