Application for Enrollment

Saint Peter the Apostle Catholic School

Application for Enrollment “Over 100 Years of Growing in Grace and Knowledge.”
Complete all information on this form. All students in grades K, 2, and 4 and all new students entering a Diocesan School are required to provide an updated physical exam at the start of the school year. After you have received the notice of final acceptance, have your family doctor complete the enclosed Pupil Medical Record and return it to the school as soon as possible.
Registration Date*

MonthDayYear
Date
Name of Person Completing this Application*

First NameLast Name
Relationship to Student*
Is the Student and/or Parent/Guardian a US Citizen?*
Name of Student*

First NameLast Name
Students Date of Birth *

MonthDayYear
Date
Students Gender*
Last 4 of Students SSN
Person Completing This Form's Phone Number*
Applying For Grade*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students Ethnicity*
Students Ethnicity
Is the Student Hispanic or Latino?*

YesNo
School Currently Attending (N/A if not currently attending a school)*
Current Grade*
School District of Residence*
Does the student have an IEP or 504 plan? (if yes, please include a copy)*

YesNo
IEP or 504 plan Copy

Cancelof

Student Medical Information
Student's Primary Doctor*
Doctor's Phone
Please enter a valid phone number.
Dentist*
Dentist's Phone
Please enter a valid phone number.
Insured Name
Insured SSN
Insurance Company
Insurance ID
Does the student have any medical conditions? (if yes please submit pertinent information)*

YesNo
Medical Information
Additional Information
How did you hear about us?*
Person Completing this Application's Signature *

Clear
Should be Empty:

Saint Peter the Apostle Catholic School