ENROLLMENT APPLICATION    Redeemer Lutheran School  2626 Liberty Blvd South Gate Ca 90280

               Last Name     First Name     Middle

                Date Of Birth   / /        Grade     SEX

Place of Birth:    Ethnicity: ( Hispanic /Black/White/Asian /Other )

Parents are:   Married        Single         Separated           Divorced     (use an X in the proper Square )

Child lives with:  Both Parents      Mother     Father      Guardian     (use an X in the proper Square )

Address:       Street    City         Zip

Phone #s :     Home     Cell        Emergency         Other  

Father's Name Occupation: Employed by    Work #  

Mother's Name Occupation: Employed by    Work #  

Guardian's Name Occupation: Employed by   Work #   

Brother / Sister's Age    Name    Age   Name   Age    

Brother / Sister's Age    Name    Age   Name   Age    

Main Language Spoken at Home

Family Church Affiliation / Denomination:  

Name of Home Church :  City:

Does Child attend Church ?   Does Child attend Sunday School ? 

Has Child Been Baptized ?                 If Baptized then date? 

Child's Current or Previous School:

School address:    Street    City         Zip

Please Note:  Signature below authorizes Redeemer Lutheran School to request above-named student's records from his/ her previous school.  As Parent or legal guardian, you have the right to inspect the records.

Signature of Parent or Legal Guardian                                                                                  Date Signed