Application for Admission

Application for School Year

Grade Applying for

Information About Student

Full Name

Check one

Male

Female

Birthday

Religion

Address

Information About Father

Full Name

Religion

Address

Occupation/Title

Name of Business

Business Address

Cell Phone #

Home Phone #

Work Phone #

Information About Mother

Full Name

Religion

Address

Occupation/Title

Name of Business

Business address

Work Phone #

Home Phone #

Cell Phone #

Information about Person(s) with Whom Student Lives

Student Lives With

If "Other," Name:

Address

Phone Number

Additional Information about Student

Name of School Last Attended

Address of School

Current Grade

Does student have any health insurance?

Does student have any health concerns?

If student has any health concerns please list them here:

Has student ever received a diagnostic/psychological testing? If yes, a complete copy must be provided to Assumption School

Sacraments Received

Baptism

Date

Name of Church

Address

First Reconciliation

Date

Name of Church

Address

First Communion

Date

Name of Church

Address

Do you have any relatives of the student who are alumni of Assumption School?

Please list the Name/Class/Relationship

In the event that my child is accepted, my signature below indicates my agreement to abide by all of The Assumption School's guidelines and policies including the following:

Parents are expected to volunteer their services and expertise within the school
Parents agree to adhere to the school's policies as given in the school handbook
As part of a contract with the school, parents assumer the responsibility of paying all tuition and fees according to the school's tuition policy, and the undersigned agree to pay all costs of collection, including attorneys' fees, should they fail to pay all of such tuition and fees.

Signature of Parents/Guardians (Both parents/guardians must sign)

Name:

Signature

Date

Name

Signature

Date