Student's Information
Student's First Name:
Student's Last Name:
Address:
Religion:
Gender:
Date of Entrance:
Race:
Place of Birth:
Date of Birth:
Mother's Information
Mother's Full Name:
Address:
Work Phone:
Email:
Place of Birth:
Education:
Marital Status:
Religion:
Home Phone:
Parish:
Date of Birth:
Occupation:
Father's Information
Father's Full Name:
Address:
Work Phone:
Email:
Place of Birth:
Education:
Marital Status:
Religion:
Home Phone:
Parish:
Date of Birth:
Occupation:
All numbers and emails will be listed in the annual Family Phone List unless you check the appropriate box below.
I do not want my email listed in the Family Phone List.
I do not want my phone number listed in the Family Phone List.
Student Lives With:
Notes Regarding the Custodial Parent:
In the case of an emergency, if the parent cannot be reached, please call the following people in this order:
Name:
Relationship:
Phone:
Daily Pickup: If your child is in grades K - 2, please list who will be picking him/her up each day after school.
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
St. Catherine School normally has adult strength Ibuprofen in the office. If your child complains of pain or discomfort, may we give him/her a 200 mg tablet?
Primary Care Physician:
Address:
Phone:
Insurance Company:
Medications (Taken on a regular basis)
Medication:
Reason:
Allergies
Allergy:
Epi Pen Needed:
Baptism:
First Communion:
First Reconciliation:
Confirmation: