New Student Enrollment Form
Student Information
Student Name
*
First Name
Middle Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First Contact Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Ethnicity/Race
*
White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian/Pacific Islander
Other
Place of Birth
*
Name of Hospital, City, State
Is the student baptized?
*
Yes
No
Parish of Baptism
Name of Parish, City, State
Date of Baptism
Month - Day - Year
Religious Affiliation
Catholic, Lutheran, Methodist, Christian, etc.
Grade to Enter
*
Half Day 3 Year Old Kindergarten (M-F)
Full Day 3 Year Old Kindergarten (M-F)
Half Day 4 Year Old Kindergarten (M-F)
Full Day 4 Year Old Kindergarten (M-F)
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
All other part-time options for 3K and 4K (example: 3 day 3K) must be approved by the Principal.
Name of Previous School (Include City &State) IF APPLICABLE
Parent/Guardian Information
Father/Guardian
*
First Name
Last Name
Address (if different than Student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
Employer (Include Occupation)
*
Religion (Include Parish of Membership)
*
Mother/Guardian
*
First Name
Last Name
Address (if different than Student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
Employer (Include Occupation)
*
Religion (Include Parish of Membership)
*
Marital Status of Parents
*
Married
Divorced
Separated
Widowed
Other
If there is a custody/placement schedule or court order please be sure to share this information and discuss any restrictions, etc. with the school. Copies of legal documents will be required for the student file.
*
Yes, there is a custody/placement schedule and/or restrictions for this child.
No custody/placement schedule or restrictions.
Additional Student Information
Does the student have an allergy or medical condition that we need to be aware of?
*
Yes
No
If Yes, please explain. Allergy Action Plans are available for students that need them.
Does the student have any other restrictions?
*
Yes
No
If Yes, please explain.
Children entering school are required to meet Wisconsin state immunization requirements or have a signed parent health waiver on file.
*
Immunizations are in process or current.
Health Waiver
3K/4K ONLY: Student is fully toilet trained.
Yes
No
Referred to Shepherd of the Hills School by:
Parent/Guardian Signature
Submit
Should be Empty: