Loading...

St. Sebastian Regional Catholic School 2022-2023

Home Language Survey

 


This survey is used to determine a primary or home language other than English.

Parents or guardians are asked to complete the following questions about the language use of your child. When appropriate, the child may answer the questions. Parents are not required to answer questions with regard to origin. However, even countries of origin whose primary language is English may have a dialect making it difficult for a child to understand American dialects.

First Parent/Guardian Name
First Name*
Last Name*
Phone*
First Parent/Guardian Age Acknowledgment*
First Parent/Guardian Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent/Guardian Signature*
Second Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Third Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fourth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fifth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Sixth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Seventh Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Eighth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Ninth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Tenth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Student Information
Full Name (First / Middle / Last) *
Date of Birth *
Age *
Grade*
Country of Student's Origin *

Other Countries of Residence (Please List)
What was the first language your child learned to speak?*
English
Other
Other
What language(s) does your child speak most often at home?*
English
Other
Other
What language(s) can your child read?*
English
Other
Other
What language(s) can your child write?*
English
Other
Other
What language(s) do you use when speaking to your child?*
English
Other
Other
What language(s) is spoken most often in your home?*
English
Other
Other
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!