NEW STUDENT ENROLLMENT FORM

Welcome to St. Gabriel School. The online form listed below needs to be completed as it serves the basis of your student(s) permanent record. This form is a compilation of data about your student and you will be asked to sign and date the form on the last page.

This form is for NEW STUDENTS only.

You will need the names and phone numbers for your child's doctor and dentist to complete the form.

In order to save your progress please select 'save my progress and return later' option at any time. The form is designed to help you 'skip' pages that don't apply to your family.

Please submit after you have completed the form in its entirety.

If you require assistance, please email Maggie.shero@st-gabrielschool.org OR call 440.352.6169

Page 1 of 14 - Student 1 Information

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PLEASE INDICATE SCHOOL YEAR YOU ARE ENROLLING YOUR NEW STUDENT(S): *

Example 2018.19
Student 1 Information and Emergency Medical Authorization
Student 1 Information
Student 1 Name Student 1 Name * First Last
Student 1 Gender *
Student 1 Date of Birth Student 1 Date of Birth * / MM / DD YYYY
Student 1 Birthplace City *
Student 1 Birthplace State *
Student 1 Ethnicity (Optional)

Data used for Diocesan Reports
Student 1 School Attended in the last school year *
Student 1 Religion *
Student 1 If other Religion selected, please list Religion
Student 1 Baptism Date Student 1 Baptism Date * / MM / DD YYYY

New students required to provide a copy of the baptismal certificate.
If student has not been baptized OR you are unsure of the date, please enter today's date.
Emergency Medical Authorization for Student 1

To enable parents/guardians to authorize the provision of emergency treatment for children who become ill or injured under school authority, when parents/guardians cannot be reached.
Doctor~Student 1 Doctor~Student 1 * First Last
Doctor phone~Student 1 Doctor phone~Student 1 * - ### - ### ####
Dentist~ Student 1 Dentist~ Student 1 * First Last
Dentist phone~ Student 1 Dentist phone~ Student 1 * - ### - ### ####
Facts concerning Student 1's medical history including allergies, medication taken, and any physical impairments of which a physician should be alerted: *

This information is extremely important in a medical emergency. If there are no medical concerns please type "NONE"
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by the above named doctors, or, in the event the designated preferred practitioner is not available, by any other licensed physician or dentist; and (2) the transfer of Student 1 to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity of such surgery, are obtained prior to the performance of such surgery. *
If you refused to grant consent please answer the following. In the event of illness or injury requiring medical treatment, I wish the school authorities to take the following action for Student 1:
Are you enrolling a 2nd NEW student? *
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

NEW STUDENT ENROLLMENT FORM

NEW STUDENT ENROLLMENT FORM

Page 1 of 14 - Student 1 Information

Student 1 Information and Emergency Medical Authorization

Student 1 Information

Emergency Medical Authorization for Student 1