Returning Families (Please Print Clearly):

Returning Families (Please Print Clearly): 2023 Northwestern Ave Racine, WI 53154 (262) 637-2012

Family name: _______________________________________________________________________________________ Address: __________________________________________

City: _____________________ Zip: _____________

Family Phone: ______________________________________Email: ____________________________________________

RETURNING STUDENTS: Child’s Name:

Grade for Next School Year:

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NEW SIBLINGS: Please list any new siblings for 2017-2018

Child’s Full Name: _______ ________________ ___Grade next year ____________ Date Of Birth: ______________ Preferred Name: ___________________________________________________

Gender:

 Male

 Female

Baptism Date: ____________ Church: __________________________________ City: _______________ State: _______ Reconciliation Date: ____________ Church: ______________________________ City: ________________ State: ______ First Communion Date: _________ Church: ______________________________ City: _______________ State: ______ Race:  American Indian  African-American  Asian Caucasian

 Hispanic  Multi-Racial

 Pacific Islander Is this student Hispanic/Latino Ethnicity? Yes  No 

___ My child will not be returning for 2017-2018. Reason:_______________________________________________ _______________________________________________________________________________________________

Signature of Parent: _________________________________________________________________

For Office use Only: Received Date: _______________

 Check #: ________________  Cash: _________

 Birth Certificate

 Baptismal Certificate

 Accepted ___________

 Powerschool  Acceptance Letter Sent