St. Antoninus School5425 Julmar Drive

Mrs. Shelly Kahny Cincinnati, OH 45238

513-922-2500

513-922-5519 (Fax)

NEW STUDENT REGISTRATION FORM – School Year 2018-19

Please print. Complete both sides. Must be completed by custodial parent.

Family Name: ______Registration Date: ______

Registered Member of St. Antoninus Parish (Y/N) _____Registered at another Catholic Parish (Y/N) ______

Child lives with: Both ParentsMotherFatherOther: ______(Circle One)

Birth Parents: MarriedSeparatedDivorcedSingleCourt Order** (Circle One)

If divorced, who has custody? ______

Legal custodian document must be on file with the school

**If other than natural parent, evidence of legal custody must be presented and filed with the school.

Registering for grade: Half Day K Full Day K 1st 2nd 3rd 4th 5th 6th 7th 8th (please circle)

STUDENT INFORMATION

Last Name: ______First Name: ______Middle Initial ______

(Name must be as it appears on the birth certificate.)

Preferred Name: ______Race: ______Male/Female: ______

Birth Date: ______Place of Birth (City/State): ______

Religion (Catholic/Non-Catholic): ______

Public School District of Residence: ______

Name of last school attended ______Grade ______

SacramentsDate Church City/State

Baptism______

First Eucharist ______

Reconciliation ______

Confirmation ______

OFFICE USE ONLY:

Registration Fee Paid Y/N: _____Amount Paid: ______Paid by Cash or Check: ______Check #: ______

Registered with FACTS Y/N _____ Annual Tuition ______

Marital Status (circle one):MarriedSeparatedDivorcedSingle

Last Name: ______First Name: ______Middle Initial: ____

Maiden Name: ______Race: ______

Place of Birth (City/State): ______

Address: ______

Street CityState Zip

Home Phone:______Work Phone: ______Cell Phone: ______

Email: ______Religion (Catholic/Non-Catholic):______

Place of Business/Occupation: ______

Relationship to Child (circle one): Birth Mother StepmotherGuardian Deceased

Custodial Rights (Y/N): _____

Marital Status (circle one):MarriedSeparated DivorcedSingle

Last Name: ______First Name: ______Middle Initial: ____

Maiden Name: ______Race: ______

Place of Birth (City/State): ______

Address: ______

Street CityState Zip

Home Phone:______Work Phone: ______Cell Phone: ______

Email: ______Religion (Catholic/Non-Catholic):______

Place of Business/Occupation: ______

Relationship to Child (circle one): Birth Father Stepfather Guardian Deceased

Custodial Rights (Y/N): _____

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Who has financial responsibility for tuition payment? ______

If financial responsibility for tuition payments are share, what is the percentage shared and by whom:______

My signature below certifies that I am a custodial parent of the child named above, and the information given is true and accurate to the best of my knowledge. Further, if my child is accepted, any registration fees paid are non-refundable. Signature of Custodial Parent______.