Nursery Registration Form
Valid for the September 2021-June 2022 School Year
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Email *
Registration Date: *
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Student Name: *
Entering into Grade Level *
Required
Please indicate your first preference: *
Please indicate your second preference(if applicable):
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Please indicate your preference of days: *
Child's Full Legal Name - First, Middle, Last: *
Child's Date of Birth: *
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Child's Gender: *
Parent's Name: *
Mother's Maiden Name: *
Current Address(Including City, State and Zip Code): *
Home Phone Number: *
Cell Phone Number: *
Email Address (Mother): *
Email Address (Father): *
How do you wish correspondence sent home to you from school to be addressed? *
Ethnicity: Is the student Hispanic or Latino? *
Race: What is the student's race? *
Registered and Contributing in What Parish? *
Geographically in What Parish? *
Will you be able to provide a copy of your child's birth certificate? *
Will you be able to provide a copy of your child's baptismal certificate? *
Will you be able to provide a copy of your child's health records? Specifically, the immunization record, which is mandatory as required by the Diocese of Rockville Centre. *
Do you acknowledge the required registration fee of $150? (Check made payable to LBCRS or Cash) *
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