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Please tell us what year you are applying for
Mother/ Legal Guardian Information:
Home Address
Home Address
Employer Address
Employer Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Are you an Alumna of Holy Angels?
Father/Legal Guardian Information:
Whois allowed to pick up your children?
Home Address
Home Address
Employer's Address:
Employer's Address:
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Are you an Alumnus of Holy Angels?
Emergency Contact Information
If you are a one-parent household, can the the other parent be contacted if needed?
Emergency Contact #1
Emergency Contact #1
Home Phone
Home Phone
Cell Phone
Cell Phone
Emergency Contact #2
Emergency Contact #2
Home Phone
Home Phone
Cell Phone
Cell Phone
Individuals besides parents/guardians permitted to to pick up your child with legal identification?
Person 1
Person 1
Person 2
Person 2
Person 3
Person 3
Person 4
Person 4
Student Information
Student #1
Student #1
Incoming Grade
Does your child have an IEP?
Gender
Date of Birth
Date of Birth
Is this an Illinois Action Recipient? *
Is this an Illinois Action Recipient?
Student #2
Student #2
Incoming Grade
Does your child have an IEP?
Gender
Date of Birth
Date of Birth
Is this an Illinois Action Recipient? *
Is this an Illinois Action Recipient?
Student #3
Student #3
Incoming Grade
Does your child have an IEP?
Gender
Date of Birth
Date of Birth
Is this an Illinois Action Recipient? *
Is this an Illinois Action Recipient?
Financial Questionnaire (if new to HACS)
Financially Responsible Party
Financially Responsible Party
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Financial Questions for New Holy Angels Families
Please check all answers that apply to your family.
Medical Information
Please be sure to add individual children's names along with medical information.
Physician's Name
Physician's Name
Address
Address
Phone
Phone
Please provide any known health issues, allergies, or medications your child has or needs. Also be sure to provide the student's name.
Photo and Video Release
I(We) give consent for use of photos and videos of child(ren) to be taken and used for promoting Holy Angels Catholic School. I understand that it may be used on the school’s website and/or other school marketing materials during the 2017-18 school year (and as long as they are students at Holy Angels Catholic School).