St. Maximilian Kolbe School Registration Application
Please fill out this application completely.
Are you a member of St. Maximilian Kolbe Parish *
If no, where is your parish?
Your answer
Registering for Grade *
If you are registering for Pre-K 3 3 days please list which 3 days you are interested in having your child attend. (same days for the entire year)
Your answer
Child's Full Name *
Your answer
Child's Gender *
Child's Address (street, city, county, state, zip code) *
Your answer
Child lives with *
If other than both parents please answer the following: who is the primary physical custodial parent, if there is special custodial court instructions( please provide a copy) and provide step parent information if applicable.
Your answer
Home Phone Number *
Your answer
Date of Birth of Child *
MM
/
DD
/
YYYY
City, State, Country of Birth of Child (a copy of the birth certificate is required) *
Your answer
Ethnicity of Child *
Race of Child *
Religion of Child *
Eastern Rite *
Place of Baptism *
If Other, Where was your child baptized? (Church, City, and Date) Copy of Baptismal Certificate is required. If at St. Max date of baptism *
Your answer
Has your child received any other Sacraments? *
If yes, please list the Sacrament, date received and Church.
Your answer
School District in which your child resides *
If applying for grades 1-8, current school your child is attending.
Your answer
Reason for leaving that school.
Your answer
Has your child ever been in a program for special needs or help? *
If yes, please elaborate
Your answer
Does your child have an Individual Education Plan (IEP)? *
Parent's Marital Status *
Mother's Name *
Your answer
Mother's Maiden Name
Your answer
Mother's Address (street, city, county, state, zip code) *
Your answer
Mother's Cell Phone Number *
Your answer
Mother's Work Phone Number *
Your answer
Mother's Email Address *
Your answer
Mother's Religion *
Your answer
Mother's Country of Birth *
Your answer
Father's Full Name *
Your answer
Father's Address (street, city, county, state, zip code) *
Your answer
Father's Cell Phone Number *
Your answer
Father's Work Phone Number *
Your answer
Father's Email Address *
Your answer
Father's Religion *
Your answer
Father's Country of Birth *
Your answer
2 Emergency contacts are required: name, phone number, and relationship cannot be parents. *
Your answer
Please describe any medical alerts, serious illnesses or disabilities we should be aware of.
Your answer
How did you hear about St. Maximilian Kolbe School? *
If you answered a current St. Max family, please tell us who they are. They can be rewarded for recommending you.
Your answer
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