Class of 2026 Student Profile Form
The information you provide in this form will help us to create a complete student profile for our newest Ritamen, including all current family contact information for our database.

We ask that one form be completed for each incoming freshman no later than Wednesday, July 6, 2022.

If you have any questions, please contact Mr. Josh Blaszak '02, Principal, at jblaszak@stritahs.com or 773.925.6600 ext.6626.

Thank You!
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Student's Formal First Name: *
Student's Middle Name (if any):
Student's Last Name: *
Student's Preferred Name: *
 (ex. Michael or Mike, John or Johnny, etc.) - This is the name that will be placed on the student's ID.
Student's Date of Birth: *
(##-##-####)
Student's Cell Phone Number: *
(###-###-####)
Student's Grammar School: *
Grammar School City: *
What city is the grammar school located in?
Student's Ethnic Background: *
Please select the category that best describes the student's racial/ethnic background.
Student's Religion: *
Sacraments Student Has Received: *
Please select any that apply.
Required
Student's Parish/Church:
Parish/Church City:
What city is the parish/church located in?
Formal Name of Parent(s)/Guardian(s) with whom the student lives: *
(e.g. Mr. & Mrs. John Doe or Ms. Jane Doe) - This is how all correspondence will be addressed.
Primary Mailing Street Address: *
This is the mailing address to which all correspondence should be sent.
City: *
State: *
Zip: *
Home Phone Number: *
(###-###-####) - This can be the same as a parent cell phone number if no landline exists.
Father: *
Required
Mother: *
Required
Parent(s) are: *
Student Lives With: *
PLEASE NOTE:  In case of separation/divorce, if there is a restriction to correspondence being sent to both parents, please contact Mrs. Noreen Kelliher at nkelliher@stritahs.com or 773-925-6600 ext. 6652.
Besides English, what other language is commonly used at home?: (If Applicable)
Father's Contact Information (IF APPLICABLE)
If the student lives with his father OR he does not live with his father, but his father should receive school correspondence please answer the following.
Father's First Name:
Father's Last Name:
Father's Email Address:
Father's Cell Phone Number:
(###-###-####)
Father's Religion:
Father's Occupation/Place of Work:
Father's Work Phone Number:
(###-###-####)
Father's Street Address (IF DIFFERENT FROM STUDENT):
City:
State:
Zip:
Mother's Contact Information (IF APPLICABLE)
If the student lives with his mother OR he does not live with his mother, but his mother should receive school correspondence please answer the following.
Mother's First Name:
Mother's Last Name:
Mother's Email Address:
Mother's Cell Phone Number:
(###-###-####)
Mother's Religion:
Mother's Occupation/Place of Work:
Mother's Work Phone Number:
(###-###-####)
Mother's Street Address (IF DIFFERENT FROM STUDENT):
City:
State:
Zip:
Guardian's Contact Information (IF APPLICABLE)
If the student is not living with his father or mother, please answer the following Guardian information.
Guardian's First Name:
Guardian's Last Name:
Guardian's Relationship to Student:
Guardian's Email Address:
Guardian's Cell Phone Number:
(###-###-####)
Guardian's Occupation/Place of Work:
Guardian's Work Phone Number:
(###-###-####)
Emergency Contact Information
Please complete the emergency contact information questions below.

In addition, parents are asked to please review the information that has been posted under the heading "Medical Documentation Information" on the Parent Information Page of the school website.

Students who have certain medical conditions, including asthma, seizures, allergies and/or diabetes must have emergency action plans on file in the Nurse's Office. Please complete the downloadable forms found on the website and return them to the Nurse's Office as soon as possible. If you have any questions, please contact the school nurse at nurse@stritahs.com.
In case of emergency or accident, the school should first notify: *
If no one can be reached from above information, the school should notify: *
Please list the NAME, PHONE NUMBER, & RELATIONSHIP of an emergency contact other than a parent/guardian/
Legacy Information (IF APPLICABLE)
If a student is part of a family legacy (family members who have attended/may attend St. Rita or other Augustinian high schools) please complete the following questions.
Please list the name(s) & class year(s) of the student's brothers currently enrolled at St. Rita:
If the student's father, grandfather, great-grandfather, and/or brother(s) graduated from St. Rita, please list names and graduation year below:
If the father, grandfather, or great-grandfather attended another Augustinian high school such as Mendel please make note.
Please list the name(s) and grade level(s) of the student's younger brother(s):
Freshman Orientation Questions
The following information will help us prepare for the student's transition into high school, especially Freshman Orientation.
Student's T-Shirt Size *
During Freshman Orientation & the Freshman Overnight we will provide food. Please inform of us of any special food allergies or accommodations the student needs that we should know about. (IF APPLICABLE)
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