Student Registration

St. Hyacinth Academy

KR-8th Enrollment Form

2025-2026

Returning Student*

Answer required for "Returning Student"

Yes

New Student*

Answer required for "New Student"

Yes

Former School Name

Answer required for "Former School Name"

Family Name*

Answer required for "Family Name"

Student's Full Name*

Answer required for "Student's Full Name"

Student lives with:*

Answer required for "Student lives with:"

Both Birth Parents

Mother Only

Father Only

Mother/Step-Father

Father/Step-Mother

Guardian

Other:

Grade Entering*

Answer required for "Grade Entering"

Date of Birth*

Answer required for "Date of Birth"

Are you baptized Catholic?*

Answer required for "Are you baptized Catholic?"

yes

First language spoken by student*

Answer required for "First language spoken by student"

Languages spoken at home*

Answer required for "Languages spoken at home"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone

Number Required

Parent 1 Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Employer*

Answer required for "Employer"

Work Phone

Number Required

Religion*

Answer required for "Religion"

Practicing?*

Answer required for "Practicing?"

Yes

Parent 2 Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Email*

Answer required for "Email"

Mobile Phone*

Number Required

Employer*

Answer required for "Employer"

Work Phone

Number Required

Religion*

Answer required for "Religion"

Practicing?*

Answer required for "Practicing?"

Yes

Please complete below if student is Catholic

Worshiping Parish:

Answer required for "Worshiping Parish:"

Registered?*

Answer required for "Registered?"

Yes

Practicing Catholic?*

Answer required for "Practicing Catholic?"

Yes

Baptismal Date and Church Name:

Answer required for "Baptismal Date and Church Name:"

1st Communion and Church:

Answer required for "1st Communion and Church:"

Ethnic Background*

Answer required for "Ethnic Background"

American Indian/Native Alaskan

Native Hawaiian/Pacific Islander

African American

White/Caucasian

Asian

White/Racial

Hispanic

Multi-Racial

Other:

Emergency Contact Information

Full Name*

Answer required for "Full Name"

Relationship to Student*

Answer required for "Relationship to Student"

Phone Number*

Number Required

Emergency Contact Information 2

Full Name*

Answer required for "Full Name"

Relationship to Student*

Answer required for "Relationship to Student"

Phone Number*

Number Required

Family Doctor Information

Family Doctor Name*

Answer required for "Family Doctor Name"

Business Number*

Number Required

Hospital of Choice*

Answer required for "Hospital of Choice"

List of medications child is taking:*

Answer required for "List of medications child is taking:"

List any medical limitation/allergies*

Answer required for "List any medical limitation/allergies"

Agreement of Terms/Contract

I am aware of the school's financial policies and I agree to comply. I understand that non-payment of tuition will result in the exclusion of my child from school and/or events. I understand that written notice is required two weeks prior to withdrawal of my child from school and that I am finanically responisble for tuition during this time regardless of attendance. I understand that tuition is ongoing and is based on the program to which my child is committed rather than upon attendance.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Student Registration