New Student Registration Form (One For Each Student)

Student Information Section

Student Last Name

Student First Name

Student Gender

Student Entering Grade

Describe the Relationship Between the Student & the Head of Household Where the Student Resides

Student Ethnicity

Language Spoken At Home

Language Spoken By Student (if not English)

Please provide the names and ages of all children under the age of nineteen living in the household

Enter the Name of Person #1 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A)

Enter the Age of Person #1 (Leave Blank if N/A)

School Attended By of Person #1 (Leave Blank if N/A)

Enter the Name of Person #2 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A)

Enter the Age of Person #2 (Leave Blank if N/A)

School Attended By of Person #2 (Leave Blank if N/A)

Enter the Name of Person #3 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A)

Enter the Age of Person #3 (Leave Blank if N/A)

Please provide the names and ages of all children under the age of nineteen living in the household

Student's Date of Birth

Please provide the Sacramental Information For the Student (Complete Only If the Student Is Catholic)

If sacraments were received at a parish other than St. Cornelius, St. Tarcissus or St. Thecla, a Sacramental Certificate must be on file at the school office.

Student's Date of Baptism (Leave Blank if Not Baptized)

Student's Date of Reconciliation (Leave Blank if Not Applicable)

Student's Date of First Communion (Leave Blank if Not Applicable)

Student's Date of Confirmation (Leave Blank if Not Applicable)

Please provide information about the student's family in the section below

Father's Last Name

Father's First Name

Father's Religion

Father's Ethnicity

Mother's Last Name

Mother's First Name

Mother's Religion

Mother's Ethnicity

Parent or Guardian Signature

Date of Submission

4 + 13 =