St. Mary's
Assumption School

Cottonport, LA

Registration Form

- Admissions

St. Mary's Assumption School

"A School with a Vision for God and Education"
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- Student's First Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Student's Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Registering For REQUIRED Please fill out this field.
- Physical Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
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  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Mailing Address REQUIRED Please fill out this field. Please enter valid data.
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- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Last School Attended REQUIRED Please fill out this field. Please enter valid data.
- Name and Grade of Other Children at St. Mary's
- If Catholic, which church parish do you belong to? Please enter valid data.
- If you had to attend a public school, which school would you be zone for? REQUIRED Please fill out this field. Please enter valid data.
- Father/Guardian
  
  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 (home) REQUIRED Please fill out this field. Please enter a phone number.
  
  Phone Number (cell) REQUIRED Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Employer REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number (work) REQUIRED Please fill out this field. Please enter a phone number.
- Mother/Guardian
  
  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 (home) REQUIRED Please fill out this field. Please enter a phone number.
  
  Phone Number (cell) REQUIRED Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Employer REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number (work) REQUIRED Please fill out this field. Please enter a phone number.
- If parents are separated/divorced, with whom does the child reside? Please enter valid data.
- Custody of Child Please enter valid data.
- Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- I am aware that all fees paid to register are non-refundable.
  I Agree Please select this field.
- Do not send payment information with this form. A link will be emailed to you so you can pay your registration fees online.
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Registration Form

"A School with a Vision for God and Education"