St. Francis of Assisi School

610 Jefferson Blvd.

Warwick, RI 02886

737-2721

 Registration Fee is $35.00 and is Payable at This Time

 Entering Grade______________________________                                   Date____________

 Student’s Name_____________________________________________________­__________M____ F____

                            Last                                       First                                       MI

Address_____________________________________________________________________Phone____________

                 #                             Street                                    City                             Zip

Date of Birth ___________________Place of Birth_______________________________________Y_____N____

                                                                                                      City                       State                               Citizen

Date of Baptism_________________Church ________________________________________________________

                              Mo/Day/Year                                     City                                                 State

Date of First Communion ______________  Church _________________________________________________

                                                                                                     City                                       State

Father’s Name ________________________________________________________________________________

                           Last                                                   First                            MI         Religion                                    Occupation

Mother’s Name ________________________________________________________________________________

                                          Last                                                   First                            MI        Maiden Name     Religion                     Occupation

(Check One)

Marital Status:                  Married _____         Divorced ______   Widowed________

Pupil Lives With:              Both Parents______   Mother______ Father______   Other______

If  other, please complete ________________________________________________________________________

                                            Last Name                                                                 First Name                                                          MI

                                                      ___________________________________________________________________________________________

                                                       Religion                                      Occupation                                  Relationship to Student

Mother’s Place of Employment ____________________________________________________________ Phone______________________

Father’s Place of Employment _____________________________________________________________Phone______________________

Parish to Which You Belong__________________________________________________________________________________________

Former School _____________________________________________________________________________________________________

                                Name                                                                          City/State                                        Grades Attended

Please complete this form in its entirety.  All information is important.  Copies of Birth and Baptismal Certificates are needed at the time of registration.  No Baptismal Certificate is needed if child was baptized at St. Francis Church.

                                                                                          For Office Use Only

Date_____________     Fee Pd. ____________          Bapt._____________     Birth_____________     Medical__________     FACTS__________

REFERRED BY:____________________________________________