*
Required
Student Information
First
*
required
Last
*
required
Preferred Name
Gender
Male
Female
Birth Date
(mm/dd/yyyy)
Address 1
Address 2
City
State
Zip
Person Inquiring
*
required
Relationship to Student(s)
*
required
If inquiring about more than one student, please list name(s), gender(s), and birth date(s) below:
Student(s) Entering Grade
Junior Kindergarten
Kindergarten
First Level
Second Level
Third Level
Fourth Level
Fifth Level
Sixth Level
Seventh Level
Eighth Level
Student(s) Entering Year
2023-2024
Student(s) Current Grade
Junior Kindergarten
Kindergarten
First Level
Second Level
Third Level
Fourth Level
Fifth Level
Sixth Level
Seventh Level
Eighth Level
Present School
Present School City
Household 1 (Parent 1 and 2)
Household address is same as student(s) address
Resides with Student(s)
Address 1
Address 2
City
State
Zip
Parent / Guardian 1
Primary Parent / Guardian
Prefix
First
*
required
Middle
Last
*
required
Suffix
Relationship to Student(s)
*
required
Email
*
required
Mobile Phone
*
required
Business Phone
Business Address 1
Business Address 2
Business City
Business State
Business Zip
Parent / Guardian 2
Primary Parent / Guardian
Prefix
First
Middle
Last
Suffix
Relationship to Student(s)
Email
Mobile Phone
Business Phone
Business Address 1
Business Address 2
Business State
Business Zip
Household 2 (Parent 3 and 4)
Household address is same as student(s) address
Resides with Student(s)
Address 1
Address 2
City
State
Zip
Parent / Guardian 3
Primary Parent / Guardian
Prefix
First
Middle
Last
Suffix
Relationship to Student(s)
Email
Mobile Phone
Business Phone
Business Address 1
Business Address 2
Business City
Business State
Business Zip
Parent / Guardian 4
Primary Parent / Guardian
Prefix
First
Middle
Last
Suffix
Relationship to Student(s)
Email
Mobile Phone
Business Phone
Business Address 1
Business Address 2
Business State
Business Zip
Additional Information
How did you hear about St. Bernard Academy?
Do you have any questions for us?
Anything else you'd like our Admissions office to know?
Please send a confirmation email to the address below: