Student Data Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Birth Date REQUIRED Please fill out this field. Please enter a date.

Grade Entering REQUIRED Please fill out this field. Please enter an integer (number).

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.

Student Resides With - Please check all that apply: REQUIRED Birth Parents Mother Only Father Only Mother/Stepfather Father/Stepmother Other (please explain below) Please fill out this field.

Other Please enter valid data.

Parent Status - Please check all that apply REQUIRED Together Divorced/Separated Single Mother Deceased Father Deceased Mother Remarried Father Remarried Please fill out this field.

If Parents Divorced - Please indicate custody and Domiciliary Parent or Legal Parent/Guardian Joint No Joint

Domiciliary Parent is Please enter valid data.

Legal Guardian is Please enter valid data.

Contact Information

Emergency/Medical Information

In case of accident or a serious illness, school will notify the parent. If the parent cannot be reached, the school will make whatever arrangements are deemed necessary. Please update your daughter's medical conditions, especially allergies. IF LEFT BLANK, IT IS ASSUMED THERE ARE NO MEDICAL CONCERNS OR ISSUES.
Illnesses/Other Conditions - Check all that apply Diabetes Asthma Other (Explain below)
Other:
Current Medications
Allergies to Food
Allergies to Medications
Other Allergies
Psychological/Educational Evaluations
EMERGENCY CONTACTS:
List those individuals, other than parents, who may be contacted when parents cannot be reached, in the event of illness, emergency dismissal or early checkout: (Any siblings listed must be 18 years or older.)
Contact 1 REQUIRED Please fill out this field. Please enter valid data.
Relationship REQUIRED Please fill out this field. Please enter valid data.
Home Phone Please enter a phone number.
Cell Phone REQUIRED Please fill out this field. Please enter a phone number.
Contact 2 REQUIRED Please fill out this field. Please enter valid data.
Relationship REQUIRED Please fill out this field. Please enter valid data.
Home Phone Please enter a phone number.
Cell Phone REQUIRED Please fill out this field. Please enter a phone number.

Parent and Student School Messaging Information

Emergency and school announcments will be made through the instant messaging broadcast system to the phone numbers provided by parents or guardians. You may OPT-OUT of messaging by contacting the office. REMEMBER, opting-out may cause you to miss important communications from the school.
Name Please enter valid data.
Relationship to Student Please enter valid data.
Cell Phone Please enter a phone number.
Name Please enter valid data.
Relationship to Student Please enter valid data.
Cell Phone Please enter a phone number.
Student Cell Phone Please enter a phone number.
Student Email Address Please enter an email address.

Additional Student/Family Information

School Bus Information

I reside within Jefferson Parish and my daughter will require bus transportation to and/or from school for the 2020-21 school year. REQUIRED Yes No Please fill out this field.
My daughter will require special needs REQUIRED No Yes (Specify below) Please fill out this field.
If Yes, Specify:

CONSENT FOR RELEASE OF PERSONAL AND ACADEMIC INFORMATION TO THE STATE

Per the Student Handbook, your daughter's personal information (Full Name, Birthdate, Social Security Number) and academic information (transcipt data) will be shared with the Louisiana Office of Financial Assistance (LOSFA), the Department of Education (DOE), the Office of Technology Services (OTS), and the postsecondary education institution (Colleges or Universities) to which your daughter applies through the Board of Regents (BOR). These departments track your daughter's progress of courses and grades and monitor her TOPS eligibility and other college aid payments using the Louisiana Award System. This information will ultimately be used by the Institution (College or University) to process your daughter's application for admission. If you do not wish to share your daughter's information with the above departments, Academy of Our Lady must receive, in writing, a DO NOT CONSENT FORM, obtained from the school office and signed by the parent or student, if she is over the age of 18. Not consenting to the disclosure of the student's data to LOFSA and BOR for the postsecondary Institutions, will delay the evaluation of eligibility for TOPS and for admission to college until the information necessary to make the determination is provided. You may provide consent at a later date.

ACKNOWLEDGEMENT OF NON-PROVISION OF SPECIAL EDUCATION SERVICES BY PARENTS

The undersigned, who represent that they are the parents and/or legal guardians of the Student, presently enrolled in Academy of Our Lady, acknowledge that the school does not provide special education services or facilities. The undersigned further acknowledge that the Academy, its principal, faculty, and staff are only required to make minor adjustments in the Academy's education program to attempt to accommodate whatever special needs their child/student may have and that the nature and extent of such minor adjustments is within the sole discretion of the principal of Academy of Our Lady. The undersigned further acknowledge that, should the principal of Academy of Our Lady determine in her own discretion that minor adjustments in the Academy's education program have not resulted in satisfactory accommodation of the program to the special needs of their child and that it is in the best interest of both the school and the child that she be placed in a more appropriate learning environment, then the principal may ask the undersigned to withdraw their child/student from Academy of Our Lady and/or the child/student will be removed from rolls of the school and/or not be allowed to re-enroll.

REGISTRATION IS INCOMPLETE WITHOUT PARENT AGREEMENT, ALL PAPERWORK AND FEES

Please select "I AGREE" and fill out "NAME" and "DATE" to indicate that you have read, understood, completed and made any necessary changes to the data, emergency, medical and bus information, release of information to the state, and acknowledgement of the non-provision of special education services by the schools of the Archdiocese of New Orleans.
I Agree Please select this field.
Full Name REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.