archbishop rummel high school application for admission

Grade Entering: 8 9 10 11 12
ARCHBISHOP RUMMEL HIGH SCHOOL
APPLICATION FOR ADMISSION
1901 Severn Ave. Metairie, LA 70001
Phone: 504.834.5592 Admissions Fax: 504.834.7859
To Be Completed by Parent or Guardian • Please Print or Type
Date __________________________
Applicant’s Name______________________________________________________________________________________________
Last First Middle
Applicant Known as ________________________________
Social Security Number __________ - _______ - ___________
Date of Birth ______ /_____ /______ Age________ Place of Birth _______________________________________
Month Day Year City,State
Mailing Address_______________________________________________________________________________________________
Street City State Zip
Home Telephone Number ______________________________
Church Parish _______________________________________
Religion ___________________________________________
Applicant’s Present School ____________________________
Other Schools Attended
________________________________________________________________________________ Grade(s) ____________________
________________________________________________________________________________ Grade(s) ____________________
________________________________________________________________________________ Grade(s) ____________________
Grade(s) Repeated (if any) ____________________ Reason ___________________________________________________________
Check if Applicable:
Parents Separated Father Deceased Mother Deceased
Parents Divorced Father Remarried Mother Remarried
INFORMATION FOR MALE ADULT LIVING WITH APPLICANT Circle one: Father Stepfather Other
MALE First Name: (Circle) Mr. Dr. MALE MI: MALE Last Name: Suffix:
MALE Work Phone:
( )
MALE Place of Employment:
MALE Cell Phone:
( )
MALE Occupation:
MALE E-mail:
MALE Work Address: MALE Work City: Work State: Work Zip:
INFORMATION FOR FEMALE ADULT LIVING WITH APPLICANT Circle one: Mother Stepmother Other
FEMALE First Name: (Circle) Ms. Mrs. Dr. FEMALE Maiden Name: FEMALE Last Name:
FEMALE Work Phone:
( )
FEMALE Place of Employment:
FEMALE Cell Phone:
( )
FEMALE E-mail:
FEMALE Occupation:
FEMALE Work Address: FEMALE Work City: Work State: Work Zip:

INFORMATION FOR PARENT NOT LIVING WITH STUDENT (if applicable)
Name: (Circle) Mr. Ms. Dr. Relationship to student:
Street Address: City: State Zip
Home Phone:
( )
Work Phone:
( )
E-mail:
If non-resident spouse is a Rummel graduate, what year?
Names of Brothers, Sisters Date of Birth Grade Level School Now Attending
If the applicant’s father is an alumnus of Archbishop Rummel High School, indicate his year of graduation. _______________
Are there other immediate relatives of the applicant who are alumni of Archbishop Rummel High School?
If yes, indicate name(s) and year(s) of graduation.____________________________________________________________________
Has the applicant ever been in a remedial or resource program? Yes No
Has the applicant ever had an educational evaluation? Yes No
Has the applicant ever had a psychological evaluation? Yes No
Has the applicant ever been suspended from any school? Yes No
Has the applicant ever been placed on probation from any school? Yes No
Has the applicant ever been dismissed from any school? Yes No
(If either a psychological or educational evaluation has been made, this would be a valuable resource in the placement process and a
copy of it should accompany this form.)
If answered YES to any above, please explain ______________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
A NON-REFUNDABLE $20.00 TESTING FEE IS REQUIRED WITH THIS APPLICATION FOR STUDENTS APPLYING
FOR EIGHTH AND NINTH GRADES.
PLEASE SEND THIS COMPLETED FORM TO:
Office of Admissions
Archbishop Rummel High School
1901 Severn Avenue
Metairie, LA 70001
ATTACH CURRENT
PHOTO
Archbishop Rummel High School admits students of any race, color, national and ethnic origin to all the
rights, programs, and activities generally accorded or made available to students of the school. It does
not discriminate on the basis of race, color, national and ethnic origin or disability in violation of state and
federal law or regulation in administration of its educational policies or programs.
Application Incomplete
Without Photo
Parent or Guardian Signature:___________________________________________________
Print Name: _________________________________________________________________

