Author: Paul Carlson

Trinity Catholic Academy
Registration Form

Office Use:
Birth Certificate
Baptism Certificate
$50.00 Registration Fee
Date Form Received:
__________________

Student Information

Student Last Name

First Name

Middle Name

Suffix

( )

Student Home Street Address

City

Zip Code

Main Phone

/ /

M

F

Date of Birth

Place of Birth

Entering Grade

Preschool (if applicable)

Gender

Student’s Religion

Parish of Registration (if applicable)

Family Information

Student lives with: (check all that apply)
Both Parents Mother Only Father Only Legal Guardian
Mother/Stepfather Father/Stepmother Other Relative: ________________
Parents are:
Married Separated, Joint Custody Other: ________________

( )

( )

Father’s Name

Father’s Phone

Father’s Cell

Father’s Address, City, State

Father’s Email Address

( )

Father’s Place of Employment

Father’s Work Phone

Father’s Religion

( )

( )

Mother’s Name

Mother’s Phone

Mother’s Cell

Mother’s Address, City, State

Mother’s Email Address

( )

Mother’s Place of Employment

Mother’s Work Phone

Mother’s Religion

Federally Required Ethnicity Information
Part A: Is the student Hispanic/Latino (select only one)
No, not Hispanic or Latino Yes, Hispanic or Latino
Part B: What is the student’s race? (select one or more regardless of ethnicity)
American Indian or Alaska Native Native Hawiian or Other Pacific Islander
Black or African American Asian White

Sacramental Record

/ /

Date of Baptism

Church

City and State

/ /

/ /

Date of First Confession

Church

City and State

/ /

Date of First Communion

Church

City and State

/ /

Date of First Confirmation

Church

City and State

Preschool Only Information
Please choose a section:
3yr old: 3 day, all day 3day, half day 5 day, all day 5 day, half day
4yr old: 3 day, all day 3day, half day 5 day, all day 5 day, half day
Do you plan to send your child to TCA Kindergarten? Yes No Undecided

Mailing address: TCA, 650 4th Street, La Salle, IL 61301
Phone number: 815-223-8523
Email: tcasaints@lasallecatholic.org
Website: www.lasallecatholic.org
Direct questions to: Mr. Jerry Carls, Principal
Jenny Peters, Secretary
Esmeralda De La Torre, Business Manager