St. Joseph/St. Robert School

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 ______

______

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 ______

______

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:

______

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 ______

______

First Penance Date ______Church ______

City & State ______

______

First Communion Date ______Church ______

City & State ______

______

Confirmation Date ______Church ______

City & State ______

______

Please describe any special circumstances we should be aware of in teaching this child.

______