Application For Registration  







Date:  
School Year:           
Form:                    
First Name:           
Last Name:                    
Date Of Birth :
Year:                    
Male
Female
Country Of Birth:           
Religion:                    
Address:           
E-mail Address:           
    Cell Phone:                
Blood Type:           
Last Attended School
Name Of School:                   
Contact Person:                   
Address:                   
Country:                   
Phone #:                   
E-mail:                   
Date of Attendence:                   
Nationality:                   
Student Information





Student Lives With:         Mother:             Father:           Both:         Other: (specify below)
Are Both Parents Alive:                                    Yes                                                  No
Are Parents Living Together:                           Yes                                                  No
 If Parents Are:                                     Separated                                      Divorced
Specify Parent With Legal Custody     
Family Information & Contact
Father's Name:         Legal Gardians Name:   
  Title: Mr.  Rev.   Pastor     Dr.         Title:  Mr.  Rev.  Pastor     Dr.   
Home Address:           
Mailing Address & P.O. Box #   
Email Address:        (1)(2)
    Phone #'s:   (H) (W) (C)
 Occupation:             
Place of Employment:
      Religion:            





Mother's Name:           Legal Gardians Name:   
 Title:     Mrs.         Ms.        Dr.                         Title:         Mrs.           Ms.         Dr.    
Home Address:     
Mailing Address & P.O. Box #:   
Email Address:      (1)(2)
   Phone #'s:      (H) (W)(C)
Occupation:             
Place of Employment:
      Religion:            
Is a language other then English spoken at home?                     Yes                                       No
If Yes please specify              
Have any siblings attended St. Anthony's Secondary School           Yes                               No
If Yes please provide their names and year of enrollment (below)
Has this student had any special  in                    Testing                 Tutoring           Therapy      the last two years?
If so, please describe and make available nature and results of such efforts (below)
Is the student suffering with any health problems of which we should be aware:      Yes       No
If yes, please specify:      
Other Emergency Contact
(List two on-island individuals we can contact in the event both parents are unavailable.)
Name#1:        Relationship to child:
   Phone #'s:      (H) (W)(C)
Name#2:        Relationship to child:
Phone #'s:      (H)     (W)       (C)
Family Physician
Name:
Phone #'s:           (W)(C)
Family Dentist
Name:
Phone #'s:           (W)(C)