2012/2013

New Student Application 2012/2013

First Name: Last Name: Gender Entering Grade:

Year: Date of Birth: Birth place: US Citizen:

Parent/Guardian with whom the child lives/relationship:

First Name:	Last Name:	Relationship:
Address:	City:	Zip:
Phone #	Email Address:

Person to contact about this application:

First Name:	Last Name:	Relationship:
Address:	City:	Zip:
Phone #

Briefly state the reason(s) you would like your child to attend St. Bernard's School:

Family History:

Father's First Name:	Father's Last Name:
Place of Birth:	Country of Citizenship:	Where employed:
Occupation:	Phone #:
Business Address:	City:	Zip:
Religion:	Email:

Mother's First Name:	Mother's Last Name:
Place of Birth:	Country of Citizenship:	Where employed:
Occupation:	Phone #:
Business Address:	City:	Zip:
Religion:	Email:

School most recently attended (by child): Phone #:
Address: City: State: Zip:

Catholic School Transfer: Parent Alumni If so, year graduated

Marital status of parents:
US Census Question: If Other please specifiy:

Siblings presently attending St. Bernard's:
Name:Grade:
Name:Grade:
Name:Grade:
Name:Grade:

Siblings presently on the waiting list at St. Bernard's:
Name:Grade:
Name:Grade:
Name:Grade:
Name:Grade:

Religion: Catholic Non-Catholic

Name of Parish where you are an active member: City:

(If St. Bernard's, please state under which name you are registered in the parish and your envelope number:)
Name registered: Envelope:
(Tuition does not cover the actual education cost per child. St. Bernard's Parish subsidizes every child who attends the school; for this reason we ask the question above.)

Baptism Date:
Reconciliation Date:
Communion Date:
Confirmation Date:

This application will be held until the last day of the present school year. If you would like your child's application to be carried over to the following school year, please contact the school secretary by June 1 of this school year.

Parent e-signature
Parent e-signature Date: February 22, 2012, 9:56 pm