Application for New Families
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Parent Information  
Thank you for your interest in Queen of Peace School
Please contact the office with any questions
(503) 362-3443
school@qpsalem.org
Application for New Families
Parent/Guardian Information
Parent 1 Name *
First Name Last Name
Religion


Email
Cell Phone
Work Phone
Occupation/Employer
Marital Status
Home Address
Address1 City State Zip

Parent 2 Name
First Name Last Name
Religion


Email
Cell Phone
Work Phone
Occupation/Employer
Marital Status
Home Address (if different)
Address1 City State Zip
 

 
Applicant Information

We request that the following children be admitted to Queen of Peace School for the 2019-2020 School Year:

Student 1 Name *
First Name * Middle Name Last Name *
Gender *


Date of Birth *
- -
MM * DD * YYYY *
Grade, Fall of 2019 *
Race *
Ethnicity *
Religion *


Name and location of Baptism if Catholic
Any allergies or limitations? *
Any other physical or psychological issues? *
Is your child on an IEP/ Service Plan? *


Public School Child Would Attend *
Student 2 Name
First Name Middle Name Last Name
Gender


Date of Birth
- -
MM DD YYYY
Grade, Fall of 2019
Race
Ethnicity
Religion


Name and location of Baptism if Catholic
Any allergies or limitations?
Any other physical or psychological issues?
Is your child on an IEP/ Service Plan?


Public School Child Would Attend
Student 3 Name
First Name Middle Name Last Name
Gender


Date of Birth
- -
MM DD YYYY
Grade, Fall of 2019
Race
Ethnicity
Religion


Name and location of Baptism if Catholic
Any allergies or limitations?
Any other physical or psychological issues?
Is your child on an IEP/ Service Plan?


Public School Child Would Attend
Student 4 Name
First Name Middle Name Last Name
Gender


Date of Birth
- -
MM DD YYYY
Grade, Fall of 2019
Race
Ethnicity
Religion


Name and location of Baptism if Catholic
Any allergies or limitations?
Any other physical or psychological issues?
Is your child on an IEP/ Service Plan?


Public School Child Would Attend
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