HFCHS-Fire 24 Application

Transportation Request

Busing Options *

I live in District 112 and my child will need busing.
I do not need District 112 busing.
I live outside of District 112 and would be interested in transportation provided by Holy Family for a fee.

Short Answer

Additional Information Request

Is there any department, coach, or activity leader with whom you'd like to speak? Please provide a general idea in the space provided and our admissions team will make the connection.

Parent Responses

Name of Parent Completing
Are you interested in learning more about our need-based tuition assistance? *	Yes No
To assist us in getting to know your student's needs right away, is there anything you'd like us to know? (Optional)

Mother/Guardian 1 Information

First Name
Last Name
Custodial Parent?	Y N
Spouse's Name
Address Street
City/State/Zip
Home Phone	( ) -
Cell Phone	( ) -
Work Phone	( ) - x
Employer
Occupation
M Email

Father/Guardian 2 Information

First Name
Last Name
Custodial Parent?	Y N
Spouse's Name
Address Street
City/State/Zip
Home Phone	( ) -
Cell Phone	( ) -
Work Phone	( ) - x
Employer
Occupation
F Email

Grandparent Information

Please share grandparent information so we may invite them to special events (i.e. Grandparents Day) and send our quarterly magazine, Passages.

Maternal Grandparents
MG Home Address Street
City/State/Zip

Maternal Grandparents Home Email
Paternal Grandparents
PG Home Address Street
City/State/Zip
Paternal Grandparents Home Email

Consent to Release Private Data

Authorization: I authorize HOLY FAMILY CATHOLIC HIGH SCHOOL to obtain information from the school listed above.

The information to be released:
• Official School Records (e.g., name, address, attendance record, grades, test results, behavior)
• Standardized Testing Results
• Health Records
• Psychological Records
• Social Work Reports
• Current School Counselor Observations
• Chemical Abuse/Dependency Report
• Medical Reports (including related services)
• Special Education Results (including related services)

I understand that student records may be examined by parent/guardian(s) or the student if age 18 or older. I understand that this authorization takes effect the day I sign it. I understand I may change or revoke this authorization at any time. This authorization expires one year from the date of my application submission.

Effective Date of Release *	Yes, I release my child's records effective today. No, please request my child's records at the end of the school year. I understand this may delay final acceptance.
Use your mouse on desktop or finger on phone or tablet to sign	Use your mouse or touchscreen to create your handwritten signature.

Student Legal First Name *
Student Middle Name *
Student Last Name *
Student Suffix (Jr, III, etc...)
Student Informal Name

Student Address * Street
City/State/Zip
Date of Birth *
Student Home Phone *	( ) -
Gender *	M F
School Year Enrolling *	2020-2021
Grade Enrolling In Transfer students currently in grades 9-12 should use the Transfer Application. *
	9
School Attending in 2019-2020 School Year Class of 2024 (2019-2020) *

School Address Street
City/State/Zip
Public School District in Which You Reside *
Religion
Parish/Church
Ethnic Affiliation (for statistical purposes only)	Asian-Pacific Islander Caucasian Latino/Hispanic Native American African American Multiracial (please identify)
Student Resides with *	Parents Mother Father Guardians Mother & Stepfather Father & Stepmother Other (please explain)
Student Interests and Hobbies *
Class Registration Nights are held in February. You will be contacted to confirm your preferred date.	February 18, 2020 February 20, 2020
Student T-shirt Size

Sibling Name
Grade in 2019-2020 School Year 2019-2020
Current School
Gender	M F

Sibling Name
Grade in 2019-2020 School Year 2019-2020
Current School
Gender	M F

Sibling Name
Grade in 2019-2020 School Year 2019-2020
Current School
Gender	M F

Sibling Name
Grade in 2019-2020 School Year 2019-2020
Current School
Gender	M F

Duplicate Mailings name of person to send duplicate mailings to
Address Street
City/State/Zip

How did you learn about enrolling opportunities at Holy Family?	Family Website Open House Friend Neighbor Realtor Magazine School Parish Facebook Twitter Newspaper Article Other (please explain)