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 _____________