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REGISTRATION FORM
St. Mary’s Catholic School
1206 8th Avenue
Worthington, MN 56187
507/376-5236
stmarysschool@frontiernet.net
St. Mary’s Mission
St. Mary’s Catholic School is a Christ-centered community
which actively fosters and implements an education of excellence within a loving,
nurturing, and motivating Christian environment.
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Child’s Name:_______________________________________________________ Sex: M_____ F____
(Last) (First) (Middle)
Child’s Birth Date: _______________________ Child’s Birthplace: _______________________
(Month) (Day) (Year) (City) (State)
Mailing Address: _______________________________________________________________
(Street Address/PO Box) (City) (State) (Zip)
Home Phone: ____________________________ Cell Phone: ____________________________
E-mail Address:___________________________
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Date Name of Church City State
Baptism: ______________________________________________________________________
First Eucharist:__________________________________________________________________
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School child last attended:________________________________________________________
(Grade) (Name of School)
______________________________________________________________________________
(School’s Address) (City) (State) (Zip)
Grade child will enter in September: _____
Names and ages of other children in family: _________________________________________
______________________________________________________________________________
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Father’s Name: _________________________
(First) (Last)
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Mother’s Name: ________________________
(First) (Maiden) (Last)
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Father’s Religion: _______________________
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Mother’s Religion:______________________
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Father’s Occupation: ____________________
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Mother’s Occupation: ___________________
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Business Phone:________________________
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Business Phone: ________________________
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Father’s Education: _____________________
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Mother’s Education: ____________________
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Name of parish in which you are registered (other than St. Mary’s Worthington):
______________________________________________________________________________
(Name of Parish) (Address) (City) (State) (Zip)
Marital Status: _____Married _____Separated _____Remarried _____Divorced
Parent with legal custody of child: _________________________________________________
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