Online Registration Form

- Admissions

Limited spots are available for the 2020-21 school year. Please call or email our Advancement Director, Susan Mollahan to get up to date information on grade availability, prior to completing our online registration form.
**We are no longer accepting applications for Pre-Kindergarten, Kindergarten, 7th and 8th grades.
The maximum number of form submissions has been reached. This form is currently not available.
- Student Information
  
  Chilld's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Entering in 2020-2021 REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Home Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  PO Box Number (if applicable) Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Primary Email REQUIRED Please fill out this field. Please enter an email address.
  
  Public School District REQUIRED
  If your child's home school district is not listed below, choose "Other" and Holy Cross will contact you for details.
  Please fill out this field.
  
  Child's Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
  
  Religion of Child REQUIRED
  If your child's religion is not listed here, choose "Other" and Holy Cross will contact you for details.
  Please fill out this field.
  
  Parish Membership REQUIRED
  If your parish is not listed here, enter "Other" and Holy Cross will contact you for details.
  Please fill out this field.
  
  Race REQUIRED Please fill out this field.
- Father's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Occupation Please enter valid data.
  
  Father's Employer Please enter valid data.
  
  Father's Work Phone Number Please enter a phone number.
  
  Father's Cell Phone Number Please enter a phone number.
  
  Father's Email Address Please enter an email address.
- Mother's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Occupation Please enter valid data.
  
  Mother's Employer Please enter valid data.
  
  Mother's Work Phone Number Please enter a phone number.
  
  Mother's Cell Phone Number Please enter a phone number.
  
  Mother's Email Address Please enter an email address.
- Emergency Contacts (at least two are required)
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Relationship of Contact 1 to Child REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Relationship of Contact 2 to Child REQUIRED Please fill out this field. Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Phone Number Please enter a phone number.
  
  Relationship of Contact 3 to Child Please enter valid data.
- Spiritual Information for Child
  
  Name and Address of Church Where Baptism Occurred
  If your child has not been Baptized, enter "Not applicable" here.
  Please enter valid data.
  
  Date Please enter a date.
  
  Name and Address of Church Where First Penance Occurred
  If your child has not performed First Penance, enter "Not applicable" here.
  Please enter valid data.
  
  Date Please enter a date.
  
  Name and Address of Church Where First Eucharist Occurred
  If your child has not received First Eucharist, enter "Not applicable" here.
  Please enter valid data.
  
  Date Please enter a date.
  
  Name and Address of Church Where Confirmation Occurred
  If your child has not received Confirmation, enter "Not applicable" here.
  Please enter valid data.
  
  Date Please enter a date.
- Educational Information for Child
  
  Name of School or Pre-School Attended (if applicable) Please enter valid data.
  
  Street Address Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number Please enter a phone number.
- Health Concerns
  
  List any medical conditions that have been diagnosed for your child. Include allergies, seizure disorders, or any other chronic conditions of which we must be alerted. Please elaborate on the state health form, which is required for enrollment.
- Other Information
  
  Indicate how your child will usually depart from school REQUIRED Please fill out this field.
  
  Will your child participate in our CARES After-School Program? REQUIRED Please fill out this field.
- Sibling Information (Please list all siblings, their dates of birth, and the schools they are attending.)
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School Attending
  If the sibling is no longer attending school -- for example, because of graduation -- then note that here.
  Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School Attending
  If the sibling is no longer attending school -- for example, because of graduation -- then note that here.
  Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School Attending
  If the sibling is no longer attending school -- for example, because of graduation -- then note that here.
  Please enter valid data.
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  School Attending
  If the sibling is no longer attending school -- for example, because of graduation -- then note that here.
  Please enter valid data.
Submit
Note that this registration will not be complete until we receive your non-refundable $100 fee made payable to "Holy Cross Regional Catholic School."