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BISHOP BAUMGARTNER MEMORIAL CATHOLIC SCHOOL
281 Calle Angel Flores, Sinajana, Guam 96910
671-472-6670/671-477-2677/671-477-1026/671-477-4010/671-477-4003/671-477-4028(fax)
NEW STUDENT REGISTRATION FORM
STUDENT INFORMATION
DO NOT WRITE HERE FOR
ASSESSMENT PURPOSES
ONLY
STUDENT #_____________
□ Birth Certificate
□ Baptismal Certificate
□Transferee Report Card
□Medical/Physical Form
□ Immunization Record
□RenWeb
Signed by:
SCHOOL YEAR 20__-20__ GRADE ENTERING(please check one) K
□ 1□ 2□ 3□ 4□ 5□ 6□ 7□ 8□
LAST NAME ________________ FIRST NAME ______________________ MIDDLE NAME(S)______
NICK NAME ___________ GENDER
□ M□ F BIRTHDATE
AGE____ PLACE OF BIRTH
SOCIAL SECURITY #______________ HOME PHONE CELLPHONE __________________________
HOME ADDRESS
- - - -----------------------------------------------------------------------------------ETHNICITY_____ (if blank choose from below) LEGAL STATUS _____
(if blank choose from below)
□ MULTI-RACIAL (if multi-racial please choose the ethnicities below that comprise the racial mix.)
□Chamorro
□ Caucasian
□ Palauan
□ U.S. Citizen
□ Filipino
□ African-American □ Other(s)(please specify)
□ Dependent of Non□ Chinese
□ Hispanic
_____________
Immigrant Worker/H4
□ Japanese
□ Chuukese
_____________
□ Other (please specify)
□ Korean
□ Yapese
_____________
□ Resident Alien
Alien Registration #_____
---------------------------------------------------------------------------------------CHILD LIVES WITH ____________ (if blank choose from below) TRANSPORTATION TO SCHOOL _____________
□ Both Parents
□ Grandparents
□ Father
□ Grandfather
□ Mother
□ Grandmother
□ Takes turns between □ Uncle and Uncle
Father and Mother □ Uncle
□ Guardian
□ Aunt
□ Relatives (please specify)
________________
________________
□ Private Car
□ Bus
□ Car Pool
□ Other (please specify)
________________
------------- --------------------------------------------------------------------RELIGION
BAPTISM
□ CATHOLIC □ CHRISTIAN, Please specify denomination __________ □Other (please specify) ___________
FIRST HOLY COMMUNION
Brothers and Sisters presently enrolled at BBMCS
Date __/__/____
Date __/___/_____
Church ___________ Church _____________
Place _____________ Place _______________
To what parish do you go to? ____________________
Fully accredited by the Western Association of Schools and Colleges
PARENT’S INFORMATION - MOTHER
PARENT’S INFORMATION – MOTHER
LAST NAME ___________________ FIRST NAME _________________________ MIDDLE NAME(S)__________________________
HOME ADDRESS __________________________________________________________________________________________________
MAILING ADDRESS _______________________________________________________________________________________________
(if different from above)
HOME PHONE _____________________________ MOBILE PHONE _________________________ EMAIL _______________________
□ EMPLOYED □ SELF-EMPLOYED
COMPANY NAME __________________________________________________________
WORK ADDRESS ________________________________________________________________________________________________
OCUPATION ____________________ WORK PHONE _________________ SOCIAL SECURITY # __________________________
NATIONALITY ____________________ ETHNICITY __________________ ALIEN REGISTRATION #(if applicable) ____________
MARITAL STATUS :
□SINGLE □MARRIED□SEPARATED□ DIVORCED□ WIDOWED IF DIVORCED, REMARRIED? □ YES □ NO
RELIGION ____________________ DATE OF BIRTH _____________________ PLACE OF BIRTH____________________________
BISHOP BAUMGARTNER CATHOLIC SCHOOL GRADUATE?
