Registration Form New Students English

Our Lady Star of the Sea Regional School                                                 

15 N. California Avenue

Atlantic City, NJ  08401

609-345-0648  phone             609-344-6735  fax

 

 

New Student Registration Form

Student Entering Grade_____________________________________  Student Start Date__________________

First Name_____________________ Middle Name_________________Last Name_______________________

Birth Date______________________Birth Place___________________________________________________

Ethnicity_______________________Race________________________Religion_________________________

Parish (if applicable)______________________Public school district of residence________________________

Sacrament Information (if Catholic)

                                                Parish                          City                              State                            Date

Baptism                       ________________________________________________________________________

First Reconciliation     ________________________________________________________________________

First Communion        ________________________________________________________________________

Confirmation               ________________________________________________________________________

School History

Previous School Address______________________________________________________________________

Dates attended______________________________________  Grades completed_______________________

School’s Telephone and Fax Numbers___________________________________________________________

Is this student enrolled in any above grade level learning classes at this school?                             ____________

Does this student receive any supplemental instructional aide/accommodation at this school?  ____________

Are there any instructional plans on record for this student at this school?                                      ____________

Records Release

I give permission for Our Lady Star of the Sea Regional School to request my child’s records from the above school including cumulative folder, intelligence/achievement results. Health record, child study team placement/assessment record, discipline record, and any other information pertinent to pupil placement/instruction including speech, guidance, and other related services.

Parent/Guardian Signature:______________________________________________ Date:_________________

One per household:

Our Lady Star of the Sea Regional School

Date___________________________________________

Household Name____________________________________________________________________________

Person to whom mailings are to be sent_________________________________________________________

Mailing address____________________________________________________________________________

Mother__________________________________    Father__________________________________________

Maiden Name_____________________________

Mailing Address (if different from above)                 Mailing Address (if different from above)

________________________________________    ________________________________________________

________________________________________     ________________________________________________

E-mail Address____________________________    E-mail Address____________________________________

PLEASE CIRCLE PHONE PREFERRED FOR CONTACT

Home Phone______________________________   Home Phone_____________________________________

Cell Phone________________________________   Cell Phone_________________________________

Work Phone______________________________    Work Phone______________________________

Employer________________________________     Employer________________________________

Child/ren live with:     ____Both Parents       ____Mother    ____Father

                                    ____Guardian-please indicate relationship_______________________________

                          Please submit copies of any custody/court order papers

Language primarily spoken in the home___________________________________________________

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