Online Student Information Form

Student's First Name REQUIRED Please fill out this field. Please enter valid data.

Student's Last Name REQUIRED Please fill out this field. Please enter valid data.

Student's Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Male or Female REQUIRED Male Female Please fill out this field.

Program Selection REQUIRED Please fill out this field.

Religion Information REQUIRED Catholic Other Please fill out this field.

Baptized REQUIRED Yes No Please fill out this field.

Name and Address of Church where Baptized REQUIRED Please fill out this field. Please enter valid data.

Baptism Date REQUIRED Please fill out this field. Please enter valid data.

Student's First Name Please enter valid data.

Student's Last Name Please enter valid data.

Student's Date of Birth Please enter valid data.

Male or Female Male Female

Program Selection

Religion Information Catholic Other

Baptized Yes No

Name and Address of Church where Baptized Please enter valid data.

Start Date REQUIRED Please fill out this field. Please enter valid data.

Mother's First Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Last Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Maiden Name Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter valid data.

Home Phone Number REQUIRED Please fill out this field. Please enter valid data.

Mobile Phone Number REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Please fill out this field.

Religion REQUIRED Catholic Other Please fill out this field.

If Other, list: REQUIRED Please fill out this field. Please enter valid data.

Father First Name REQUIRED Please fill out this field. Please enter valid data.

Father's Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address (if different than above) Please enter valid data.

City (if different that above) Please enter valid data.

State (if different than above) Please enter valid data.

Zip (if different than above) Please enter valid data.

Home Phone Number REQUIRED Please fill out this field. Please enter valid data.

Mobile Phone Number REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Please fill out this field.

Religion REQUIRED Catholic Other Please fill out this field.

If Other, list: REQUIRED Please fill out this field. Please enter valid data.

Student(s) Live with: REQUIRED Please fill out this field.

Guardian Name Please enter valid data.

Guardian Address Please enter valid data.

Guardian Home Phone Please enter valid data.

Guardian E-mail Address Please enter valid data.

Relationship to Student Please enter valid data.

Saint Mary Catholic School

Learning Today, Leading Tomorrow

Online Student Information Form

Agnus Dei Academy accepts students who are age 3 or 4 by September 1st and are bathroom independent.