St. Matthew School
Family Registration Form

School Year: ___________   Family Last Name: _________________    Check New or Returning family
Family Religious Affiliation: ______________ Parish:  ___________________________
Home Info
Parental Status: Married  Separated  Divorced  Remarried  Single  Widow/Widower Other
Students Live With: Both Parents/Guardian   Mother   Father  Mother/Stepfather 
                               Father/Stepmother  Grandparents  Other
Language spoken at home: English   Spanish    Other: ______________________
Fill in the address of the person/s with whom the students live.
Address: _________________________________ City: ______________________   State: ______  Zip:________
Home Phone: _____________________    Silent Number. Other Phone: _____________________
Email Address _____________________________  Exclude email from School Directory
If the family email address would be the same as the  father or mother's email address, leave this blank.
Exclude family from the School Directory  Exclude Address from School Directory
Father
Name:______________________________
Occupation: ____________________________
Employer:_______________________________
Cell Phone: ________________
Exclude Father Cell from School Directory
Bus. Phone:____________________
Father Email: _______________________________
Exclude Father Email from School Directory
Religion: _____________________
Mother
Name:_______________________________
Occupation: _____________________________
Employer:________________________________
Cell Phone: ________________
Exclude Mother Cell from School Directory
Bus. Phone:____________________
Mother Email:_______________________________
Exclude Mother Email from School Directory
Religion: _______________   Maiden Name: _______________
Other Adults Living at this Home
___________________________________
___________________________________
Transportation
List anyone else who may pick up your students.
______________________________________________________
Emergency Contact
List persons who can be contacted in case of an
emergency if Parent/Guardian is not available.
Name: _________________________  Phone: ____________
Name 2: _______________________  Phone 2: ___________
Medical
Doctor:__________________________ Phone: _________
Dentist: ________________________ Phone: _________
Hospital: ______________________________
If a second family should receive information from the school, enter that information below.
Name: _____________________________    Relationship to Student/s: _______________________
Address: ____________________________________________________
City: ____________________________   State: _____________    Zip:___________  Phone: ____________
Comments: Enter any additional comments about your family you feel the school should have. ______________________

_____________________________________________________________________________________________________
 
Parent Signature ______________________________ Date ___________________
 
For Office Use Only:
Date Received:_____________________ Fee Paid:_________________
Received By:_____________________________ Check #_____________ Cash ____