NEW STUDENT REGISTRATION
Church of the Assumption School

STUDENTS NAME (last)__________________________ (first) __________________________ 
PARENT(S) NAME (last)__________________________ (first) __________________________ 
ADDRESS ________________________________ CITY Cincinnati ST OH ZIP ____________ 
PHONE _______________________ DOB_____________ SEX_____ FOR GRADE _________ 
SOCIAL SECURITY NUMBER___________________________ RELIGION _________________ 

BAPTISMAL DATE _________________________ WHERE? ____________________________ 
SCHOOL DISTRICT _____________________________________________________________ 

PARENTS: Married?_________ Separated?________ Divorced?_________ Single?__________ 
If Divorced, who has legal custody? _________________________________________________ 

CURRENT CUSTODIAL PAPERS MUST BE SUBMITTED 
If child is living with other than natural parents: 

Name: ______________________________ Relationship _______________________________ 
Is father living? __________ Does students live with father?_______________________________ 
Father's name _________________________ Address___________________________________ 
Place of Employment _____________________________ Phone______________ Ext._________ 
Is mother living?__________Does students live with mother?_______________________________ 
Mother’s name ________________________ Address __________________________________ 
Place of Employment _____________________________ Phone______________ Ext._________ 
In case of emergency, call: Name:_______________________________ Phone ________________ 

Name of Last School Attended? ________________________________ Phone ________________ 
Address____________________________________ Contact Person _______________________ 

Was student enrolled in any special programs or have any unusual problems we should be made aware of? 
____________________________________________________________________ 
____________________________________________________________________ 


______________________________________ ____________________________ 
Signature of Parent or Guardian Date 

If other than natural parent, evidence of legal guardianship must be presented and filed on student's cumulative record. DOCUMENTATION NEEDED: (Other than custodial or guardianship papers if applicable) BIRTH CERTIFICATE, BAPTISMAL CERTIFICATE, SOCIAL SECURITY NUMBER AND PROOF OF IMMUNIZATION.