New Student Registration Form (One For Each Student) Student Information Section Student Last Name Student First Name Student Gender Student GenderFemaleMale Student Entering Grade Student Entering GradePre-K (3)Jr. KKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth Grade Describe the Relationship Between the Student & the Head of Household Where the Student Resides Student Ethnicity Language Spoken At Home Language Spoken By Student (if not English) Please provide the names and ages of all children under the age of nineteen living in the household Enter the Name of Person #1 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A) Enter the Age of Person #1 (Leave Blank if N/A) School Attended By of Person #1 (Leave Blank if N/A) Enter the Name of Person #2 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A) Enter the Age of Person #2 (Leave Blank if N/A) School Attended By of Person #2 (Leave Blank if N/A) Enter the Name of Person #3 Under the Age of 19 Who Lives In the Household (Leave Blank if N/A) Enter the Age of Person #3 (Leave Blank if N/A) Please provide the names and ages of all children under the age of nineteen living in the household Student's Date of Birth Please provide the Sacramental Information For the Student (Complete Only If the Student Is Catholic) If sacraments were received at a parish other than St. Cornelius, St. Tarcissus or St. Thecla, a Sacramental Certificate must be on file at the school office. Student's Date of Baptism (Leave Blank if Not Baptized) Student's Date of Reconciliation (Leave Blank if Not Applicable) Student's Date of First Communion (Leave Blank if Not Applicable) Student's Date of Confirmation (Leave Blank if Not Applicable) Please provide information about the student's family in the section below Father's Last Name Father's First Name Father's Religion Father's Ethnicity Mother's Last Name Mother's First Name Mother's Religion Mother's Ethnicity Parent or Guardian Signature Date of Submission 11 + 3 = Submit Request