APPLICATION FOR ADMISSION
School_____________________________________________________City________________________________
Pupil_________________________________________________________________________________________
(Last) (First) (Middle)
Address_________________________________________________________________________Zipcode_______
Change of address___________________________________________ School District______________________
Telephone#________________________ Cell #_________________________ Change of Number______________
Place of Birth___________________________________ Date of Birth____________________ Citizen__________
Registered Parish_____________________________________ Location__________________________________
Admitted from: _______________________________________________ Date_____________ Grade ________
(School)
_____________________________________________________________________________________________
(Address)
Parish City/Town/State Date
Baptism_______________________________________________________________________________________
Reconciliation _________________________________________________________________________________
Holy Communion _______________________________________________________________________________
Confirmation __________________________________________________________________________________
Name Occupation Religion Education
Father________________________________________________________________________________________
Mother_______________________________________________________________________________________
Gauardian_____________________________________________________________________________________
Siblings_______________________________________________________________________________________
Relationship of guardian to child__________________________________________________________________
Home situation: ( ) Parents ( ) One parent ( ) Parents separated or ( ) Divorced
Restructured: ( ) Father/Stepmother or ( ) Stepfather/Mother ( ) Father Remarried ( ) Mother Remarried
Child/Children resides with ___________________________________________________________
Parental Rights (in case of separation or divorce)_____________________________________________________
(Please attach copy of court order)
Language (other than English) spoken at home_______________________________________________________
My child will be a: Bus rider_______ Car Rider ______ Walker ______ Other _______
If a bus rider – What school district? ________________________________________________
If a walker – what line? Chestnut Street_______________ or Walnut Street________________
Date of registration__________________________________________________
Information concerning the learning abilities of your child:
Are there any known learning disabilities? ________________________ If yes, would you share with us what
information you have and if any steps have been taken to remedy these.
Are there any emotional problems your child is experiencing at this time or has experienced in the not too
distant past?
Be assured that this information will be considered highly confidential and will not be shared with anyone
without your express permission.
…………………………………………………………………………………………………………………………………………………………………………….
I agree that my child and we (parents/legal guardians will abide by the policies and regulations set forth in the
Parent/Student Handbook of Sacred Heart School and those established by the Diocese of Harrisburg.
Signature of Parent/Guardian___________________________________________________________________
Registration Fee: $30.00 per child