FATHER EDWARD W. TROIKE LEADERSHIP PROGRAM-2008

CATHEDRAL PREPARATORY SEMINARY

56-25 92nd Street    Elmhurst NY  11373

1-718-592-6800 x105

PLEASE PRINT

 

NAME______________________________________TELEPHONE # ___________________________

     Last                     First

 

ADDRESS _________________________________________________________________________

        Number   (apt. no.)      Town                  State              Zip

 

PARISH _________________ SCHOOL _________________ GRADE (as of 9/08)___________________

 

AGE _____________________________ DATE OF BIRTH ________________________________

 

FATHER’S NAME ______________      BUSINESS TEL. No. _____________________________

 

MOTHER’S NAME ____________________BUSINESS TEL. No. _____________________________

 

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EMERGENCY HOME CONTACT

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 *___________________       READING ____________ VOCABULARY _______________

                                    *(If in Catholic School)

 

COMPREHENSION ______________        MATH _______________ ENGLISH ___________________

 

 

CHARACTER RECOMMENDATION: ______________________________________________________________

 

__________________________________________________________________________________________

______________________________________________________

                                          Principal’s or Teacher’s Signature

------------------------------------------------------------------------------------------$500 payment enclosed: check/money order #  ________________    date _____________________