Good Shepherd Catholic School
2019-2020 Re-enrollment Form
Student's Name
First Name
Last Name
Father's Name & Address
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
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Liberia
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Mali
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Martinique
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Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
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Singapore
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Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
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Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Father's Email
example@example.com
Father's Phone Number - Home
-
Area Code
Phone Number
Work
-
Area Code
Phone Number
Cell
-
Area Code
Phone Number
Mother's Name & Address
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Mother's Email
example@example.com
Mother's Phone Number - Home
-
Area Code
Phone Number
Work
-
Area Code
Phone Number
Cell
-
Area Code
Phone Number
Father's Place of Employemnt
Employment Address
Mother's Place of Employment
Business Name
Employment Address
Business Name & Address
Has any of the above information changed from last year?
For what grade is your child applying?
Please include any additional new information that you would like us to know about the applicant at this time.
Are you registered in a Catholic Church? If yes, which one?
My child was baptized at:
Is there another name and address to whom correspondence should be sent?
Student Emergency Information
Child's Physician
Physician's Phone Number
Date Last Seen
Allergies and any action to be taken in case of a reaction:
Medical Background (symptoms or history that the teacher should be aware of to protect your child's health).
Child's Dentist
Dentist name and phone number
Date Last Seen
Child's Therapist/Counselor
Therapist's Name and Phone Number
Date Last Seen
Please list two (2) nearby relatives or neighbors who will assume temporary care of your child(ren) if you cannot be reached.
Name
Phone Number
2.
Name
Phone Number
In case my child(ren) incur(s) an accident or illness or in any other situation that warrants an emergency response at school or during a school-related function, I expressly agree to give to Good Shepherd Catholic School personnel control to seek emergency medical care for my child(ren), including transportation to the emergency room if necessary. I understand that at school or during a school-related function it is Good Shepherd Catholic School personnel's sole discretion to make decisions about appropriate treatment necessary for my child(ren). I hereby authorize the health-care provider in charge to administer whatever treatment is necessary at my expense.
(Electronic) Signature of Parent/Guardian
I hereby give permission for
Physician
Physical mailing address:
to release medical immunization information to Good Shepherd Catholic School. I give Good Shepherd Catholic School permission to share any pertinent information regarding my child with the staff and faculty.
(Electronic) Signature of Parent/Guardian Date
Permission to Photograph:
I give my permission to for Good Shepherd Catholic School to photograph/videotape; during school related activities. These photos may be submitted to newspapers for publicity purposes and also may be posted on the G.S.C.S. website and social media outlets. Photos may also be placed in the Good Shepherd yearbook.
I do not want my child to be photographed or videotaped during school related activities.
Transportation Permission: I give permission for the following person(s) to transport my child(ren):
Name Phone Number
Name Phone Number
Name Phone Number
Please fill this section out only if your child will be walking home at the end of the day on a regular basis. The days he or she will be regularly walking are:
Please list days of the week
Field Trips: Good Shepherd Catholic School regards the town of St. Johnsbury as a valuable academic and cultural resource. Teachers occasionally walk their classes to area places such as St. John's Church, The Father Lively Parish Center and playground, the Fairbanks Museum, the Athenaeum, the St. Johnsbury Academy, Catamount Arts, Canterbury Inn, the fire station or other nearby destinations. At times, a class may simply fo for a short walk as an exercise break.
I request that my child be allowed to take walking field trips in the town of St. Johnsbury.
I do not want my child to participate in walking field trips.
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