Enrollment Form

Student Information

Student Name*

First Last

Entering Grade*

Student Type*

Parent / Guardian Information

Parent / Guardian Name*

First Last

Marital Status*

School Mailings Sent To:*

Primary Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address Saint Stanislaus will use for parent mailings, report cards, registration and school information.

Parent / Guardian #2 Name

First Last

Secondary Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Complete only if you wish Saint Stanislaus to send school mailings to a second address.

Emergency Contact

In case parents or guardians cannot be reached.

Contact #1*

First Last

Relationship #1*

Cell Phone #1*

Contact #2*

First Last

Relationship #2*

Cell Phone #2*

Contact #3*

First Last

Relationship #3*

Cell Phone #3*

Student Health Information

Food Allergies*

Food Allergy Information

Please list any foods to which your child is allergic or severely allergic, as well as how your child reacts when exposed to the food that is listed.

Student's Primary Physician*

First Last

Student's Primary Physician Phone Number*

Copy of Health Insurance Card

Max. file size: 256 MB.

Please upload a copy of the front and back of the student's health insurance card.

Siblings

How many siblings does the student have?*

Sibling #1

First Last

Brother / Sister

Age

Sibling #2

First Last

Brother / Sister

Age

Sibling #3

First Last

Brother / Sister

Age

Sibling #4

First Last

Brother / Sister

Age

Sibling #5

First Last

Brother / Sister

Age

Sibling #6

First Last

Brother / Sister

Age

Brothers of the Sacred Heart Connections

Have any relatives attended Saint Stanislaus or a Brothers of the Sacred Heart School?*

Please list any relative who is presently attending or who has graduated from Saint Stanislaus or a Brothers of the Sacred Heart School.

Name - Relative #1

First Last

Relationship to Student

He is my ...

School Attended

Class Of

Name- Relative #2

First Last

Relationship to Student

He is my ...

School Attended

Class Of

Name - Relative #3

First Last

Relationship to Student

He is my ...

School Attended

Class Of

Enrollment Information

Student Information

Parent / Guardian Information

Emergency Contact

Student Health Information

Siblings

Brothers of the Sacred Heart Connections