* = required field
Applicant Name (person submitting application)*
Applicant Phone Number*
Date of Birth*
American Indian/Native AlaskanAsianBlackNative Hawaiian/Pacific IslanderWhite2 or more Races
Student's Religious Affiliation*
MarriedSeparatedDivorcedDeceased (Father and/or Mother)
Student lives with*
If you checked Other above, list who student lives with below:
Father's Address (if different)
Father's Religion/Church Attending*
Mother's Address (if different)
Mother's Religion/Church Attending*
Sibling #1 Name
Sibling #1 Relationship
Sibling #1 Age/Grade
Sibling #2 Name
Sibling #2 Relationship
Sibling #2 Age/Grade
Sibling #3 Name
Sibling #3 Relationship
Sibling #3 Age/Grade
Sibling #4 Name
Sibling #4 Relationship
Sibling #4 Age/Grade
If your child has been or is currently enrolled in school, please tell us where so that records may be requested.
If your child has been referred for testing, has been tested, or is currently participating in a Special Education program, please tell us where and when so that records may be requested.
Has your child ever been expelled from school?*
If yes, when and where?
Please list any health problems of which the school should be aware such as medications, physical challenges, visual/hearing difficulties, ADD/ADHD, asthma, etc.
By signing this form, I do hereby agree to accept all guidelines set forth by St. Rose of Lima School. I further understand that if my child is accepted, he or she will be expected to follow all the policies of St. Rose School and the Archdiocese of Indianapolis. I also understand that violation of said rules and regulations will be dealt with in accordance to established school and Archdiocesan policies. These guidelines are in effect for all students attending St. Rose of Lima School. We reserve the right to cancel the registration of this student for reason of deficiency in scholarship, unsatisfactory conduct, or any other just cause. I agree to accept the obligation of meeting tuition payments and payments of other regular fees in accordance to school policy for each period of enrollment.
I agree to St. Rose’s Medication Policy, Internet Policy, and Code of Conduct.
I agree that my child’s image and/or work may be used for promotional purposes and marketing unless I provide written notification to the school office.
This application will not be considered final until confirmation is received from the previous school (if applicable) that all financial obligations are current.
Signature of Parent/Guardian (type your full name as your signature)*
St. Rose of Lima School
114 Lancelot Dr.
Franklin, IN 46131