Name* Street Address* City* State* ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Phone Number* Email Address* NAME OF CHILD/CHILDREN 1. Name Current School Year of School Looking to Enter 2. Name Current School Year of School Looking to Enter 3. Name Current School Year of School Looking to Enter Relationship to Perspective Student(s) How did you hear of Holy Childhood? If newspaper, which one? Who referred you? Who has spoken to you about our school? Do you know anyone who attends? If so, please share this information with us so that we can properly thank them. What are you most interested in knowing about our school? Would you like to schedule a school visit? ---YesNo Would you like to attend an Open House? ---YesNo Would you like to talk to the principal? ---YesNo What is the best day/time to reach you? Questions or comments that you have at this time: Thank you for taking the time to complete this form. Please click on the SUBMIT button below. We will be getting back to you. 215 North John Street Mascoutah, Illinois 62258 618.566.2922 hcs@holychildhoodschool.com