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Grade Entering: 

Student Information

Last Name: First Name:
Middle Name: Nickname: (Only if used in school)
Ethnicity: Sex:
Student's Religion:
Student's DOB :

Address

Address 1:
Address 2:
City:
State:   Zip Code: 
Home Phone:
How long at present address? 
Student resides with: 
Church Parish in which you are registered:

Medical Information

Enter the student's doctor and phone number.

Doctor Name: Phone:

Enter your hospital preference (in Baton Rouge)

Hospital Name: Phone:
Hospital Name: Phone:

Is this student taking any medication?
Does your child have a medical diagnosis?
Does this pupil have dyslexia, dysgraphia, ADD, ADHD, speech or language impairment, visual or hearing impairment, etc.?

School/Schools Previously Attended

Please list all schools including any preschool programs for the student being registered, especially most recent school so we can request records.


Was this pupil enrolled at any time in any type of special education class?
Did this pupil receive any type of remedial tutoring at any time?
Was this pupil tested for a Gifted and Talented Program?

Sibling Information

Please list below all brothers and sisters under nineteen (19) years of age


 

 

 

Picture of trees - Part 1