REGISTRATION FORM(Family information) (PRINTABLE COPY)
SAINT JOSEPH CATHOLIC SCHOOL
509 PAVONIA AVENUE
JERSEY CITY, NEW JERSEY 07306
(201) 653-0128
DATE:____________________
LIST THE NAME OF EACH CHILD WHO WILL BE ATTENDING SAINT JOSEPH SCHOOL IN SEPTEMBER 2002
1. STUDENT NAME______________________________________ D.O.B.________________GRADE____________
LAST FIRST MIDDLE MO. DAY YEAR
2. STUDENT NAME______________________________________ D.O.B.________________GRADE____________
LAST FIRST MIDDLE MO. DAY YEAR
3. STUDENT NAME______________________________________ D.O.B.________________GRADE____________
LAST FIRST MIDDLE MO. DAY YEAR
HOME ADDRESS_________________________________________________________________________________
NUMBER STREET APT NO. CITY ZIP CODE
HOMEPHONENO.______________________________ BEEPER/CELL
PHONE________________________________
E-MAIL ADDRESS: _____________________________________________________________________________
MOTHER'S NAME ________________________________________________________________________________
LAST FIRST MAIDEN
ADDRESS OF COMPANY____________________________________________________________________________
NUMBER STREET CITY STATE
BUSINESS NUMBER_________________________ EXT________ BEEPER/CELL PHONE______________________
FATHERS NAME(Please indicate Stepfather or Boyfriend)_________________________________________
LAST FIRST
ADDRESS OF COMPANY____________________________________________________________________________
NUMBER STREET CITY STATE
BUSINESS NUMBER_________________________ EXT________ BEEPER/CELL PHONE______________________
Who has legal custody of the student?______________________________________________
Is the family on welfare or receiving child assistance? ________Yes ________No
Religious affiliation of the family___________________________________________________
Are you an active parishioner of Saint Joseph Church? ________Yes ________No
Parents are: ______ Married ______ Separated ______ Divorced ______ Not Married
Student lives full time with - ______ Mother and Father ______ Grandparent
______ Mother ______ Father
______ Guardian______ Other_______________________
The Federal Government requires the school to give an ethnic breakdown of our school
population for purposes of non-discrimination.
Please check one of the following:
1. ______White 4. ______Asian
2. ______Black 5. ______American Indian or Alaskan Native
3. ______Hispanic 6. ______Multi-Racial
7. ______Hawaiian/Pacific Islander
Country family originated from____________________________________________________________
Language(s) spoken at home________________________________________________________________
EMERGENCY INFORMATION - THIS INFORMATION MUST BE EXACT AND UPDATED WHEN NECESSARY
YOUR CHILD'S WELFARE DEPENDS ON PROPER INFORMATION
NAME OF STUDENTS(S)_________________________________________________________________
LAST FIRST(OLDEST TO YOUNGEST)
EMERGENCY NUMBER_________________________(Person must be at home during the day and
living in Jersey City)
NAME OF PERSON______________________________________________________________________
RELATIONSHIP TO CHILD_______________________________________________________________