Overview

Sheet 1: Sheet1


				*4913 Schofield St.*
				*Monona, Wisconsin 53716*
				*608.222.8831 www.ihm-school.org*


Inspiring Hearts and Minds				REGISTRATION FORM


*Student Information*

Student's Name_________________________________________________________________________
	Last			First		Middle

Address_______________________________________________________________________________
	Street			City		State Zip

Phone_____________________________			E-Mail Address____________________________________

Date of Birth_____________Place of Birth_________________		___________		Place of Birth	_____________________________
	month/day/year

Other Siblings	1.____________________________________________				Date of Birth __________________
		Name				month/day/year

Other Siblings	2.____________________________________________				Date of Birth __________________
		Name				month/day/year

Other Siblings	3.____________________________________________				Date of Birth __________________
		Name				month/day/year

Language used at home______________________ Student lives with ___Father___Mother___Both

Registering for Placement in Grade ________ Student's age on September 1, 2007___________
							Years Months
Previous Schools attended		1._____________________________________________________________
Please list most recent first		School City, State Dates

		2._____________________________________________________________
		School City, State Dates

		3._____________________________________________________________
		School City, State Dates

Special educational or medical needs (please list) ______________________________________________

_______________________________________________________________________________________

Religious Information

Registered Member of_______________________________________________________________ Parish

Baptism________________________________________________________________________________
	Date	Church		City		State

What other sacraments has the student received?_______________________________________________

Sheet 2: Sheet2

*Mother/Guardian Information*

Name_________________________________________________________________________
	Last			First	Middle

Address_______________________________________________________________________________
	Street			City	State Zip

Home Phone____________________			Cell Phone ______________ Work Phone_________________


Place of Birth	______________________________________________________
	City			State

Occupation	______________________________________________________


Registered Member of_______________________________________________________________ Parish




*Father/Guardian Information*

Name_________________________________________________________________________
	Last			First	Middle

Address_______________________________________________________________________________
	Street			City	State Zip

Home Phone____________________			Cell Phone ________________ Work Phone______________


Place of Birth	______________________________________________________
	City			State

Occupation	______________________________________________________


Registered Member of_______________________________________________________________ Parish


How did you hear about IHM School? cSibling Attends IHM
c Preschool		cNewspaper c Other Media(please list):_______________
c IHM Church		cIHM Family(name) :_____________________



Immaculate Heart of Mary School does not discriminate on the basis of					For Office Use Only
race, creed, national origin, sex or physical disability.					Date Received_______

Please return this form with a $200.00 non-refundable registration fee per					Amt. Received_______
newly registered family. $150.00 of this fee will be applied towards the
2007-2008 Tuition Balance.					Check No. _________