Student Registration Form K3-K4 - Our Lady Of The Angels
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3Our Lady of the Angels School
404 Cherry Street, Columbia, PA 17512
717-684-2433 † Fax 717-684-5039
Student Registration Form
K3-K4
Student Information:
Last Name
First Name
Middle Name
Registering for K3____ K4______
Gender
Date of Birth
Birthplace (City/State)
Ethnicity
Language Spoken in Home
Religion
Registered Parish
City
Family Status: Two Biological parents_______
School District Of Residence
Single Parent_______ Restructured_______
Sacraments:
Date
Performed By (Pastor)
Church
Address (Street/City/State
Baptism
Health Information:
Allergies: __________________________________________________________________________
Other Conditions: ___________________________Special Needs____________________________
Insurance: _____________________________Hospital:_________________________________
Parent /Legal Guardian:
Father
Mother
Name (Title/Last/First)
Name (Title/Last/First)
Maiden Name
Address
Address
Phone: Home-Cell-Work
Phone: Home-Cell-Work
Email
Email
Employer
Employer
Religion/Parish
Religion/Parish
Marital Status
Marital Status
Child Resides With: (List all that reside in household)
Name
Birthdate
Relationship To Student
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