Holy Trinity School

154 West Government Avenue

Norfolk, Virginia 23503

757-583-1873 Fax 757-587-3677

Family Registration

20 ___ - 20___ School Year

$125.00 per Family

(This fee is non-refundable and payment must accompany this form)

Family Name: ______________________________________________________________________

Street Address: ______________________________________________________________________

City: ______________________ State: ___________________ Zip: ___________________________

Home Phone: ______________________ Parish __________________________________________

Family E-mail address ________________________________________________________________

Mother/Guardian (please specify)______________________________________________________

Name: _________________________________ Business: ________________________________

Occupation: _____________________________ Business Phone:___________________________

Religion: _______________________________ Cell/Pager: _______________________________

Marital Status:___________________________

Father/Guardian (please specify) _______________________________________________

Name: _________________________________ Business: ________________________________

Occupation: _____________________________ Business Phone:___________________________

Religion: _______________________________ Cell/Pager: _______________________________

Marital Status:___________________________

Student Name: Sex: M or F Grade in fall: _______Religion_______________

Social Security #_____________ Birth Date ____________ Place Of Birth _________________________

Baptism : Y N Date______________ Place_______________________________

Reconcil: Y N Date______________ Place_______________________________

1^st Comm: Y N Date______________ Place_______________________________

Confirm : Y N Date______________ Place_______________________________

The following optional but helpful information is about the ethnic status of the student is for use in the applying for Federal Grants and NCEA Data Bank Information. Please check one:

American Indian/Alaskan Native ( ) Asian ( ) African American ( ) Hispanic ( )

Native Hawaiian/Pacific Islander ( ) White ( ) Multi Racial ( )

Student Name: Sex: M or F Grade in fall: _______Religion_________________

Social Security #_____________ Birth Date ____________ Place Of Birth _________________________

Baptism : Y N Date______________ Place_______________________________

Reconcil: Y N Date______________ Place_______________________________

1^st Comm: Y N Date______________ Place_______________________________

Confirm : Y N Date______________ Place_______________________________

The following optional but helpful information is about the ethnic status of the student is for use in the applying for Federal Grants and NCEA Data Bank Information. Please check one:

American Indian/Alaskan Native ( ) Asian ( ) African American ( ) Hispanic ( )

Native Hawaiian/Pacific Islander ( ) White ( ) Multi Racial ( )

Student Name: Sex: M or F Grade in fall: _______Religion_______________ Social Security #_____________ Birth Date ____________ Place Of Birth _________________________

Baptism : Y N Date______________ Place_______________________________

Reconcil: Y N Date______________ Place_______________________________

1^st Comm: Y N Date______________ Place_______________________________

Confirm : Y N Date______________ Place_______________________________

The following optional but helpful information is about the ethnic status of the student is for use in the applying for Federal Grants and NCEA Data Bank Information. Please check one:

American Indian/Alaskan Native ( ) Asian ( ) African American ( ) Hispanic ( )

Native Hawaiian/Pacific Islander ( ) White ( ) Multi Racial ( )

Student Name: Sex: M or F Grade in fall: _______Religion_______________ Social Security #_____________ Birth Date ____________ Place Of Birth _________________________

Baptism : Y N Date______________ Place_______________________________

Reconcil: Y N Date______________ Place_______________________________

1^st Comm: Y N Date______________ Place_______________________________

Confirm : Y N Date______________ Place_______________________________

The following optional but helpful information is about the ethnic status of the student is for use in the applying for Federal Grants and NCEA Data Bank Information. Please check one:

American Indian/Alaskan Native ( ) Asian ( ) African American ( ) Hispanic ( )

Native Hawaiian/Pacific Islander ( ) White ( ) Multi Racial ( )

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The following documents are required to complete the application process:

1. Copy of Birth Certificate
2. Copy of Social Security
3. Completed and signed Record Release Form
4. State of Virginia Health Form
5. Copy of Baptismal Certificate
6. Completed Registration Form
7. Signed Contract
8. Completed Emergency Card