APPLICATION FOR ADMISSION

Tri-Parish Preschool        

 at Our Lady of Lourdes

 Lewiston ID 83501

 (208) 305-9160 Preschool (208) 743-4411 Office 

Fax (208) 743-9563

 

 

 

School Year 20_____-_____

 

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________

 

 

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______________________________

 

 

 

                                                                                                                                                            (Over)

 

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.

 

 

                                                                                                              _______________________________