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Thank you for your interest in SRCES - Madonna Catholic Regional School!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

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Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone
  • How Did You Hear About Us? *
    Details:
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Child's Current School (if no current school, enter NA)
    *

  • Has this student:

    Had an IEP?
    * Yes   No

  • Repeated a grade?
    * Yes   No

  • Been Suspended from school?
    * Yes   No

  • Asked to Transfer?
    * Yes   No

  • Expelled from school?
    * Yes   No
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •