Application - Saint Rita Catholic School

st.ritaschool.org

Application - Saint Rita Catholic School

St. Rita Catholic School

2013-2014 Application

Faith Excellence Stewardship

Student Information

Entering Grade in September 2013 __________

Parents:

Attach Photo

of Child

Birth date _________/________/________

____________________________/ _____________________________/ ________________________

Last Name First Name Middle Name

Gender M____ F ____ Place of Birth _________________________________________________

___________________________________________________________________________________________

Address City State Zip

_________________________/ ____________________________/ ___________________________

Home Phone Number Cell Phone Mom Cell Phone Dad

______-______-________ ______-______-________ ______-______-________

Social Security Number Child Social Security Number Mother Social Security Number Father

Registration fee $250.00 (per family ) Non-refundable

Paid _______ Date_________Check#_______

Are you a Saint Rita Parishioner? Yes _______ No ________ Number of years _______ Envelope #_______

Father/Stepfather/Guardian

Family Information

Mother/Stepmother/Guardian

Name _______________________________________________

Birthplace ___________________________________________

Relation____________________________________________

Address____________________________________________

City________________________________________________

State____________________________ Zip Code___________

Email_______________________________________________

Home#( )________________________________________

Occupation__________________________________________

Employer____________________________________________

Work # ( )_______________________________________

Religion___________________Parish____________________

Marital Status_______________________________________

Drivers License #____________________________________

Name_________________________________________________

Birthplace_____________________________________________

Relation_______________________________________________

Address_______________________________________________

City__________________________________________________

State____________________________Zip Code______________

Email__________________________________________________

Home#( )__________________________________________

Occupation____________________________________________

Employer_____________________________________________

Work # ( )_________________________________________

Religion____________________Parish_____________________

Marital Status_________________________________________

Drivers License #______________________________________

St. Rita Catholic School 322 N. Baldwin Ave., Sierra Madre, CA 91024 (626)355-6114 Fax: (626)355-0713


Child lives with ________ Mother & Father ________Mother only ________Father only

Other Please specify______________________________________________________________

Language spoken in the home______________________________________________________

Is your child currently attending school? YES NO Grade______________

If Yes, School _____________________________________________

Name

_______________________________

Phone Number

Address _____________________________________________________________________________________

City State Zip Code

Is this student currently receiving:

Has this student ever received:

Special Education Yes No Special Education Yes No

Related Services Yes No Related Services Yes No

Please specify these services: ________________________________________________________

(Speech, counseling, etc.)

For a new student entering above the first grade, please be prepared to present recent report cards and

progress reports.

Both parents are asked to sign (if possible)

Father or Guardian_____________________________________________________________________ Date________________

Mother or Guardian____________________________________________________________________Date_________________

Sacramental Information

__________________________ /_____________________________________________/________________________________________

Baptism Date Name of Church City & State

__________________________ /_____________________________________________/_______________________________________

1st Communion Date Name of Church City & State

If not Catholic, than what religion is your child? _______________________________________________________________________

Sibling Information

Name__________________________________ Age_______ Birthdate_______________Current School________________________

Name__________________________________ Age_______ Birthdate_______________Current School________________________

Name__________________________________ Age_______ Birthdate_______________Current School________________________

Name__________________________________ Age_______ Birthdate_______________Current School________________________

St. Rita Catholic School 322 N. Baldwin Ave., Sierra Madre, CA 91024 (626)355-6114 Fax: (626)355-0713

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