Our Lady Queen of Peace Regional Catholic School
Registration Form
STUDENT INFORMATION
SCHOOL YEAR 2015-2016
FIRST:
LAST NAME:
Address:
MIDDLE:
City
APPLYING FOR GRADE:
Zip:
All Day or
PRE-K ATTENDANCE
Half Day
5 days M-F or
I WILL PRE-PAY THE ANNUAL TUITION or
I WILL SIGN UP FOR THE SMART TUITION PAYMENT PROGRAM
Nick Name:
Birth Date:
Language spoken at home:
Baptism Date:
Birth Place:
Ever attended OLQP?
Baptism Church:
Public School District:
Religion:
Social Security No.
Present Parish:
Ethnicity-please check one: YES
HISPANIC OR LATINO
NO
Race---please check one:
NATIVE AMERICAN
ASIAN
BLACK
NATIVE HI/PACIFIC ISLAND
WHITE
MULTI-RACIAL
UNKNOWN
Gender:
Female
Male
School transferring from:
If Parents are separated or divorced, a copy
of documentation as to who has custody of
the child must be kept in the child’s file at
the school.
Student lives with Both Parents
Mother
Father
Guardian
Other
PARENT OR GUARDIAN INFORMATION
FATHER:
MOTHER:
Home phone:
Home phone:
Work phone:
3 days M-W-F
Ext:
Work phone:
Ext:
Cell phone:
Cell phone:
Email:
Email:
Occupation:
Occupation:
Employer:
Employer:
Religion:
Religion:
Parish:
Parish:
Race/Ethnicity:
Race/Ethnicity:
Education:
Education:
Marital Status:
Maiden Name:
Address: (if different)
Address: (if different):
Names and ages of student’s brothers and sisters:
Continue on page 2
STUDENT LAST NAME:
FIRST NAME:
MIDDLE NAME:
Grandparents:
Grandparents:
Mailing Address:
Mailing Address:
City, State, Zip:
City, State, Zip:
Email Address:
Email Address:
EMERGENCY CONTACT LIST:
Students will not be released to anyone who is not on this list! Permission is given to the following people:
Please check all boxes that apply.
Name:
Relationship:
Address:
approved to pick up my child
Home:
Work:
Cell:
call in case of emergency
add to schools mailing list
Name:
Relationship:
Address:
approved to pick up my child
Home:
Work:
Cell:
call in case of emergency
add to schools mailing list
Name:
Relationship:
Address:
approved to pick up my child
Home:
Work:
Cell:
call in case of emergency
add to schools mailing list
Name:
Relationship:
Address:
approved to pick up my child
Home:
Work:
Cell:
call in case of emergency
add to schools mailing list
Name:
Home:
Relationship:
Work:
Address:
Cell:
approved to pick up my child
call in case of emergency
add to schools mailing list
NEW FAMILIES ONLY: We were referred to Our Lady Queen of Peace by one of the
school families. That family is :
Our Lady Queen of Peace reserves the right to ask a student to withdraw if he/she cannot adjust to our program or environment. The
Administration of OUR LADY QUEEN OF PEACE CATHOLIC SCHOOL agrees to accept this student at OUR LADY QUEEN OF PEACE
CATHOLIC SCHOOL for a period of Six (6) Weeks. This conditional acceptance is granted to determine the student’s ability to meet the
expectations of the school program. The student must maintain passing grades and acceptable behavior as outlined in the current Our Lady
Queen of Peace Family Handbook. The Administration of Our Lady Queen of Peace will determine the status of continued enrollment at the end
of the designated time. I read and understand the terms of the above. I do accept these terms and choose to enroll my son/daughter at Our Lady
Queen of Peace under the above terms. I am fully aware that there is no guarantee of re-enrollment if these terms are not satisfactorily met.
Parents’s Signature_
x______________________________________________________________________________________________________
Date of Registration_______________________________________________________________________________________________________