The following items should accompany the completed Registration Form:
Copy of Child’s Birth Certificate; Copy of Child’s Baptismal Certificate; Wallet Size
Picture of Child; and $225.00 Education Fee.
STUDENT
PLEASE PRINT & FILL OUT COMPLETELY
Last Name:
First Name:
Saint Bernadette School
Education Fee Paid:
Date Rec’d ______________20_____
Middle Name:
Amount $__________Ck #___________
Cash_____
Sex
Date of Birth
REGISTRATION FORM
Student’s Birthplace:
M
F
Residence Address:
SACRAMENTS
City:
County:
BAPTISMAL CERTIFICATE
Zip Code:
Month
Day
Year
Home & Cell Phone:
STUDENT ENTERED FROM:
Country
City
State
Student’s Parish/Church City/State
Parochial
Dates Received
Month
Day
Year
Verified by:
School
Baptism
Church
City
Reconciliation
Rite
State
First Communion
City
Grade Entering
Confirmation
State
K 1 2 3 4 5 6 7 8
STUDENT LIVES WITH
Last Name
First Name
Maiden Name
Birthplace
Occupation
Employer
Natural Mother (NM)
Natural Father (NF)
Custodial Mother (CM)
Custodial Father (CF)
Other
PARENT’S RELIGION
NM
NF CM CF
PARENT’S STATUS: NM NF
CM
CF
PARENT’S EDUCATION
NM
NF
Catholic
Living
Under 12 Years
Protestant
Deceased
High School Graduate
Jewish
Living, Separated
College Non-Graduate
Other
Living, Divorced
College Graduate
LEGAL GUARDIAN:
Living, Remarried
Beyond College
Name:
Living, Widowed
Address
Single
LANGUAGE SPOKEN AT HOME
OTHER CHILDREN IN THE FAMILY: NAME AND BIRTHDATE
1.
1.
4.
2.
2.
5.
3.
6.
The following information is necessary for the State of Ohio. Each student must be represented by one of these categories. Please check one:
(001) ______ Alaskan Native or American Indian (origins in any of the original peoples of North America)
(002) ______ Asian (Oriental) or Pacific Islander (origins in peoples of Far East, Southeast Asia, Pacific Islands)
(003) ______ African American (origins in any of the black racial groups of Africa)
(004) ______ White American (origins in peoples of Europe, North Africa or Middle East)
(005) ______ Hispanic (origins in Mexico, Puerto Rico, Central South America or other Spanish cultural origin)
Other
School
Phone
CM
CF
The above information is correct and I understand that the $225.00 Education Fee is non-refundable.
Parent/Guardian Signature_________________________________ Date ___________Email___________________________________@____________________