Pre-registration Sacred Heart School

Grade _______________

Date _____________________ Year _______________

___________________________________________________________________ M F

(Last Name) (First Name) (Middle)

Address ___________________________________ Home Phone_________________________

City/State __________________________________ Emergency Phone ____________________

Date of Birth______________________ Place of Birth City/State ____________________

Date of Baptism___________________ Church _________________ City/State ______________

Date of First Communion ____________ Church _________________ City/State ______________

Date of Confirmation _______________ Church _________________ City/State ______________

Father’s Name ____________________ Residence ______________ Occupation _____________

Mother’s Maiden Name _____________ Residence ______________ Occupation ____________

Religion of Father _________________ Mother _________________

Church of Marriage ________________________________ Address ______________________

Transferred From __________________ Grade _________________ City ___________________

Parents are members of ____________________________________________ Parish

Will your child take the bus? __________ Yes __________________ No

Parishioner of Sacred Heart Church____ Yes __________________ No

Is he/she the only child in our school? ___ Yes __________________ No

If NO, please fill out the bottom information.

Name of Brothers and Sisters Present Grade in Sacred Heart School

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________________________________ ________________________________

________________________________ ________________________________

________________________________ ________________________________

________________________________ ________________________________

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