□ YES□ NO IF YES, YEAR GRADUATE _________________
-----------------------------------------------------------------------------------------------
PARENT’S INFORMATION – FATHER
LAST NAME _________________ FIRST NAME ___________________________ MIDDLE NAME(S)______________________
HOME ADDRESS _____________________________________________________________________________________________
MAILING ADDRESS ___________________________________________________________________________________________
(if different from above)
HOME PHONE _______________________ MOBILE PHONE _____________________________ EMAIL ___________________
□ EMPLOYED □ SELF-EMPLOYED
COMPANY NAME ______________________________________________________
WORK ADDRESS ____________________________________________________________________________________________
OCUPATION ____________________ WORK PHONE _______________ SOCIAL SECURITY # _______________________
NATIONALITY ________________ ETHNICITY __________________ ALIEN REGISTRATION #(if applicable) ____________
MARITAL STATUS:
□SINGLE □MARRIED □SEPARATE□DIVORCED□WIDOWED, IF DIVORCED,REMARRIED?□YES □NO
RELIGION ____________________ DATE OF BIRTH __________________ PLACE OF BIRTH____________________________
BISHOP BAUMGARTNER CATHOLIC SCHOOL GRADUATE?
□ YES□ NO IF YES, YEAR GRADUATE _________________
Fully accredited by the Western Association of Schools and Colleges
GUARDIAN S INFORMATION (if child is living with guardian)
LAST NAME _____________________ FIRST NAME ____________________ MIDDLE NAME(S) __________________________
RELATION TO CHILD
□STEPMOTHER □ STEPFATHER □ AUNT □ UNCLE □ SISTER □ BROTHER
□ GRANDMOTHER □ GRANDFATHER □ Other, please specify _________________________________
MAILING ADDRESS ____________________________________________________________________________________________
HOME PHONE __________________ MOBILE PHONE _____________________ EMAIL____________________________________
□ EMPLOYED □ SELF-EMPLOYED
COMPANY NAME ____________________________________________________________
WORK ADDRESS ______________________________________________________________________________________________
OCCUPATION ___________________ WORK PHONE ________________ SOCIAL SECURITY # ___________________________
NATIONALITY __________________ ETHNICITY ________________ ALIEN REGISTRATION # (if applicable) _______________
MARITAL STATUS:
□SINGLE□MARRIED□SEPARATED□DIVORCED□WIDOWED IF DIVORCED,REMARRIED?□YES□NO
RELIGION _____________________ DATE OF BIRTH _______________________ PLACE OF BIRTH__________________________
BISHOP BAUMGARTNER CATHOLIC SCHOOL GRADUATE?
□YES □ NO IF YES, YEAR GRADUATE _____________________
EMERGENCY CONTACT
In case of emergency, the school immediately contacts the parents. If parents are not available, please provide the information below for the
name of the person(s) to contact should an emergency arise.
LAST NAME ______________________ FIRST NAME __________________ MIDDLE NAME(S) __________________________
RELATION TO CHILD
□STEPMOTHER □ STEPFATHER □ AUNT □ UNCLE □ SISTER □ BROTHER
□ GRANDMOTHER □ GRANDFATHER □ Other, please specify _________________________________
HOME PHONE ____________________ WORK PHONE _____________________ MOBILE PHONE ___________________________
EMAIL ADDRESS _______________________________
SIGNATURE OF PARENT OR GUARDIAN ______________________________________ DATE _____________________________
LAST NAME ______________________ FIRST NAME __________________________ MIDDLE NAME(S) ______________________
RELATION TO CHILD
□STEPMOTHER □ STEPFATHER □ AUNT □ UNCLE □ SISTER □ BROTHER
□ GRANDMOTHER □ GRANDFATHER □ Other, please specify _________________________________
HOME PHONE _____________________ WORK PHONE _____________________ MOBILE PHONE _________________________
EMAIL ADDRESS _______________________________
SIGNATURE OF PARENT OR GUARDIAN ______________________________________ DATE _____________________________
Fully accredited by the Western Association of Schools and Colleges
Fully accredited by the Western Association of Schools and Colleges