Grades 1 - 8 Registration Form
$75 Registration Fee
Date of Application
/
Month
/
Day
Year
Date
Student's First Name
Student's Middle Name
Student's Last Name
Student Date of Birth
-
Month
-
Day
Year
D.O.B.
Student's City of Birth
Student Gender
Male
Female
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father’s Name
First Name
Last Name
Father’s Occupation
Father’s Cell Phone
Please enter a valid phone number.
Father’s Email
example@example.com
Mother’s Name
First Name
Last Name
Mother’s Occupation
Mother’s Cell Phone
Please enter a valid phone number.
Mother’s Email
example@example.com
Race/Ethnicity
Please Select
African American
Asian
Hispanic
Latino
Native American
White
Child lives with:
Please Select
Both Parents
Mother
Father
Other
Religion
Catholic
Non-Catholic
Baptized
Yes
No
Parents are registered members of:
Name of Church (City/Town)
We request that our child's name be submitted to our pastor for financial sponsorship.
Yes
No
My child is insured by:
Name of Insurance Provider or Not Insured (N/A)
Most recent school attended:
Name of School (City/Town)
Registering for Grade:
Please Select
1
2
3
4
5
6
7
8
Selecting Grade Level Child is Entering
My child currently has:
An IEP (Individualized Education Plan)
A 504 Accommodation Plan
A Diagnosed Learning Disability
None of the Above
Other
Individual(s) responsible for payment of tuition:
Submit
Should be Empty: