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K-7 Registration Form
Valid for the September 2023 - June 2024 School Year
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* Indicates required question
Email
*
Your email
Registration Date:
*
MM
/
DD
/
YYYY
Student Name:
*
Your answer
Entering into Grade Level
*
Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Child's Full Legal Name - First, Middle, Last:
*
Your answer
Child's Date of Birth:
*
MM
/
DD
/
YYYY
Child's Gender:
*
Boy
Girl
Parent's Name:
*
Your answer
Current Address(Including City, State and Zip Code):
*
Your answer
Home Phone Number:
*
Your answer
Cell Phone Number:
*
Your answer
Email Address (Mother):
*
Your answer
Email Address (Father):
*
Your answer
Ethnicity: Is the student Hispanic or Latino?
*
Yes
No
Race: What is the student's race?
*
Choose
White (Not Hispanic)
Asian
American Indian or Alaska Native
Black or African American (Not Hispanic)
Other (Specify)
Student's Religion:
*
Your answer
Family Affiliation:
*
Parishioner
Non-Parishioner
Non-Catholic
Registered and Contributing in What Parish?
*
Choose
St. Ignatius
St. Mary's
OLMM
Sacred Heart
Other
Not Registered or Contributing in a Parish
Geographically in What Parish?
*
Choose
St. Ignatius
St. Mary's
OLMM
Sacred Heart
Other
Will you be able to provide a copy of your child's birth certificate?
*
Yes
No
Will you be able to provide a copy of your child's baptismal certificate?
*
Yes
No
Baptismal Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic)
*
Your answer
Reconciliation Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet)
*
Your answer
First Holy Communion Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet)
*
Your answer
Confirmation Information - Must include Date of Sacrament, Church Name, and Location (Enter Not Applicable if Non-Catholic OR if Child Has Not Received Yet)
*
Your answer
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.
*
Yes
No
Do you acknowledge the required registration fee of $150? (Check made payable to LBCRS or Cash)
*
Yes
No
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