Child’s Full Name___________________________________________________________________________

Last First Middle Goes by

Address_________________________________________________________________Phone_____________

Number & Street City & State Zip

Date of Birth__________________Place of Birth__________________________Boy_______Girl__________

Month Day Year City State

Ethnicity: Black_____Hispanic_____Asian/Pacific Isl_____Native American_____White_____Other________

Baptism_______________________Church________________________Place__________________________

Month Day Year City State

First Communion_________________Church________________________Place________________________

Month Day Year City State

Church child attends___________________________________________With__________________________

Please check with whom child lives and furnish names:

_____Father_______________________________ _____Mother_______________________________

_____Step-father___________________________ _____Step-mother___________________________

_____Other_______________________________ _____Other________________________________

Home phone____________E-mail______________ Home phone____________E-mail______________

Place of employment_______________________ Place of employment________________________

Occupation_______________________________ Occupation________________________________

Daytime business phone_____________________ Daytime business phone______________________

Religious affiliation_________________________ Religious affiliation_________________________

Parish/Church______________________________ Parish/Church______________________________

If a child does not live with both parents, please indicate:

a. Which parent has legal custody________________________________________________________

b. Which parent will assume financial responsibility_________________________________________

c. If both parents are to receive school communications (newsletters, mailings, etc).________________

Sibling’s name/s Age School attending Grade

Please list any family members (immediate or extended) who have attended St. Stanislaus Tri-Parish School.

Please attach sheet if needed.

Name Address Relationship Year graduated

Name Address Relationship Year graduated

Name and address of last school attended________________________________________________________

Please list your child’s special qualities (strengths) as you perceive them.

What are some areas your child needs to strengthen?

Are there any hearing, eye, or health conditions of which the teacher should be aware?

We will be distributing a family directory for the 2008-2009 school year. If you are NOT interested in having your family’s name, address and phone number listed, please sign here.

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