2014-2415 Preschool Registration Form

Family Name:

Home Phone:

Father's name:

Work Phone

Occupation:

Email address

Cell Phone

Mother's Name:

Work Phone

Occupation:

Email address

Cell Phone

Father's Religion:

Mother's Religion:

BIRTHDAY

STUDENT'S NAME

GRADE

LIST OF ATLERGIES

1)

2)
3)
4)

In case of emergenry, please notifii fother than parent)

Name
PHONE tHl

_(WJ

_-.-*_--(cl

If I cannot be reached, my child may be released to the above named person. I further give my permission for medical
treatment to St" Mary's Catholic School in case of an emergency and neither I nor my contact cannot be reached.

The following people may pick up my child from school:

2)

3)

Parent Signature

Date

Parent Signature

Date