Mother's Name
Father's Name
Street or P. O. Box for mailing
City
State
Zip
Email address
Telephone number for contact - please include area code
How should we best contact you?	Telephone Email
Future student's name
Date of birth
Grade entering	Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th
Year entering	2010 2011 2012 2013 2014 2015
Is child baptized Catholic?	Yes No
Is family practicing/active Catholics?	Yes No
Parish, City
Other children - name/DOB
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