St. Agnes School
39 Medford St.
Arlington, MA 02474
781-648-9031

MISSION:  St. Agnes School, as a Catholic School, strives to foster in its students strong academic achievement with personal character
development as a foundation for living the Gospel message of Christ in the Twenty-first Century.

Registration Form

                                                                              Grade Entering ___ Year of Entrance Sept. ____

Child's Full Name ___________________________________________________ M ___ F ___
Address
    Street ____________________________________ City __________________ State _________ Zip ______

Date of Birth: Mo. ____ Day _____ Yr. ______ Place of Birth:  City ___________________ State __________

Name child is called _________________ Religion Practiced _________ Church Attend/Support __________
                                                                                                           If St. Agnes Parish, Env#________
Date of Baptism:
    Mo ______ Day _____ Yr. _________ Church ______________________ City ____________ St. ______

Child lives with:  Both Parents _______Mother _____ Father _____ Other (Specify) _____________________

Father/Guardian______________________________  Mother/Guardian ______________________________

   Address __________________________________  Address _____________________________________

                __________________________________                ____________________________________
                    City                            State                    Zip                                  City                                State                    Zip

   Hm Phone (_____)____________Pub.___Y___N        Hm Phone (____)______________Pub.____Y____N

   Father's Place of Birth _____________________        Mother's Place of Birth ________________________

   Father's Occupation _______________________        Mother's Occupation__________________________

   Employer _______________________________         Employer __________________________________

   Father's Work Number ____________________          Mother's Work Number _______________________

   Father's Religion _________________________         Mother's Religion ____________________________

   Language spoken at home _________________         Mother's Maiden Name ________________________

   Child's present school ______________________________________

   School's Address __________________________________________

                             ___________________________________________