SAINT MARY PARISH SCHOOL
675 HWY D
BELGIUM, WI 53004
(262) 285-3532
smarybel@wi.rr.com
REGISTRATION FORM
2007-2008
Please fill in the following information to be placed in your child’s Cumulative File:
STUDENT’S NAME
LAST
FIRST
SEX
BIRTH
MIDDLE
YEAR
1)
M
F
2)
M
F
3)
M
F
MONTH
DATE
CITY / STATE
HOME ADDRESS
STREET
PHONE (
)
CITY
STATE
ZIP
MEMBER OF
NAME OF PARISH
CITY
E-MAIL ADDRESS _____________________________ WOULD YOU PREFER TO RECEIVE
YOUR WEEKLY FOLDER AND OTHER COMMUNICATIONS VIA E-MAIL?
Y N
IF TRANSFERRING FROM
ANOTHER SCHOOL:
SCHOOL NAME
ADDRESS
CITY
FATHER (GUARDIAN)
LAST
RELIGION
FIRST
MIDDLE
OCCUPATION
MOTHER (GUARDIAN)
LAST
RELIGION
FIRST
MIDDLE
MAIDEN
OCCUPATION
NAMES OF OTHER CHILDREN IN FAMILY (list oldest first, and age)
PARISH
BAPTISM
CITY/STATE
1)
(Student number
from above) 2)
3)
OVER
DATE
(CONTINUED FROM FRONT)
ARE THE NATURAL PARENTS MARRIED?
1) Y N
2) Y N
3) Y N
COMPLETE ONLY IF ANSWERED “NO” TO LAST QUESTION.
IF INFORMATION IS DIFFERENT FOR EACH STUDENT, PLEASE EXPLAIN AT BOTTOM.
ARE THE NATURAL PARENTS: DIVORCED SEPARATED UNMARRIED WIDOWED?
IF DIVORCED, SEPARATED OR UNMARRIED,
WHO IS THE CUSTODIAL PARENT?
NAME OF PARENT/GUARDIAN WITH WHOM THE CHILD LIVES:
DOES THE NON-CUSTODIAL PARENT HAVE ANY COURT
RESTRICTIONS PLACED ON HIS/HER PARENTAL RIGHTS?
YES
NO
IF YES, WHAT ARE THE RESTRICTIONS?
WHAT ARE THE VISITATION RIGHTS?
SUBSTANTIATE THESE ITEMS BY ATTACHING A COPY OF THE COURT
ORDER/DIVORCE DECREE TO THIS FORM.
Parent/Legal Guardian Signature ______________________________ Date _____________