2584 Main Street Glastonbury, CT 06033 - (860)633-8333
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All fields required unless specified otherwise.
Registration for:

Student's Name:

First

MI:   (opt)
Last:


Student's Address:

Street:

City:

State: 
Zip: 

Parent's Names:

First:

MI:   (opt.)
Last


First:

MI:   (opt.)
Last:


Primary Email Address:

Secondary Email Address:
 (opt.)

Primary Home Phone:    
Seconday Phone: (opt.)    
   
Primary Work Phone: (opt)    
Secondary Work Phone: (opt.)    

Age: 

Date of Birth:
   

Grade in School: 

#1.) What school do they attend?


#2.) Does your child have any special needs about which we should be aware? (Please explain):


#3.) Does your child have any allergies to food? Please explain any procedures to follow.


#4.) Other allergies we should be aware of. Please explain any procedures to follow.


#5.) Any other information about your child that may be helpful to teachers.


#6.) Is your child new to St. James’ Church School?






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St. James Episcopal Church