Your Name: Your Relation to Student: Mother Father Step-parent Uncle Aunt Grandparent Guardian Other Street: City: State: Zip: Day Phone: Evening Phone: Email Address: Mother's name: Father's Name: Child 1 Name: Child 1 DOB: Child 1 Grade: K 1 2 3 4 5 6 7 8 Child 2 Name: Child 2 DOB: Child 2 Grade: K 1 2 3 4 5 6 7 8 Child 3 Name: Child 3 DOB: Child 3 Grade: K 1 2 3 4 5 6 7 8 Child 4 Name: Child 4 DOB: Child 4 Grade: K 1 2 3 4 5 6 7 8 How did you hear about us? A Current Family Website Church Bulletin Archdioces of Cincinnati Alumni Flyer Newspaper Mailing Radio/TV Other Are you interested in Extended Day Kindergarten? Yes No What would you most like to know about Bishop Leibold? (Check all that apply) Religious Education Academic Program Discipline Standardized Test results Transportation Becoming a member of the parish Financial Assistance Facilities Extra Curricular Activiites Other Would you like be contacted by our Ambassador Program (current parents who speak to prospective families)? Yes No Are you interesed in learning more about becoming a member of: Our Lady of Good Hope Parish (Miamisburg) St. Henry's Parish (Miami Township) Questions or Comments?
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