20 to 20 TermDate of Registration:

Entering Grade Age:
Childs Last Name: First MI.
Home Address:
Zip: Home Phone with area code:

Please Note: Children entering our Kindergarten must be five years old on or before September 1st to coincide with State of Illinois regulations.

Date of Birth: City of Birth:   State of Birth: Sex: Male Female

Name of School Last Attended: Grade:
Address of School:
City: State: Zip:

Record of Sacraments Received

	Date	Church	City	State
Baptism
First Penance
First Communion
Confirmation

Baptismal Certificate required if Baptism not at St. Vincent de Paul Church. The certificate will be returned to you. 
Will Send      We are Attaching

Birth Certificate required and will be returned to you.     Will Send     We are Attaching

Number of Older Children in Family:     Boys:     Girls:

Number of Younger Children in Family:     Boys:    Girls:

Number of year’s family has been registered in St. Vincent de Paul Parish:

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Father’s Name: Religion:
Place of Birth: Father Cell Phone w/area Code:
E-Mail Address:
Education:

Less than High School	High School/GED	Some College
2 Yr. College Degree	4 Yr. College Degree (BS, BA)	Masters Degree
Doctoral Degree	Professional Degree (MD, JD)

Deceased

Remarried

Married

Single

Separated

Divorced

Joint Custody of Child(ren): Yes No
Employer of Father: Occupation of Father:
Work Phone w/area Code:

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Mother’s Name & Maiden Name:
Religion:
Place of Birth: Mother Cell Phone w/area Code:
E-Mail Address:
Education:

Less than High School	High School/GED	Some College
2 Yr. College Degree	4 Yr. College Degree (BS, BA)	Masters Degree
Doctoral Degree	Professional Degree (MD, JD)

Deceased

Remarried

Married

Single

Separated

Divorced

Joint Custody of Child(ren): Yes No
Employer of Mother: Occupation of Mother:
Work Phone w/area Code:

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Guardian’s Name: Religion:
Place of Birth: Guardian Cell Phone w/area Code:
E-Mail Address:
Education:

Less than High School	High School/GED	Some College
2 Yr. College Degree	4 Yr. College Degree (BS, BA)	Masters Degree
Doctoral Degree	Professional Degree (MD, JD)

Deceased

Remarried

Married

Single

Separated

Divorced

Joint Custody of Child(ren): Yes No
Employer of Guardian: Occupation of Guardian:
Work Phone w/area Code: