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PRS/EC New Student - Enrollment Form

- Faith Formation
  - Adult Faith Formation
    
    Bio-Ethics
    RCIA
    That Man Is You
    Women of Faith
  - Youth Ministry
    
    St Luke School
    Youth & Young Adult Ministry
    Catholic Youth Organization (CYO) Athletics
    Scouting
  - Early Childhood & PSR
    
    Early Childhood and PSR
    
    PRS/EC New Student - Enrollment Form
    
    Children's Liturgy of the Word (CLOW)
    Little Flowers Girls Club
    St Luke School
    Vacation Bible School (VBS)

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- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email: (Allows us to lesson costs to provide timely infomation) REQUIRED Please fill out this field. Please enter an email address.
- Parent(s) or Guardian(s) The Student Lives With
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Child Please enter valid data.
- Religion Please enter valid data.
- Preferred Phone Number Please enter a phone number.
- STUDENT INFORMATION
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Sacraments Recieved (Provide date, Church & State in Comments) REQUIRED Baptism Reconciliation Eucharist Confirmation RCIA Please fill out this field.
- Comments or Request to Set Up Appointment
- Name of School Attending this Year REQUIRED Please fill out this field. Please enter valid data.
- Grade Level in School REQUIRED Please fill out this field. Please enter valid data.
- Name of IEP (if any) and any Special Accomodations required Please enter valid data.
- Enrolling in REQUIRED Early Childhood Program, age 3 as of Sept 5 Parish School of Religion Please fill out this field.
- Students Previous Formal Religious Education ((Indicate grades and Last Church Providing Religous Ed. REQUIRED Please fill out this field.
- Please provide documentation of previous religious education if not at St Luke.
Submit

St Luke Church and School

Beavercreek, OH

PRS/EC New Student - Enrollment Form