Enrollment Application Form

Enrollment for Academic Year
Application Date

MonthDayYear
Approved Date

MonthDayYear
Returning RCS
New Student
Application Fee ($25.00 per family/NEW STUDENTS ONLY)
Registration Fee ($150 per family)
PTO Fee ($75 per family)
Accelerated Reading/Math Fee (50.00 x number of students)
Book Fees may vary. Book fee rental may be accessed.
Last School Attended (For New Student ONLY)
Final acceptance will be based on the following:

· Completion of a Placement Test.

· A review of the student’s academic records, standardized test scores, and conduct grades.

· The completion of a parent and student interview.
Child Information
How many children are you registering?*
Please register all of your children, ages birth through grade 8 on this form.
First Child
Child's Name

First NameMiddle NameLast NameSuffix
Preferred Name
Grade
Date of Birth

MonthDayYear
Date
Place of Birth
Gender
Race
Social Security Number
Church Affiliation
Has the child repeated a grade?
Grade Repeated
Email Address
List any medication(s).
(Medical information is required to provide proper student care.)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Second Child
Child's Name

First NameMiddle NameLast NameSuffix
Preferred Name
Grade
Date of Birth

MonthDayYear
Date
Place of Birth
Gender
Race
Social Security Number
Church Affiliation
Has the child repeated a grade?
Grade Repeated
Email Address
List any medication(s).
(Medical information is required to provide proper student care.)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Third Child
Child's Name

First NameMiddle NameLast NameSuffix
Preferred Name
Grade
Date of Birth

MonthDayYear
Date
Place of Birth
Gender
Race
Social Security Number
Church Affiliation
Has the child repeated a grade?
Grade Repeated
Email Address
List any medication(s).
(Medical information is required to provide proper student care.)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Fourth Child
Child's Name

First NameMiddle NameLast NameSuffix
Preferred Name
Grade
Date of Birth

MonthDayYear
Date
Place of Birth
Gender
Race
Social Security Number
Church Affiliation
Has the child repeated a grade?
Grade Repeated
Email Address
List any medication(s).
(Medical information is required to provide proper student care.)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Family Information
Father's Name

PrefixFirst NameMiddle NameLast NameSuffix
Home Address (If different from Student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Cell Phone Number
Email
example@example.com
Social Security Number
Driver's License Number/State
Employer's Name
Job Title
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number
Please enter a valid phone number.
Work Email
example@example.com
Church Affiliation
Emergency Contact?

YesNo
Allowed to pick child?

YesNo
Are you an Alumnus of Resurrection Catholic School?

YesNo
Year of 8th Grade Graduation
Mother's Name

PrefixFirst NameMiddle NameLast NameSuffix
Home Address (If different from Student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Cell Phone Number
Email
example@example.com
Social Security Number
Driver's License Number/State
Employer's Name
Job Title
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number
Please enter a valid phone number.
Work Email
example@example.com
Church Affiliation
Emergency Contact?

YesNo
Allowed to pick child?

YesNo
Are you an Alumnus of Resurrection Catholic School?

YesNo
Year of 8th Grade Graduation
Guardian's Name

PrefixFirst NameMiddle NameLast NameSuffix
Home Address (If different from Student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Cell Phone Number
Email
example@example.com
Social Security Number
Driver's License Number/State
Employer's Name
Job Title
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number
Please enter a valid phone number.
Work Email
example@example.com
Church Affiliation
Emergency Contact?

YesNo
Allowed to pick child?

YesNo
Are you an Alumnus of Resurrection Catholic School?

YesNo
Year of 8th Grade Graduation
Should be Empty:

Child Information

First Child

Second Child

Third Child

Fourth Child

Family Information