PARENTS LAST NAME____________________________ FATHER_____________________________                     CATHOLIC-YES/NO (PLEASE CIRCLE)

                                                                                             MOTHER____________________________                       CATHOLIC-YES/NO (PLEASE CIRCLE)

______________________________________________________________________________________                                IF YOU HAVE A PREFERENCE FOR CLASS PLACEMENT,
STREET ADDRESS                                                CITY                                         ZIP CODE                                                            PLEASE SPECIFY AT TIME OF ENROLLMENT.

_______________________        ________________________                    _____________________________                       ____________________________________________
HOME PHONE                               FATHER WORK                                           FATHER CELLULAR

_______________________         __________________________               _____________________________                      E-Mail Address ________________________________
HOSPITAL PREFERENCE              MOTHER WORK                                        MOTHER CELLULAR

STUDENT NAME                                                                   BIRTH DATE                     GRADE                      BAPTISM                       1ST                                1ST                           CONF.
LIST LAST NAME IF DIFFERENT                                                                                                                                                        RECON.                         COMM.