St. Brigid School Application for Admission

St. Brigid School

Application for Admission
Pleae complete ALL sections of this form and submit all required documents with application form.
Applying for Grade *
School Year *
Student Information
Child's Full Name *

First Name Middle Name Last Name
Preferred First Name
Date of Birth *

Month Day Year
Place of Birth *
Child's Religion *
Gender (required for State Reporting Purposes) *
Child's Social Security or Passport #/Country *
xxx-xx-xxxx
Ethnicity/Race (required for State Reporting Purposes) *
Student's Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Phone Number *
Please enter a valid phone number.
Student Lives With *

Both natural and adoptive mother and father Mother only Father only Mother and stepfather Father and stepmother Grandparent Legal guardian (not relative) Other
Explain Other
Parent Email Address (required for School Communication) *
example@example.com
Public School District (required for school communication) *
Students Applying for Grades 1-8
School Transferring From *
Reason for Transfer *

Special Needs: Any special needs must be indicated below and a copy of the current IEP/ISP and ERT, 504 Plan, or any other special accommodation plan must be submitted with this admission application. Please give information on any health issues or other concerns on a separate sheet and attach to this application.
Does this child have a current IEP/ISP or 504?
My child is currently receiving the following:

Speech Therapy Occupational Therapy Physical Therapy
Sacraments (Certificates Required) Date received and church name, city and state
Baptism
Sacraments (Certificates Required) Date received and church name, city and state
First Communion
Sacraments (Certificates Required) Date received and church name, city and state
Confirmation
Select Yes or No if you are planning to apply for a new Ohio EdChoice scholarship or transfer an existing EdChoice scholarship.Type a question *

Yes No

Father's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Occupation *
Employer *
Marital Status *
Cell Phone Number *
Please enter a valid phone number.
Work Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Religion *
Home Parish or Church *
Mother's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Martial Status *
Occupation *
Employer *
Work Phone Number *
Please enter a valid phone number.
Cell Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Religion *
Home Parish or Church *
Proof of Custody

For all two-household families (divorced, separated, or single parents) and guardianship situations, St. Brigid School requires a copy of the most current CUSTODY AGREEMENT AND COURT ORDER to be kept in the student's confidential file. Due at the time of application for admission, this paperwork is required to confirm the enrolling adult's legal right to enroll the student in school. Custody information portion only is required. No visitation schedule or financial information is requested. Enrollment cannot be completed without proof of custody.

Parents Who are St. Brigid School Alumni: Name and Year Graduated
Child's Sibling(s) Names and Grades *
STUDENT PHOTO and PUBLICATION PARTICIPATION (CHOOSE ONE): *

I give permission I DO NOT give permission
if St. Brigid School to use my child's picture in school sanctioned/sponsored publications such as school newsletters, school websites, advertising brochures and/or publick communciations (including newspapers and television).
Where did you learn about St. Brigid School?

Parish Bulletin Friends Family Social Media Website School Mailing Other
Please explain Other
Registration Fee $50.00

Please send the registration fee to St. Brigid School, 312 Fairground Road, Xenia, OH 45385. Please make check out to St. Brigid. Thank you.

FOR OFFICE USE ONLY
Registration Fee Paid (Cash/check #) blanks

Birth Certificate blank

Parishioner Non-Parishoner
Admission Application Date
Sacrament Certificates
Social Security/Passport
Records Release Form
Should be Empty:

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St. Brigid School