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St. Philip the Apostle School
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Religious Education On-line New Student Information Card
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Indicates required field
Child's Name (First, Middle, Last)
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Birthdate
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MM/DD/YYYY
Street Address
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City & Zip Code
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Child lives with:
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Dad & Mom
Mom alone
Dad alone
Mom & Stepdad
Dad & Stepmom
Other
Public school child attends
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Father's Name (First, Last)
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Father's Religion
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Father's Work #
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Mother's Name (First, Last)
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Mother's Religion
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Mother's Work #
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Child's Baptismal Date
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MM/DD/YYYY
Baptismal Church
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Baptismal Church Address
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City, State
First Communion Date
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MM/DD/YYYY
First Communion Church
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First Communion Church Address
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City, State
Emergency Medical Information
Please list any important health or learning information concerning your child. For example: allergic (food, medication,environmental) reactions, learning disabilities, diabetes, vision or hearing impairment, physical disabilities that would preclude climbing stairs, etc.
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Emergency contact phone numbers if parents cannot be reached at home or at work.
Emergency Contact #1 (First & Last Name)
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Phone # of Contact #1
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#1's Relationship to student
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Emergency Contact #2 (First & Last Name)
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Phone # of Conact #2
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#2's Relationship to Student
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I give permission for my child to receive emergency treatment if I or my designated emergency contacts cannot be reached at the above telephone numbers.
Parent's Name (First & Last)
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Date (MM/DD/YYYY)
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Submit