ARCHBISHOP RUMMEL HIGH SCHOOL
Student Questionnaire
To Be Completed by the Student • Please Print or Type
Why did you choose Archbishop Rummel High School?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
List the activities in which you are presently involved in both at school and in your community (clubs, service organizations, athletic
teams, etc.).
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
List any and all significant achievements and awards that you have received (honor roll, student of the month, class officer,
organization leader, etc.)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
What first interested you in Archbishop Rummel High School? Check all that apply:
( ) Academics ( ) High School Night
( ) Athletics ( ) Home Visit
( ) Raider Football Game ( ) Band
( ) Legacy ( ) Spend-a-Day
( ) Friends ( ) Open House
( ) Summer Camps ( ) Other Extra-Curricular Activities
Student’s Signature:______________________________________________
Print Name: ____________________________________________________

ARCHBISHOP RUMMEL HIGH SCHOOL
Health information form
1901 Severn Ave. Metairie, LA 70001
Phone: 504.834.5592
To Be Completed by Parent or Guardian • Please Print or Type
Date __________________________
Applicant’s Name_____________________________________________________________________________________________
Last First Middle
Mailing Address______________________________________________________________________________________________
Street City State Zip
Name(s) of brothers attending this school __________________________________________________________________________
Home Phone______________________
Father’s Name_____________________________________________________________Cell Phone _________________________
Employer _________________________________________________________ Work Phone ________________________
Mother’s Name____________________________________________________________ Cell Phone _________________________
Employer _________________________________________________________ Work Phone ________________________
If parents cannot be reached, call:
________________________________________________________________________ Phone _____________________________
Name / Relation
Doctor __________________________________________________________________ Phone _____________________________
If, in a medical emergency, we are unable to contact you, do you consent to have your child transported to a hospital? Yes
No
Upon arrival, do you grant permission for the hospital and physician on call to treat your child? Yes No
Please check the appropriate response:
( ) The school may NOT give my son medication of any kind.
( ) Upon his request, the school is authorized to give my son Tylenol.
Please note any information concerning your son’s medical or physical condition that may affect his academic performance or physical
activities at school, or that may be needed for prompt and effective care in the event of illness or emergency.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
My son is allergic to:
___________________________________________________________________________________________________________
_______________________________________________________________________________________________ continue to back

Check each item: Yes No
Has your son ever had a head injury, heat stroke, heat exhaustion, or heat cramps?
Has your son ever been unable to take physical education or participate in sports because of his health?
Has your son ever had a serious injury or operation?
Has your son used the services of a psychologist, psychiatrist, or other mental health personnel or clinic?
If yes, give details ___________________________________________________________________________________________
__________________________________________________________________________________________________________
Has your son ever had the following:
Check each item Yes No Check each item Yes No Check each item Yes No Check each item Yes No
Allergies Mental disorder Ear disease Skin disease
Anemia Pneumonia Epilepsy Thyroid trouble
Arthritis Poliomyelitis Hay fever Tuberculosis
Asthma Rheumatic fever Heart disease Ulcer
Diabetes Rupture or hernia Liver disease Vertigo
Meningitis Diphtheria Kidney disease Chicken Pox
If yes, give details ____________________________________________________________________________________________
___________________________________________________________________________________________________________
IMMUNIZATION INFORMATION
FOR OFFICE USE ONLY: Records accompany this form Records to be forwarded.
Parents are required by law to furnish the school with a valid, up-to-date copy of their son’s immunization record.
Louisiana Statute 17:170 mandates that all students be properly immunized in order to attend any school within the state. The minimum
immunization requirements for students to be eligible to attend and remain in school are:
4 DTP (Diphtheria / Tetanus / Pertussis combined)
3 Oral Polio
1 Measles / Mumps / Rubella
The last DTP and Polio must have been given after the fourth birthday. It is recommended that a student be given a DT at 14 - 16 years
of age and every 10 years after that. The law does allow for letters of dissent. However, no letter will be accepted except those signed
by the parent or guardian at the school, in the presence of a school official.
Check the appropriate response:
( ) My son has completed the immunizations require by state law. His next TD booster is due _________ to fulfill requirements.
( ) My son is still in the process of completing the immunizations require by state law. Number of doses needed to fulfill requirements:
________ DTP/TD _________ Polio _________ MMR
Parent or Guardian Signature:_______________________________________________ Date: _______________________________
Print Name: _____________________________________________________________