FATHER EDWARD W. TROIKE LEADERSHIP PROGRAM-2010
CATHEDRAL PREPARATORY SEMINARY
1-718-592-6800 x120
PLEASE PRINT
NAME______________________________________TELEPHONE
# ___________________________
Last First
ADDRESS
_________________________________________________________________________
Number (apt. no.) Town State Zip
PARISH _________________
SCHOOL _________________ GRADE (as of 9/2010)_________________
AGE _____________________________
DATE OF BIRTH ________________________________
FATHER’S
NAME ______________ BUSINESS TEL.
No. _____________________________
MOTHER’S
NAME ____________________BUSINESS TEL. No. _____________________________
RELIGIOUS
DENOMINATION_____________________________
---------------------------------------------------------------------------------
In case of an emergency, when
the parents cannot be contacted, please contact:
NAME
____________________________________RELATIONSHIP __________________________
TELEPHONE No(s).
_______________________________________________________________
Take to hospital (check one)
Yes __________ No __________ or other
instructions:
___________________________________________________________________________________
It is understood that in the
final disposition of an emergency case, the judgement
of the school authorities will prevail. The recommendation of the parent as indicated above, will be respected as far as possible.
Is there any medical problem
or disability the school should be aware of? _______________
_________________________________________________________________________________________
___________________________________________________
Parent’s
Signature
---------------------------------------------------------------------------ELEMENTARY SCHOOL CHARACTER RECOMMENDATION: PRESENT GRADE ________________
MOST RECENT REPORT CARD
GRADES:
RELIGION GRADE
*___________________ READING
____________ VOCABULARY _______________
*(If in
COMPREHENSION ______________ MATH _______________ ENGLISH
___________________
CHARACTER RECOMMENDATION:
______________________________________________________________
_____________________________________________________
Principal’s or Teacher’s Signature