HOLY SPIRIT REGIONAL SCHOOL OFFICE USE ONLY
619 Airport Road SW Date Received ___________
Huntsville, Alabama 35802 Reg.
Fee Ck#
_________
(256) 881-4852 SS#
on File _________
Birth Certificate on
File__________
Report
Card on File ___________
NEW STUDENT
ADMISSION APPLICATION 2010-2011
Proposed
Grade Placement______________ Age on 1
September___________Male_________Female_____________
(Birth Certificate Required With Registration)
Student’s
Name ___________________________________________Social Security
#__________________________
First Name Middle Name Last Name (Student’s – Required
With Registration)
Address__________________________________________________________________________________________
Street Apt. # City State Zip
Home
Telephone____________________Date of Birth________________Place of
Birth_________________________
Month/Date/Year City/State
Numbers
of Brothers:
Younger_______Older_______
Number of Sisters:Younger______Older_______
Special
Abilities___________________________________________________________________________________
Religion__________________Parish
Registered________________________________Year/Date_________________
(Student)
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Year |
Church |
City |
State |
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Baptism |
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First
Reconciliation |
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First
Communion |
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FAMILY INFORMATION
Father’s
Name___________________________________
Mother’s Name_____________________________________
Address________________________________________
Address___________________________________________
City____________________________State____________
City______________________________State____________
Occupation______________________________________
Occupation________________________________________
Business
Name & Address__________________________ Business Name &
Address____________________________
Business
Phone Cell Phone Business Phone Cell Phone
Religion
of Father_________________________________ Religion of
Mother__________________________________
E-mail
Address___________________________________ E-mail
Address_____________________________________
Person student living with
(if not parents):
_________________________________________________________________________________________________
Last
Name of Guardian/Stepparents
First Middle Initial Telephone
Address
of Guardian/Stepparents City Zip
_______________________________________________
_________________________________________________
Signature
of Father or Guardian Signature of Mother or
Guardian (continue on back)
School
attended before entering Holy Spirit:
_____________________________________________________________
School
Address____________________________________________________________________________________
City State Zip
Person
responsible for tuition payments:________________________________________________________________
Has
your child ever been tested for Special Education Services? Yes_____ No_____
If
yes, does your child receive any special education services at this time? Yes_____ No______
Has
your child been evaluated privately for learning or attention problems? Yes_____ No_____
Will
you release a copy of the evaluation? Yes_____ No_____
Medical Information
Student’s
Physican__________________________________________________________Telephone_______________
Does
your child have any health problems-Physical/Emotional? e.g. Diabetic, ADD or
ADHD, etc.
Yes_____ No_____
If yes, please
explain_______________________________________________________________
Are
there any situations or pertinent information, which we should know in order to
further understand your child? e.g.
custodial rights, visitation rights, child has been/is in counseling, etc.
_________________________________________________________________________________________________
Is
your child on any Medications? Yes_____ No_____
Name
of
Medication________________________________________________________________________________
_________________________________________________________________________________________________
How
were you referred to our school?
__________________________________________________________________
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POLICIES OF THE
CATHOLIC SCHOOLS Diocese of Birmingham in Alabama Application
for registration implies good will on the part of parents in complying with
the philosophy and regulations of Catholic Schools, Diocese of Birmingham,
Alabama (see
Handbook of Policies). “Every Catholic elementary and secondary
school in the school system of the Diocese of
Birmingham admits students without regard to sex, race, color, national and
ethnic origin
to all the rights, privileges, programs, and activities generally accorded or
made available
to students of the schools. Schools
do not discriminate on the basis of sex, race,
color, national and ethnic origin in its employment practices, administration
of education
policies, admission and treatment of students, scholarships and loan programs.” It is also our right and duty to decline the
application of students who do not meet our standards of achievement and behavior. Grounds for expulsion include, but are not
limited to, possession or use of alcohol, drugs, weapons, or other serious
misconduct. All new students must present previous report card
or records and present birth or Baptismal record for proof of age. Children entering Kindergarten must be five years
of age by September 1 of this year.
Children entering first grade must be six years of age by September 1
of this year. Proof of age must be
presented at time of application, and it will be subject to verification. All students are required to participate in
religion class and any other specified religious activities or services. Any information on this form which is later found
to be erroneous could be cause for nullification of registration or immediate
dismissal of student. _________________________________________________ ____________________ Superintendent of
Schools Parent’s Signature Date Diocese
of Birmingham |
(Revised
1/19/2010)