Application to Holy Child Academy

Grade*

Academic Year*

Nursery 2 applicant must be two (2) years of age on or before August 31.

Nursery 3 applicant must be three (3) years of age on or before August 31, as well as fully independent in the bathroom.

Pre-Kindergarten applicants must be four (4) years of age on or before August 31.

Kindergarten applicant must be five (5) years of age on or before August 31.

1st Grade applicant must be six (6) years of age on or before August 31.

Please select program*

Applicant's First Name*

Applicant's Familiar Name

Middle

Last Name*

Applicant's Birth Date*

Gender*

Male Female

Applicant's Place of Birth*

Religion of Applicant*

Parish or Church Affiliation*

Date of Baptism (if applicable)

Place of Baptism (if applicable)

School District in which applicant resides*

Public elementary school applicant would be assigned*

Applicant's Current School*

Current Grade or Level*

Address of Current School (if applicable)*

City

State

Zip

Name of principal/head/director*

School phone*

List schools attended, most recent first, giving location, and length of time at each.*

Has the applicant ever been recommended for evaluation or evaluated for academic, speech, language, sensory integration, physical, behavioral, emotional, or attention difficulties by a school official, psychologist, physician or other professional?*

Yes No

If yes, please state condition.*

Has the applicant ever been diagnosed with a medical condition or allergy?*

Yes No

If yes, please state condition.*

Does the applicant take any prescription medication?*

Yes No

If yes, please list medication(s).*

Application to Holy Child Academy

Family Information

Father/Guardian

Education

Mother/Guardian

Education

Family Information

Agreement