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Registration information for Student Data Form 2018-2019 ver 2:
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Registration for Guerin College Prep's Class of 2022.

Registration Form:
 
  Section 1: Student Information
First Name:  
Middle Initial:  
Last Name:  
Student E-mail:  
Primary Phone:  
Birthdate use mm/dd/year:  
Elementary School:  
  Sex
            Female
            Male
  Ethnicity
            Hispanic or Latino
            Not Hispanic or Latino
  Race
            American Indian or Alaska Native
            Asian
            Black or African American
            Caucasian
            Native Hawaiian or Other Pacific Islander
            Two or more races
            Unknown
  Religious Background
            Catholic
            Non- Catholic
  Religion/Faith
            Christian
            Muslum
            Buddism
            Other
List Religion:  
Name of Church/Parish:  
  Is a second language spoken at home
            Yes, list language below
            No
Language:  
  Student resides with
            Both parents
            Father Only
            Mother Only
            Guardian
  Section 2: Parent/Guardian Information
Name of Parents/Guardians (As you would like mail to be addressed):  
Address:  
City:  
State:  
Zip:  
Mother's full name:  
Mother's employer:  
Mother's occupation:  
Mother's work phone:  
Mother's cell phone:  
Mother's email address:  
Father's Full Name:  
Father's Employer:  
Father's Occupation:  
Father's work phone:  
Father's cell phone:  
Father's email address:  
  If parental or custodial rights are currently restricted or barred by any court order or administrative agency, do you wish to advise Guerin College Prep High School of these
            Yes, we will contact you for further details
            No
  Section 3: Does this student require a second mailing of school records and notices
            Yes, Complete Section 3
            No, Continue to Section 4
  Section 3: Second Mailing Information
Name of other parent or legal guardian:  
Address of other parent or legal guardian:  
City of other parent or legal guardian:  
State of other parent or legal guardian:  
Zip Code of other parent or legal guardian:  
Primary Phone of other parent or legal guardian:  
Employer of other parent or legal guardian:  
Occupation of other parent or legal guardian:  
Work phone of other parent or legal guardian:  
  Section 4: Tuition Guarantee Program: Should the parent/guardian listed in Section 3 be covered instead of the persons listed in the parent/guardian information
            Yes
            No
  Section 5: Emergency Contact REQUIRED
The parent listed above will always be contacted first. In case we are unable to reach the parent/guardian we need two persons listed.
Emergency Name 1:  
Emergency Relationship 1:  
Emergency Phone 1 :  
Emergency Name 2:  
Emergency Relationship 2:  
Emergency Phone 2:  
  Section 6: Medical Information
Does this student have any medical conditions?

            Yes, Complete Section 6
            No, Continue to section 7
  Section 6: 2Medical Information
Explain Other Health Conditions:  
List medications:  
If preferential seating is necessary?

            Yes, list reason below
            No
Reason for seating preferential:  
Will need to leave the classroom for a snack to adjust insulin/blood sugar level

            Yes
            No
Is the student currently seeing a counselor or therapist

            Yes
            No
Explain any issues (medical or emotional) that would interfere with the student's learning:  
List any additional comments regarding health history:  
  Section 7: Sibling Information Information
Does this student have a sibling attending Guerin Prep?

            Yes
            No
  Section 8: School Legacy Information
Does the student have a Parent, Sibling, Grandparent or Aunt/Uncle that graduated from Guerin Prep, Mother Guerin or Holy Cross?

            Yes, Complete Section 8
            No, You have completed this form. Continue >> Confirm Registration
  Section 8: School Legacy Information
Relationship to student Check all that apply

            Sibling
            Parent
            Grandparent
            Aunt/ Uncle
What school did they attend? Check All that apply

            Guerin Prep
            Mother Guerin
            Holy Cross
Name of Graduate and year of graduation:  
 

Continue/Confirm Registration


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