Registration Form

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Testing Fee: $50 Our Lady of Lourdes Academy

to accompany this form Registration Form

Student Information: School Year: ___________(Circle) Entering Grade: 9 10 11 12)


Name: _______________________________________________________________ Religion:_____________________
Last First Middle

Social Security #: _____/____/_______ Date of Birth: ______________________ Place of Birth_____________________


Mo. Day Yr.

Student Lives With:___ Both Parents ___Mother ___Father ___Guardian ___Mother/Stepfather ___Father/Stepmother
Name of Person Student Lives With: ____________________________________________________________________

Home Address: _____________________________________________________________________________________


Zip Code
Home Telephone: _________________________________ Email Address: ____________________________________
School Currently Attending: ___________________________________________________________________________
Name Address Telephone

Baptized: _____________________________________________________________Date: _______________________

Name of Church Address Zip Code Mo. Day Yr.

First Communion: ______________________________________________________ Date: _______________________


Name of Church Address Zip Code Mo. Day Yr.

Confirmation: _________________________________________________________ Date: _______________________


Name of Church Address Zip Code Mo. Day Yr.

Sister(s) currently attending Our Lady of Lourdes Academy:

Name: _____________________________________________________ Current Grade: _______________________

Name: _____________________________________________________ Current Grade: _______________________


Parent information: Parish Registered: _______________________________________________________________
Address Zip Code Telephone
Parish Registration Name: _______________________ Relationship to Student: _______________________________

Mother – Name: ______________________________ Father - Name:______________________________________

Home Address:________________________________ Home Address:_______________________________________

Home Telephone:______________________________ Home Telephone:_____________________________________

Email Address: _______________________________ Email Address: _______________________________________

Cell#: __________________ Bpr#________________ Cell#: __________________ Bpr# _______________________

Title or Position: ______________________________ Title or Position:______________________________________

Name of Company ____________________________ Name of Company:___________________________________

Address: ____________________________________ Address: ___________________________________________

Telephone: __________________________________ Telephone:_________________________________________


Number in Family Alumnae Information (Lourdes Alumnae ONLY)
Sister (s): _______Older: ______ Younger:_______ Mother: ________________________Graduation Yr.___________
Brother(s):_______Older: ______ Younger:_______ Sister : ________________________ Graduation Yr.___________
Send Tuition Statements To: Sister : ________________________ Graduation Yr.___________
Name: ________________________Address:__________________ZIP CODE_____________ Relationship:___________

The Archdiocese of Miami is authorized under federal law to enroll nonimmigrant alien students and issue
I-20 certificates in order for students to obtain F-I status. If you need assistance please let the school
know at registration.
OFFICE USE ONLY

_______ Testing Fee ($50)

_______ Birth Certificate

_______ Baptism Certificate

_______ First Communion Certificate

_______ Confirmation Certificate

_______ Official 7th grade transcripts – including standardized tests

_______ Copy of first trimester 8th grade report card and mid progress report of second trimester.

_______ Immigration Status

_______ Principal’s Recommendation form

_______ Pastor Confirmation form

_______ Commitment Form

_______ Registration Fee ($550)

_______ Parents' Guild Form and Fee ($60)

_______ Emergency Contact Form

_______ Drug Policy Form

_______ Immunization Form

_______ Medical Card

_______ Physical Form

_______ Final 8th Grade Report Card

_______ File Complete

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