Ou
r
Sponsored by the Dominican Sisters of Peace
Lady
Elms
of
the
2016-2017 Student Registration Form
To be completed by a Parent or Guardian and returned to the
1375 W. Exchange St. Akron, OH 44313 330-752-2505 fax: 330-836-9351
STUDENT INFORMATION
New Student:__________ Current Student:_________
First:__________________________________________ Middle: ___________________________________
Last: _____________________________________________________________________________________
Street Address: ____________________________________________________________________________
City: _______________________________________State: __________ Zip ___________________________
Primary Phone: ____________________________________________________________________________
Secondary Phone: __________________________________________________________________________
Grade School Attended: _____________________________________________________________________
Grade In 2016-17:______________________
_____ full day _____ half day
If Pre-K indicate how many days
3 4 5
Age On 9/30/16_________
Date Of Birth: _____/______/______
Ethnicity: ___ White/Caucasian ___ Hispanic ___ Asian ___ African American
___ Multi-Racial ___ Native American/Alaskan ___ Other
Students County: __________________________________________________________________________
Place Of Worship: _________________________________________________________________________
Address: _________________________________________________________________________________
Religion: _________________________________________________________________________________
Send school mailings to address of (check all that apply) ____Student ___Father ____Mother _____ Guardian
If new, how did you hear of and/or who referred you to Our Lady Of The Elms?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
