Admission Form 1-8th, 2022-2023 Child's First Name *Child's Middle NameChild's Last Name *Child's Gender *Child's Date of Birth *Child's Place of Birth *What grade will your child be entering? *Please select an optionFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Child's Primary Contact Number *Do not include parenthesizes or dashes.Mother's Salutation *Mother's First Name (or Guardian) *Mother's Last Name (or Guardian) *Mother's Cell Phone Number *Do not add parenthesizes or dashes.Mother's Email Address *Mother's Religion *Please select an optionCatholicChristianOtherMother's Parish *Mother's Occupation *Mother's Place of Employment *Father's First Name (or Guardian) *Father's Last Name (or Guardian) *Father's Cell Phone Number *Do not add parenthesizes or dashes.Father's Email Address *Father's Occupation *Father's Place of Employment *Father's Religion *Please select an optionCatholicChristianOtherFather's Parish *Child Lives With *Relationship to child *Marital Status *MarriedWidowedDivorcedSingleSeparatedRemarriedPlease select one.Step Parent's First Name (if applicable)Step Parent's Last name (if applicable)Step Parent's Phone NumberStep Parent's Email AddressReligious HistoryName of church where child was BaptizedDate of child's BaptismName of church where child received Holy CommunionDate of child's First Holy CommunionIf child is not Catholic, please state their Religion. *School HistoryHas your child previously attended Catholic school? If so which school. *Child's Public School District *Transportation *Please select an optionBus RiderCar RiderName of previous schoolDid your child receive any special services at their previous school?IEPISTSpeechOtherPlease check all that apply.How did you hear about ICA? *Where you referred to ICA by one of our families? If so, please give us their name so we can verify their referral credit.Parent SignaturesBy registering my child, I agree to abide by all of the rules and regulations outlined in the Immaculate Conception Academy Handbook.Parent's Signature *I understand that for my child's registration to be complete I must set up my FACTS account and remit the $100 registration fee to the school office.Parent's Signature *Note:In case of separated families, custody papers MUST be made available to the school.Send MessagePlease do not fill in this field.