Saint Hedwig Parish School

32 Golden Hill Street   Naugatuck  CT  06770

203-729-2403

REGISTRATION FORM ($35.00 FEE)

All Day Kindergarten: ______                         (Other) Grade: ______

Child’s Name:  ______________________________________________________________ M/F _______

Last                                                 First                                             MI

Home Address:  ____________________________  ______________________ Telephone:  ___________

Street                                                                   City/ST/Zip

Ethnic Group:   (Ö all that apply)

                              African American __  Hispanic __  Native American __  Asian __  White __  Multiracial __

Work Phone Mother:  ___________________                               Work Phone Father:  _________________           

                                                                Emergency Phone:  _________________

Birthplace:  _____________________________________________  Date of Birth ____________________

City/State                                                      County                                           M/D/Y (copy of certificate)

Father’s Full Name:  ______________________________________  Religion:  ______________________

                                                                                                           Occupation:  ______________________

Mother’s Full Name:  ______________________________________ Religion:  ______________________          

Maiden Name

                                                                              Occupation:  ______________________

Pupil Lives with:     Parents: ___     Mother: ___     Father: ___     Other:  ____________________________

(Grandparent, Legal Guardian etc.)

Schools previously attended:

____________________________________________________________________________________

Grade Level       School                                    Address                               Entered (year)                      Withdrew (year)

__________________________________________________________________________________________________

Grade Level       School                                    Address                               Entered (year)                      Withdrew (year)

Baptism Date:        _________ ___  Parish:  _____________  City:  _______________  State:  _____  (copy of certificate)

Communion Date:  ____________  Parish:  _____________  City:  _______________  State:  _____   (copy of certificate)

Language Spoken:     English:  ___    Others:  _________________________________________________

Please List

Parish in which you are registered:  _________________________________________________________

Name                                                                                                   City/State

Non-Parishioner (K~8) – It is necessary to be registered and to use church envelopes to be eligible for church assessment. 

Should we inform your parish that your child has enrolled at St. Hedwig Parish School?  YES ___  NO ___

Names and Ages of pupil’s siblings:

____________________________________________________________________________________

____________________________________________________________________________________