S a c r e d H e a r t S c h o o l

2017-2018 Registration Application

Family Name ______Student(s) Reside with: ____ Two Parents

Address ______M./Step-father ____ One Parent

______F./Step-mother ____ Parent Deceased

First Child ______M / F

Last First Middle Grade Entering

Birth Date __ __ / __ __ / __ __ Birth City/State______US Citizen Y / N

Primary Language ______Home Language ______

Ethnicity ______Previous School ______

Religion ______Registered Parish ______

Sacraments: _____ Baptism _____ Penance _____ Holy Communion _____ Confirmation

Second Child ______M / F

Last First Middle Grade Entering

Birth Date __ __ / __ __ / __ __ Birth City/State______US Citizen Y / N

Primary Language ______Home Language ______

Ethnicity ______Previous School ______

Religion ______Registered Parish ______

Sacraments: _____ Baptism _____ Penance _____ Holy Communion _____ Confirmation

Third Child ______M / F

Last First Middle Grade Entering

Birth Date __ __ / __ __ / __ __ Birth City/State______US Citizen Y / N

Primary Language ______Home Language ______

Ethnicity ______Previous School ______

Religion ______Registered Parish ______

Sacraments: _____ Baptism _____ Penance _____ Holy Communion _____ Confirmation

*Please attach a copy of each child’s birth certificate as well as baptismal certificate, if applicable!*

Parent/Guardian Information:

Guardian 1: ______

Last First Middle Relation to Student

Address ______

______

Contact Cell: ______Email: ______

Occupation ______Highest Level of Education ______

Work Address ______

______

Religion ______

Registered Parish

Guardian 2: ______

Last First Middle Relation to Student

Address ______

______

Contact Cell: ______Email: ______

Occupation ______Highest Level of Education ______

Work Address ______

______

Religion ______

Registered Parish

Please note: All payments tuition payments are due on the 1st of the month. A refund of tuition payments remitted for the months of July & August will be made provided notification of withdraw is prior to August 20th. After this date, a refund is made only of tuition received in the payment beyond the current month in which the student is presently enrolled. Registration fees are not refundable.

Parent Signature ______Date ______

For Office Use Only

Item / Received / Item / Received / Item / Received / Item / Entered
Registration Fee / B6T / EDP / FACTS Re
Referral / Textbook Loan / EDP Reg. Fee / Genesis