2022-2023 Registration Form

2022-2023 REGISTRATION FORM

Student’s Full Name:

First Middle Last

Grade This Fall (K-8th):

Birth Date:

Preschool Class (Circle One):

4-year 5-day

4-year 3-day

3-year 5-day

3-year 2-day

Street Address:

City:

Zip:

Home Phone:

Father’s Cell:

Mother’s Cell:

Place of Birth (City/State):

Social Security # (optional):

Race:

Baptism Date:

Church Affiliation/Religion:

Public School Name:

Previous School attended and grade level completed:

Father’s Name:

Address (if different than student):

Father’s Email:

Place of Work:

Work Phone #:

Mother’s Name:

Address (if different than student):

Mother’s Email:

Place of Work:

Work Phone #:

Parents (Check One):

Married

Separated

Divorced

Deceased

List Names of Brothers/Sisters with Birth Dates:

2023-2024 REGISTRATION FORM

StepFather’s Name:

Social Security #:

Address

Cell#

Place of Work:

Work Phone#:

StepMother’s Name:

Social Security #:

Address

Cell#

Place of Work:

Work Phone#:

OPTIONAL:

Paternal Grandparents Names:

Paternal Grandparents Address:

Maternal Grandparents Names:

Maternal Grandparents Address:

GOOD SHEPHERD LUTHERAN SCHOOl

2022-2023 Registration Form