St. John XXIII CES - French Immersion Application

Student Information
Student Name Student Name * First Last
Date of Birth Date of Birth * / MM / DD YYYY
Current School *
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Number of Sibling(s) Presently in French Immersion *

Number of Sibling(s) Presently in French Immersion None One Two Three
Name and Grade of Sibling(s)
Elementary Student Admission Requirement - Policy 226A
Is the student/parent Roman Catholic *

Is the student/parent Roman Catholic Yes No
Is the student Orthodox

Is the student Orthodox Yes No
Parent/Guardian Information
Parent/Guardian Name Parent/Guardian Name * First Last
Home Telephone Home Telephone * - ### - ### ####
Alternate Telephone Alternate Telephone - ### - ### ####
Email *