Good Shepherd Catholic School
2023-2024 Re-enrollment Form
Student's Name
First Name
Last Name
Student's Date of Birth
-
Month
-
Day
Year
Date
Home Phone Number
-
Area Code
Phone Number
Student's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Name & Address
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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 (if different)
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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 Employment
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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