Office Use – Student ID_________

LEBANON CATHOLIC SCHOOL

NEW STUDENT REGISTRATION FORM

Student’s Last Name____________________________________ First Name__________________________

Middle Name______________________ Preferred Name/Nickname__________________________________

Street Address___________________________ City/State/Zip______________________________________

Date of Birth____________ City of Birth_______________ Social Security Number_____________________

Present Age _____ Present Grade _____ Grade Applying for ______ Entry Date-Fall Semester 20_______

Home Phone w/Area Code________________________________ Cell Phone__________________________

Current School____________________________________ Phone Number w/Area Code__________________

Address__________________________________________ Fax Number (if known)_____________________

School District in which you reside______________________________________________________________

Does the student have any physical limitations?_____________________________________________________

Parish/Church_____________________________________Denomination______________________________

Address of Church____________________________________ Phone Number__________________________

Parental/ Guardian Information

Father’s Full Name___________________________________________ Phone Number___________________

Home Address_____________________________________________________________________________

Employed by: ____________________________________________ Job Title___________________________

Business Address____________________________________________ Phone _________________________

Mother’s Full Name________________________________________ Maiden Name_____________________

Home Address________________________________________________ Phone _______________________

Employed by:________________________________________________ Job Title______________________

Business Address________________________________________________ Phone_____________________

Home Situation:

Both Parents__ One Parent__ Parents Separated or Divorced__ Restructured Stepfather/mother__

Father Remarried__________ Mother Remarried __________ Child resides with_____________________

Parental Rights (in case of separation or divorce)_________________________________________________

(Court Documentation Required)

Language (other than English) spoken at home____________________________________________

TUITION INFORMATION

Who is responsible for tuition payments? Name_____________________________________________

Address (if different from parents)_______________________

Phone______________________

SACRAMENTAL INFORMATION

PARISH CITY/TOWN & STATE DATE

Baptism___________________________________________________________________________

First Penace________________________________________________________________________

First Eucharist_______________________________________________________________________

Confirmation________________________________________________________________________

OTHER INFORMATION

Please list all brothers and sisters who WILL BE ATTENDING Lebanon Catholic during the upcoming year:

NAME GRADE

_______________________________________________ ________

_______________________________________________ ________

_______________________________________________ ________

_______________________________________________ ________

Why do you want to come to Lebanon Catholic? _______________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

What school, community, or parish activities have you been involved with in the past two years? ____________

______________________________________________________________________________________

What are your primary interests?_______________________________________________________________

_____________________________________________________________________________

SIGNATURE OF PARENT/GUARDIAN_______________________________ DATE_________