| October |
2
_____ 6_____ 8_____ 14 _____
23 _____ 28 _____ 29 _____ 30 _____ |
| November |
4
_____ 6_____ 7_____ 11_____
12 _____ 13_____ 18____ 20_____ |
| December |
1
_____ 4_____ 9_____ 12 ____ 18_____ |
| January
|
6
_____ 9 _____ 13_____ 27 _____ |
| February
|
3
_____ 6 _____ 19 _____ 24 _____ 27_____ |
| March |
5
_____ 11 _____ 17 _____ 20 _____ |
| April
|
7_____ 21_____ 27 ______ 30 ______ |
| May |
5_____ 14 _____ 18______ |
Student Name: _________________________________ Applying for Grade:_______________________
Current
School:_________________________________
Father’s
Name:_________________________________ Daytime Phone: __________________________
Mother’s Name:_________________________________ Daytime Phone:
__________________________
Emergency
Contact:_____________________________ Phone: _________________________________
If
possible, our child would like _________________________________
to serve as his/her host.
Please
provide some of your child’s interests and activities : ___________________________________
______________________________________________________________________________________
Our
child, _______________________________, has our permission to visit
Ursuline Academy. We understand that he/she should arrive at
the Admission Office in the Gerardine House at 8:00
a.m., and we will pick him/her up at 2:00 p.m. at the Admission
Office. Ursuline Academy has our permission to provide emergency
medical assistance, if necessary.
*Parent Signature:
___________________________________ Date:
____________________________
*Please
provide the name of the person who will be picking up your child:
________________________________________________________
Ursuline Academy 1106 Pennsylvania
Avenue Wilmington, DE 19806 | 302-658-7158 | Fax:
(302) 658-4297
|