222 Waterman Street * Sycamore, IL * 60178

Ph. 815-895-5215 Fax 815-895-5295

www.stmarysycamore.org

ENROLLMENT APPLICATION

DATE: HOME PARISH: ENTERING GRADE:

CHILD’S NAME: SEX:

CHILD’S SS #: PHONE:

ADDRESS: CITY: ZIP:

PLACE OF BIRTH: DATE OF BIRTH:

**PLEASE PROVIDE COPY OF CHILD’S LRGAL BIRTH CERTIFICATE**

SCHOOL LAST ATTENDED:

CHILD’S RELIGION:

**PLEASE PROVIDE SACRAMENTAL DOCUMENTS FOR CHILD’S FILE**

BAPTISM DATE: CHURCH:

PENANCE: (Y/N) CHURCH:

FIRST COMMUNION: (Y/N) CHURCH:

CONFIRMATION: (Y/N) CHURCH:

CHILD LIVES WITH: BOTH PARENTS _____ MOTHER _____ FATHER _____ RELATIVE _____

GUARDIAN _____ STEPMOTHER _____ STEPFATHER _____ OTHER _____

IF DIVORCED, WHO HAS LEGAL CUSTODY?______

DO YOU HAVE JOINT CUSTODY? Y/N _____ NAME OF PERSON ______

IF NO, CERTIFIED COPY OF CUSTODY AGREEMENT MUST BE ATTACHED TO THIS FORM.

SPECIAL NEEDS:

HAS THIS CHILD BEEN ATTENDING SPECIAL EDUCATION OR TITLE I CLASSES? Y/N _____

DOES THIS CHILD HAVE SPECIAL NEEDS OF WHICH THE SCHOOL SHOULD BE AWARE? Y/N _____

IF YES, PLEASE EXPLAIN ______

PLEASE DESCRIBE ANY SPECIAL CIRCUMSTANCES THAT RELATE TO THE CHILD’S HOME/SCHOOL SITUATION ON A SEPARATE PIECE OF PAPER. ATTACH TO THIS FORM.

TRANSPORTATION

IS YOUR CHILD ELIGIBLE FOR BUSING BY THE SYCAMORE SCHOOL DISTRICT? Y/N _____

DOES YOUR CHILD LIVE MORE THAN ONE AND A HALF MILES FROM SCHOOL? Y/N _____

FATHER’S NAME: EMAIL:

ADDRESS: PHONE:

PLACE OF BIRTH: RELIGION:

OCCUPATION: EMPLOYER:

WORK PHONE: CELL PHONE:

MARRIED_____ DIVORCED_____ SEPERATED_____ DECEASED_____ REMARRIED_____ SINGLE_____

MOTHER’S NAME: EMAIL:

ADDRESS: PHONE:

PLACE OF BIRTH: RELIGION:

OCCUPATION: EMPLOYER:

WORK PHONE: CELL PHONE:

MARRIED_____ DIVORCED_____ SEPERATED_____ DECEASED_____ REMARRIED_____ SINGLE_____

IF APPLICABLE, PLEASE CHECK ONE AND COMPLETE THE FOLLOWING INFORMATION:

STEPFATHER _____ STEPMOTER _____ GUARDIAN _____ OTHER ______

NAME: MAIDEN:

ADDRESS: PHONE:

PLACE OF BIRTH: RELIGION:

OCCUPATION: EMPLOYER:

WORK PHONE: CELL PHONE:

(This information needed for State and/or National purposes.)

RACE: CAUCASIAN ____ BLACK ____HISPANIC ____AM.INDIAN ____ASIAN/PACIFIC ISLANDER ____

THE PUBLISHED FAMILY LIST MAY INCLUDE OUR: ADDRESS ____ PHONE ____ EMAIL ____

PHOTOGRAPHS OF MY CHILD MAY BE USED FOR PUBLICITY PURPOSES: YES ____ NO ____

REGISTRATION FEE OF $______PAID BY CHECK # ______CASH ______

CUSTODIAL PARENT/GUARDIAN:

TUITION TO BE PAID BY

SIGNATURE: DATE:

This form is not intended to constitute nor should it be viewed as creating a “contract” between the School and the student/parent. The School reserves the right to revoke its acceptance of this application, deny enrollment and/or dismiss the student in keeping with applicable School and/or Diocesan policies. Neither this form nor any other written document issued by the School (including, but not limited to, the student handbook) should be considered to be a “contract”.

Revised 02/2017