New Student Registration Form

New Student Registration Form
What grade will your student be in September 2024?*
Student's First Name*
Student's Middle Name
Student's Last Name*
Student's Date of Birth*

MonthDayYear
MM-DD-YYYY
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Email*
example@example.com
Parent's Name*

First NameLast Name
Parent's Phone Number*
Please enter a valid phone number.
Student’s Present Conduct/Attitude:*

ExcellentGoodFairPoor
Student’s Attendance/Punctuality:*

ExcellentGoodFairPoor
Is the student enrolled in a special education program?*

YesNo
If yes, explain. Documents need to be submitted to MQP in order to ensure the child can be serviced appropriately.
Does your child have an IEP/SP/SEGO/504 Plan?*

IEPAccommodation PlanNone
If yes, explain. Documents need to be submitted to MQP in order to ensure the child can be serviced appropriately.
Please explain your reason for leaving present school:
Please explain your reason for applying to Mary Queen of Peace School:
The Remainder of the Questions below are for the Student's Permanent Record Card
Birthplace (City, St., Country)*
Student Parish/City*
Language Spoken at Home*
Student's Gender*

FemaleMale
MQP Parishioner?*

YesNoNo, but I would like more information
Student's Ethnicity*

Native AmericanAsianAfrican AmericanHispanicNative, Haw/Pac IsWhiteTwo or More Races
Please Choose One Regarding the Student:*

Hispanic/LatinoNon-Hispanic/Latino
Student's Religion*

CatholicOther
If Other Religion, please specify
Previous School's City & State (N/A for Incoming Kindergarteners)
Type of School

ParochialPublicHome SchoolOther
Public School District of Residence
Name of Public School in Student Area

Student's Sacraments (answer, if applicable)

	Date	Church, City, Sate
Baptism
First Communion
Confirmation

Student Lives With*

	Check if applicable	Last Name	First Name	Email Address	Occupation	Employer	Best Contact Number
Natural Mother
Natural Father
Custodial M
Custodial F
Legal Guardian/Other
Parenting Plan/Custody Plan - Copy of plan needs to be provided to the school

Parents/Custodial Parents*

	Checkbox	Religion	Status
Natural Mother
Natural Father
Custodial M
Custodial F
Legal Guardian/Other

To fully complete re-registration information, see below. I understand by checking the box below, my child's registration is not complete without the non-refundable registration fee paid to the main office. Payment options: you can send a check or cash with your student, or you can call at 216-741-3685 or come to the school office and use your credit/debit card.*

I agree and understand
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New Student Registration Form

The Remainder of the Questions below are for the Student's Permanent Record Card