Student Registration

St. Hyacinth Academy

KR-8th Enrollment Form

2024-2025

Returning Student*

Answer Required

Yes

New Student*

Answer Required

Yes

Family Name*

Answer Required

Student's Full Name*

Answer Required

Student lives with:*

Answer Required

Both Birth Parents

Mother Only

Father Only

Mother/Step-Father

Father/Step-Mother

Guardian

Other:

Grade Entering*

Answer Required

Date of Birth*

Answer Required

Are you baptized Catholic?*

Answer Required

yes

First language spoken by student*

Answer Required

Languages spoken at home*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Home Phone

Number Required

Parent 1 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Employer*

Answer Required

Work Phone

Number Required

Religion*

Answer Required

Practicing?*

Answer Required

Yes

Parent 2 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Employer*

Answer Required

Work Phone

Number Required

Religion*

Answer Required

Practicing?*

Answer Required

Yes

Please complete below if student is Catholic

Worshiping Parish:

Answer Required

Registered?*

Answer Required

Yes

Practicing Catholic?*

Answer Required

Yes

Baptismal Date and Church Name:

Answer Required

1st Communion and Church:

Answer Required

Ethnic Background*

Answer Required

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

Relationship to Student*

Answer Required

Phone Number*

Number Required

Emergency Contact Information 2

Full Name*

Answer Required

Relationship to Student*

Answer Required

Phone Number*

Number Required

Family Doctor Information

Family Doctor Name*

Answer Required

Business Number*

Number Required

Hospital of Choice*

Answer Required

List of medications child is taking:*

Answer Required

List any medical limitation/allergies*

Answer Required

Agreement of Terms/Contract

I am aware of the school's financial policies and I agree to comly. I understand that non-payment of tuition will result in the exclusion f my child from school and/or events. I understand that written notice is required two weks 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 comminteed rather than upon attendance.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Student Registration