St. Rita Catholic School
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Section Title

Parent Information

Father's Name: 
Mother's Name: 
Address: 
City, State ZIP: 
EMail: 
Home Phone: 
Dad's Work Phone: 
Dad's Cell Phone: 
Mom's Work Phone: 
Mom's Cell Phone: 

Information on Child #1

Child's Name: 
Gender: 
Date of Birth: 
Grade: 
School currently attending: 

Information on Child #2

Child's Name: 
Gender: 
Date of Birth: 
Grade: 
School currently attending: 

Information on Child #3

Child's Name: 
Gender: 
Date of Birth: 
Grade: 
School currently attending: 

Your relationship to the prospective student(s) listed above

Relation?: 





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