HOLY ANGELS SCHOOL
120 E. WATER ST.
SIDNEY, OHIO 45365
STUDENT REGISTRATON FORM
STUDENT INFO
Last Name:
First:
Middle:
Address:
Phone:
Social Security #:
DOB:
City of Birth:
Religion:
Gender:
Male
Female
PARENT INFO
Father's Name:
Religion:
Occupation:
Business Address:
Business Phone:
Mother's Name:
Religion:
Mother's Maiden Name:
Occupation:
Business Address:
Business Phone:
HOME STATUS
Child Lives With:
Mother
Father
Stepmother
Stepfather
Foster Parents
Other Relatives
Parents are Divorced
Mother Deceased
Father Deceased
If Child’s Progress Reports and other pertinent information are to be sent to more than one address, please indicate below:
SACRAMENTS
Date
Church
City & State
Baptism:
Penance:
First Communion:
Confirmation:
MEDICAL INFO
Please check those conditions you are aware of or suspect in your child:
Hearing Impairment:
Physical Disabilities
Visual Impairment:
Orthopedic Disability:
Speech Disability:
Mentally Handicapped:
Language Disability:
Other Handicaps:
Learning Disability:
Please explain handicaps (if any):
Emotional Problems:
Has your child been retained for a grade or entered school one year late?
Yes -
No
If Yes, please explain:
Are there any behavioral problems that your child has exhibited in the past at home or in school?
Yes -
No
If Yes, please explain:
Are there any other points you would like the school to take into consideration?
Yes -
No
If Yes, please explain:
FORMER SCHOOL INFO
Name of School:
Grade:
Address:
