HOLY ROSARY ACADEMY - KINDERGARTEN
STUDENT ENROLLMENT APPLICATION
2015-2016
STUDENT’S FULL NAME: ___________________________________ Today’s Date: ____________
Birth Date: _____________________
Gender:
M
F
MM/DD/YYYY
Birth Place: ________________________________________________________________________________
City, State (Country)
Religion/Denomination: _____________________ If Catholic, Parish:______________________
Has your child received the sacrament of Baptism?
YES
NO
If YES, please note the parish and date:__________________________________________________
Student’s Ethnic Origin - Optional, for statistical purposes only (Circle one):
Caucasian
African-American
Asian/Pacific Islander
Native American
Hispanic
Other__________________________
Mixed Race, please list: ________________________________________________
Father’s full name: _________________________________________________________________
Father’s Home Address: ____________________________________________________________
Father’s Employer: ___________________________ Occupation/Title: __________________
Father’s Business Phone: _____________________ Home Phone: _____________________
Father’s Cell Phone: __________________ E-mail ______________________________________
Mother’s full name: _________________________________________________________________
Mother’s Home Address: ____________________________________________________________
Mother’s Employer: ___________________________ Occupation/Title: __________________
Mother’s Business Phone: _____________________ Home Phone: _____________________
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HOLY ROSARY ACADEMY - KINDERGARTEN
STUDENT ENROLLMENT APPLICATION
2015-2016
Mother’s Cell Phone: _______________ Email: ________________________________________
Child resides with (Circle one):
Both Parents
Mother
Legal Guardian
Are parents divorced?
YES
NO
Father
Other____________________
Are parents separated?
YES
NO
*If student does not live with both parents, the school needs documentation of
custody arrangement for student file.
If you are a legal guardian, but not the child’s parent, please supply
documentation of guardianship.
Name: ______________________________________________________________________________
Relationship to child: ______________________________________________________________
Address: ___________________________________________________________________________
Phone number: _____________________________________________________________________
We will need to keep your child’s cell phone number on file if they bring it on
campus:
Student’s Cell Phone: ____________________
Does your child have any Special Needs? (Please describe)
Physical: ___________________________________________________________________________
Behavioral: _________________________________________________________________________
Developmental: _____________________________________________________________________
Social: ______________________________________________________________________________
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HOLY ROSARY ACADEMY - KINDERGARTEN
STUDENT ENROLLMENT APPLICATION
2015-2016
School Readiness:
Has your child attended:
Preschool
Structured Day Care
If you circled one of the above, please list and describe:
______________________________________________________________________________________
______________________________________________________________________________________
Does your child identify (Circle all that apply):
Colors
Numbers
Letters
Shapes
Does your child recite (Circle all that apply):
Alphabet
Counting Numbers
Prayers
Poems/Songs
Does your child (Circle all that apply):
Tie a bow
Write his/her name
Start a zipper
Dress unassisted
Use appropriate hygiene and bathroom behavior
PARENT/GUARDIAN SIGNATURE
I hereby apply for a place in Holy Rosary Academy for the child listed above, during the
school year 2015-2016. I understand that the obligation to pay fees for the full year is
unconditional and that no portion of such fees paid or outstanding will be refunded or
canceled in the event of absence, withdrawal, dismissal from school of the above-named
student, or any other reason within my control.
Signature of Father (or Guardian)
Date
______________________________________________________________________________________
Signature of Mother (or Guardian)
Date
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