Additional Child-Same Family Form

Student's First Name REQUIRED Please fill out this field. Please enter valid data.

Student's Middle Name Please enter valid data.

Student's Last Name REQUIRED Please fill out this field. Please enter valid data.

Nickname or Name Child Goes By Please enter valid data.

Sex REQUIRED Please fill out this field.

Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter a date.

Birth Place (City) REQUIRED Please fill out this field. Please enter valid data.

Grade for Enrollment REQUIRED Please fill out this field.

Race (check all that apply) REQUIRED African American/Black American Indian/Native American Asian White Hawaiian/Pacific Islander Two or more races Please fill out this field.

Ethnicity: Is the student Hispanic or Latino? REQUIRED Yes No Please fill out this field.

Allergies/Medications

Sibling Name(s) that currently attend Bishop John Carroll Cathedral School

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Has child ever required special services? REQUIRED Yes No Please fill out this field.

If child has required special services please elaborate on the type of special services.

Religion (Baptismal Certificate MUST be presented if Catholic) REQUIRED Please fill out this field. Please enter valid data.

Sacraments Recieved

Baptism Date Please enter valid data.

Baptism Parish Please enter valid data.

Baptism City/State Please enter valid data.

Reconciliation Date Please enter valid data.

Reconciliation Parish Please enter valid data.

Reconciliation City/State Please enter valid data.

Eucharist Date Please enter valid data.

Eucharist Parish Please enter valid data.

Eucharist City/State Please enter valid data.

Confirmation Date Please enter valid data.

Confirmation Parish Please enter valid data.

Confirmation City/State Please enter valid data.

Schools Child has attended REQUIRED Please fill out this field.
School 1
- Name of School Please enter valid data.
- Years Please enter valid data.
- Grade Please enter valid data.
School 2
- Name of School Please enter valid data.
- Years Please enter valid data.
- Grade Please enter valid data.
School 3
- Name of School Please enter valid data.
- Years Please enter valid data.
- Grade Please enter valid data.
School 4
- Name of School Please enter valid data.
- Years Please enter valid data.
- Grade Please enter valid data.

Currently enrolled in a Religious Education program Yes No

If you answered yes to previous question, where is your child attending religious education? Please enter valid data.

How many years have they attend religious education? Please enter valid data.

Mother's Email Please enter an email address.

Father's Email Please enter an email address.

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