Student's Information

Student's First Name:

Student's Last Name:

Address:

Religion:

Gender:

Date of Entrance:

Race:

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Place of Birth:

Date of Birth:

Mother's Information

Mother's Full Name:

Address:

Work Phone:

Email:

Place of Birth:

Education:

Marital Status:

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Religion:

Home Phone:

Parish:

Date of Birth:

Occupation:

Father's Information

Father's Full Name:

Address:

Work Phone:

Email:

Place of Birth:

Education:

Marital Status:

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Religion:

Home Phone:

Parish:

Date of Birth:

Occupation:

All numbers and emails will be listed in the annual Family Phone List unless you check the appropriate box below.

I do not want my email listed in the Family Phone List.

I do not want my phone number listed in the Family Phone List.

Student Lives With:

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Notes Regarding the Custodial Parent:

In the case of an emergency, if the parent cannot be reached, please call the following people in this order:

Name:

Relationship:

Phone:

Daily Pickup: If your child is in grades K - 2, please list who will be picking him/her up each day after school.

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

St. Catherine School normally has adult strength Ibuprofen in the office. If your child complains of pain or discomfort, may we give him/her a 200 mg tablet?

Primary Care Physician:

Address:

Phone:

Insurance Company:

Medications (Taken on a regular basis)

Medication:

Reason:

Allergies

Allergy:

Epi Pen Needed:

Baptism:

First Communion:

First Reconciliation:

Confirmation: