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  • Date REQUIRED Please fill out this field. Please enter a date.
  • Student Name, First, Middle, Last REQUIRED Please fill out this field. Please enter valid data.
  • Student's Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.
  • Church Attending REQUIRED Please fill out this field. Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Gender REQUIRED (Select One) Male Female Please fill out this field.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • U.S. Citizen REQUIRED (Select One) Yes No Please fill out this field.
  • Country of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Language Spoken in the Home REQUIRED Please fill out this field. Please enter valid data.
  • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Father's Name, First, Last REQUIRED Please fill out this field. Please enter valid data.
  • Father's Status REQUIRED (Select One) Married Single Separated Remarried Divorced Deceased Please fill out this field.
  • Father's Occupation REQUIRED Please fill out this field. Please enter valid data.
  • Father's Religion/Church REQUIRED Please fill out this field. Please enter valid data.
  • Father's Business Address REQUIRED Please fill out this field. Please enter valid data.
  • Father's Business Phone REQUIRED Please fill out this field. Please enter valid data.
  • Father's Education REQUIRED (Select One) High School College Bachelor Degree Trade School Advanced Degree Other Please fill out this field.
  • Mother's Name, First, Last REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Status REQUIRED (Select One) Married Single Separated Remarried Divorced Deceased Please fill out this field.
  • Mother's Occupation REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Church/Religion REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Business Address REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Business Phone REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Education REQUIRED (Select One) High School College Bachelor Degree Trade School Advanced Education Other Please fill out this field.
  • Number of Children in Family, Boys, Girls REQUIRED Please fill out this field. Please enter valid data.
  • Additional Children: Names of siblings enrolled at SJS Please enter valid data.
  • Additional Children: Name, School Currently Attending Please enter valid data.
  • Sibling Rank REQUIRED Please fill out this field. Please enter valid data.
  • Public School District Child Belongs: REQUIRED Please fill out this field. Please enter valid data.
  • Public School District Child Would Attend: Please enter valid data.
  • District Number Please enter valid data.
  • County Please enter valid data.
  • Date of Entry Please enter valid data.
  • Entering Grade REQUIRED Please fill out this field. Please enter valid data.
  • Transferred From Please enter valid data.
  • Baptism: Date, Church, City, State REQUIRED Please fill out this field. Please enter valid data.
  • First Communion: Date, Church, City, State REQUIRED Please fill out this field. Please enter valid data.
  • Confirmation: Date, Church, City, State REQUIRED Please fill out this field. Please enter valid data.
  • Describe any tutoring or special education programs the child is receiving or has received:
  • Describe any special needs of the child in which the school should be aware:
  • Ethnic Demographic/Family Background; Choose ONE that fits the best: Asian American Indian/Native American Black/African American Hispanic Native Hawaiian/Other Pacific Islander White Multi-Racial

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