This is Where It Begins!

2023-24 New Family and Student Application

This registration form is for planning purposes. It is not a contract.
If any information is falsified or omitted,
admittance in this school may be terminated.

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

Please provide your best contact information
in case there is a question about your application.

Name of Person Completing Application REQUIRED Please fill out this field. Please enter valid data.

Telephone Number of Person Completing Application REQUIRED Please fill out this field. Please enter valid data.

Email Address of Person Completing Application REQUIRED Please fill out this field. Please enter valid data.

STUDENT INFORMATION

Please carefully enter all information into the application and follow the format example given when necessary. Correct punctuation is appreciated as this information is transferred to a database for our school office and may result in an error if the information is not entered correctly. Thank you!

Full Legal Name of Student (First Middle Last) REQUIRED Please fill out this field. Please enter valid data.

Preferred Name of Student REQUIRED Please fill out this field. Please enter valid data.

Please note our Archdiocesan policy regarding age requirements:

Students entering PreK 3, three (3) years old by September 10, 2023
Students entering PreK 4, four (4) years old by September 10, 2023
Students entering Kindergarten, five (5) years old by September 10, 2023

If PreK 3, please indicate half day or full day program REQUIRED Half Day (7:45 AM-11:45 AM) Full Day (7:45 AM - 2:45 PM) N/A Please fill out this field.

Date of Birth (MM/DD/YY) REQUIRED Please fill out this field. Please enter valid data.

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

Gender REQUIRED Male Female Please fill out this field.

Ethnicity REQUIRED Hispanic Non-Hispanic Please fill out this field.

Race REQUIRED White African American Hispanic Asian Asian/Pacific Islander Native American/Alaskan Native Two or More Races Please fill out this field.

Native Language REQUIRED Please fill out this field. Please enter valid data.

Religious Affiliation REQUIRED Catholic Non-Catholic Please fill out this field.

Parish Your Family Is Currently Registered (if Catholic) Please enter valid data.

If Catholic, Date of Baptism, Name of Church, City, State (a copy of the Baptismal Certificate is required upon an Offer of Enrollment into CTKCS Please enter valid data.

Date of First Reconciliation, Name of Church, City, State Please enter valid data.

Date of First Communion, Name of Church, City, State Please enter valid data.

Name of Current School or Last School Attended (please include mailing address and telephone number) REQUIRED Please fill out this field. Please enter valid data.

Is there any disability that may interfere with academic studies or extracurricular activities REQUIRED Please fill out this field. Please enter valid data.

If yes, please explain (e.g. Asthma, Dyslexia, Dysgraphia, Learning Disability, ADD, etc.) Please enter valid data.

Is there documentation to verify any of the above diagnosis Please enter valid data.

Will the student require an evaluation to participate in our FLEX program Please enter valid data.

Has the student ever received, or is currently receiving, any type of therapy services (Physical Therapy, Speech Therapy, Occupational Therapy, Feeding Clinic, etc.) Please enter valid data.

Has your student ever been in an Early Intervention Program Please enter valid data.

If yes, please list when the student received this service and at what facility Please enter valid data.

Has the student ever been suspended or expelled REQUIRED Please fill out this field. Please enter valid data.

Has the student ever been retained REQUIRED Please fill out this field. Please enter valid data.

If yes the student has been retained, what grade Please enter valid data.

Please list any health information such as allergies and/or medications Please enter valid data.

Student Lives With REQUIRED Both Parents Single Mother Single Father Mother/Stepfather Father/Stepmother Legal Guardian Other Please fill out this field.

Name of Legal Guardian (if other than parent) Please enter valid data.

Mailing Address of Legal Guardian (if other than parent) Please enter valid data.

City Please enter valid data.

State Please enter valid data.

Zip Code Please enter valid data.

FATHER'S INFORMATION

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

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

Mailing 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. Please enter valid data.

Zip Code REQUIRED Please fill out this field. Please enter valid data.

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

Telephone Number (000-000-0000) REQUIRED Please fill out this field. Please enter valid data.

Place of Employment REQUIRED Please fill out this field. Please enter valid data.

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

Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.

MOTHER'S INFORMATION