Aquin Catholic Schools Online Registration Form
Student Information
Please complete/update all student information fields.
Will your child be returning for the 2017-18 school year? *
Student First Name *
Your answer
Student Middle Name
Your answer
Student Last Name *
Your answer
Nick Name
Your answer
Student lives with *
Student birth date *
MM
/
DD
/
YYYY
Gender *
Student Ethnicity (for state reporting purposes) *
Student Race (for state reporting purposes) *
Required
Student Religion *
Parish
If not listed above, please enter the name of your Church/Parish
Your answer
Family Physician *
Your answer
Family Physician Phone Number *
Your answer
Preferred Hospital *
Your answer
Does your student have health insurance? *
Health Insurance Provider (answer N/A if No Insurance) *
Your answer
Health Insurance Policy Number (answer N/A if No Insurance) *
Your answer
Please list any Allergies Student has:
Your answer
Please list any Medical Conditions:
Your answer
Diabetic *
Does Student take Insulin? *
Does Student use inhaler? *
Does Student need to use an Epipen? *
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