Application for Enrollment



Student InformationTODAY’S DATEGENDER FORMCHECKBOX Male FORMCHECKBOX FemaleGRADE ENTERING FORMCHECKBOX K FORMCHECKBOX 1st FORMCHECKBOX 2nd FORMCHECKBOX 3rd FORMCHECKBOX 4th FORMCHECKBOX 5th FORMCHECKBOX 6th FORMCHECKBOX 7th Last Name (as listed on birth certificate)First NameMiddle NamePreferred NameSchool Year: (ex; 2019-2020)DATE OF BIRTH (DOB)CITY, STATE OF BIRTHUNITED STATES CITIZEN? FORMCHECKBOX Yes FORMCHECKBOX NoIF NO, PLEASE IDENTIFY COUNTRY OF CITIZENSHIPWhat language did your child learn when they first began to talk? What language does your child most frequently use at home?What language do you use most frequently to speak to your child?SACRAMENTS COMPLETEDDATE OF COMPLETIONCHURCH, CITY, STATE FORMCHECKBOX Baptism* FORMCHECKBOX First Communion* FORMCHECKBOX Confirmation**Copy of Baptismal and First Holy Communion Certificate Required, unless already submitted in prior school year**Schools Previously AttendedSCHOOLADDRESS (CITY, STATE, ZIP)DATES ATTENDEDHAS THE APPLICANT EVER SKIPPED OR REPEATED A GRADE? FORMCHECKBOX Repeated FORMCHECKBOX Skipped FORMCHECKBOX NeitherWHICH GRADE AND WHYResidence Information (where applicant lives)ADDRESSCITYSTATEZIPHOME PHONESECONDARY PHONEMOBILE PHONEFAMILY E-MAIL (MOST OFTEN CHECKED)MAY WE SEND PERIODIC E-MAILS TO THIS E-MaIL ADDRESS? FORMCHECKBOX Yes FORMCHECKBOX NoParent or Guardian InformationAPPLICANT LIVES WITH (CHECK ALL THAT APPLY) FORMCHECKBOX Both Parents (Biological) FORMCHECKBOX Single Parent FORMCHECKBOX Grandparent(s) FORMCHECKBOX Guardian(s) FORMCHECKBOX Blended Family FORMCHECKBOX Mother Remarried FORMCHECKBOX Father Remarried FORMCHECKBOX Mother Deceased FORMCHECKBOX Father Deceased FORMCHECKBOX OtherParent Information FORMCHECKBOX Biological Father FORMCHECKBOX Stepfather FORMCHECKBOX GuardianParent (2) information FORMCHECKBOX Biological Mother FORMCHECKBOX Stepmother FORMCHECKBOX Guardian FORMCHECKBOX Mr. FORMCHECKBOX Dr. FORMCHECKBOX Miss FORMCHECKBOX Mrs. FORMCHECKBOX Ms. FORMCHECKBOX Dr.NAME (LAST, FIRST, MIDDLE INITIAL)NAME (LAST, FIRST, MIDDLE INITIAL)ADDRESS (IF DIFFERENT FROM ABOVE)ADDRESS (IF DIFFERENT FROM ABOVE)CITYSTATEZIPCITY,STATEZIPHOME PHONEWORK PHONEHOME PHONEWORK PHONEMOBILE PHONEMOBILE PHONEOCCUPATIONEMPLOYEROCCUPATIONEMPLOYERPLACE OF BIRTHRELIGIONPLACE OF BIRTHRELIGIONLA PUR?SIMA ALUMNI? FORMCHECKBOX Yes FORMCHECKBOX NoYEAR GRADUATEDLA PUR?SIMA ALUMNI? FORMCHECKBOX Yes FORMCHECKBOX NoYEAR GRADUATEDSibling InformationNAMEDATE OF BIRTH GENDER FORMCHECKBOX Male FORMCHECKBOX Female FORMCHECKBOX Male FORMCHECKBOX Female FORMCHECKBOX Male FORMCHECKBOX Female FORMCHECKBOX Male FORMCHECKBOX Female FORMCHECKBOX Male FORMCHECKBOX FemaleReligious InformationIS THE FAMILY A REGISTERED MEMBER OF LA PUR?SIMA PARISH? FORMCHECKBOX Yes FORMCHECKBOX NoENVELOPE NUMBERDOES THE FAMILY ATTEND MASS REGULARLY? FORMCHECKBOX Yes FORMCHECKBOX NoIF NOT A MEMBER OF LA PUR?SIMA PARISH, WHICH CATHOLIC CHURCH ARE YOU REGISTERED?ENVELOPE NUMBERHOW HAVE YOU BEEN ACTIVE IN THE PARISH?IF FAMILY IS NOT CATHOLIC, WHAT DENOMINATIONPLACE OF WORSHIP (CHURCH, TEMPLE, MOSQUE)Referral Information (IF APPLICABLE)HOW DID YOU HEAR ABOUT LA PUR?SIMA CATHOLIC SCHOOL? FORMCHECKBOX Family FORMCHECKBOX Newspaper FORMCHECKBOX Website FORMCHECKBOX Church FORMCHECKBOX Alumni FORMCHECKBOX Staff FORMCHECKBOX Other:For Office Use OnlyDATE APPLICATION RECEIVED:RECEIVING EMPLOYEE NAME:SCHOOL YEAR: registration FEE RECEIVEDPAID WITH FORMCHECKBOX Cash FORMCHECKBOX Check #:AMOUNTnon-parish supporting FEE RECEIVEDPAID WITH FORMCHECKBOX Cash FORMCHECKBOX Check #:AMOUNTCOPY OF BIRTH CERTIFICATE FORMCHECKBOX Yes FORMCHECKBOX NoCOPY OF BAPTISMAL CERTIFICATE FORMCHECKBOX Yes FORMCHECKBOX NoCOPY OF FIRST HOLY COMMUNION CERTIFICATE FORMCHECKBOX Yes FORMCHECKBOX NoCOPY OF CONFIRMATION CERTIFICATE FORMCHECKBOX Yes FORMCHECKBOX NoREPORT CARD FORMCHECKBOX Yes FORMCHECKBOX NoSTANDARDIZED TEST SCORES FORMCHECKBOX Yes FORMCHECKBOX NoHEALTH RECORD FORMCHECKBOX Yes FORMCHECKBOX NoMEETING WITH PASTORMEETING WITH PRINCIPAL ................
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