St. Joseph/St. Robert School
Student Application Form
PLEASE PRINT
Date______
Child's First Name ______Middle Name ______
Child's Last Name ______
Child's Social Security Number ______Sex ______
Home Address ______
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Home Phone ______
Mom’s Work Phone ______Dad’s Work Phone______
Mom’s Cell#______Dad’s Cell#______
Child's Date of Birth ______
Child's Place of Birth (City and State) ______
Child’s Ethnicity ______
Your Parish ______
Your School District ______
Bus Transportation Yes ______No ______
Transferred from (school) ______
School Address ______
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Grade entering in September ____ Full Day ____ Half Day ______
# of older brothers ______# of older sisters ______
Grade & Name of school(s) older brothers/sisters attend if other than St. Joseph/St. Robert's:
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Father's Full Name ______
Father's Occupation ______Deceased(Y or N)___
Father's Country of Birth ______
Father's Date of Birth ______Religion of Father ______
Father’s E-mail Address______
Mother's First Name & Maiden Name ______
Mother's Occupation ______Deceased(Y or N) ___
Mother's Country of Birth ______
Mother's Date of Birth ______Religion of Mother ______
Mother’s E-mail Address______
Over
Home Situation (Check all that apply):
___ Two biological parents _____ One parent
___ Mother/Stepfather _____ Parents separated or divorced
___ Father/Stepmother _____ Other.. Specify
Language spoken at home if not English ______
Parental Rights (in case of separation or divorce)
Attach copy of court order.
Legal Custody: ____ Joint Custody _____ Sole Custody
Physical Custody ____ Joint Custody _____ Sole Custody
_____ Mother
_____ Father
_____ Guardian
Adopted: ______Yes _____ No
Religion of Child ______
Child's Baptismal Date ______Church ______
City & State ______
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First Penance Date ______Church ______
City & State ______
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First Communion Date ______Church ______
City & State ______
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Confirmation Date ______Church ______
City & State ______
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Please describe any special circumstances we should be aware of in teaching this child.
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