The Good Shepherd Catholic Montessori Student Record
Student Information. Please enter your child's name, not your name.
Parent Email*
Confirm Parent Email*
Please update the following information for your child.
Date of Birth*
Ethnicity*
(None Selected)
Asian
Black
Hispanic
Multiracial
White
Sex*
(None Selected)
Male
Female
Neighborhood*
(None Selected)
Amberley Village
Anderson Township
Batavia
Blue Ash
Bond Hill
Boone County
Brown County, OH
Columbia Township
Columia Tusculum
Covington, KY
Dayton, KY
Dayton, OH
Deer Park
Downtown/OTR
Eastgate
Erlanger, KY
Fairfax
Finneytown
Ft. Mitchell, KY
Golf Manor
Goshen
Guilford, IN
Hamilton
Hyde Park
Indian Hill
Kennedy Heights
Kenwood
Lakeside Parks, KY
Lebanon
Linwood
Loveland
Madeira
Madison Place
Madisonville
Mariemont
Mason
Miami Township
Milford
Monfort Heights
Montgomery
Mt Airy
Mt. Lookout
Mt. Washington
New Richmond
Newtown
No. Kentucky
North Avondale
Northside
Norwood
Oakley
Pleasant Ridge
Price Hill
Sharonville
Silverton
Southgate, KY
Sycamore Township
Symmes Township
Terrace Park
Union Township
Walnut Hills
West Chester
Westwood
White Oak
Withamsville
If your neighborhood is not listed, please email Jana Widmeyer at jwidmeyer@gscmontessori.org
School District*
(None Selected)
Unknown
Batavia
Beechwood
Bethel-Tate
Boone County
Campbell Cty
Cincinnati Public
Clermont Northeastern
Dearborn
Deer Park
Erlanger
Finneytown
Forest Hills
Goshen
Indian Hill
Kenton County
Kings Local
Lakota
Lebanon
Loveland
Maderia
Mariemont
Mason
Milford
New Richmond
Newport
Northwest
Norwood
Princeton
Ross
Sycamore
West Chester
West Clermont
Western Brown
Wyoming
Public School Child Would Attend, example Maddux Elementary*
Denomination*
(None Selected)
Baptist
Catholic
Christian Non-Denom.
Eastern Orthodox
Episcopal/Anglican
Greek Orthodox
Jewish
Lutheran
Methodist
None
Pentecostal
Presbyterian
Protestant
Other
Church*
(None Selected)
All Saints
Anderson Hills United Methodist
Bellarmine Chapel
Blessed Sacrament
Cathedral Basilica of the Assumption
Christ the King
Church of the Redeemer
Church of the Ressurection
Cincinnati House of Prayer
Community of the Good Shepherd
Crossroads Community Church
Epiphany United Methodist
Faith United Church of Christ
First Unitarian Universalist Church of Cincinnati
Gaines United Methodist
Georgetown Baptist
Good Shepherd Lutheran
Guardian Angels
Holy Trinity
Horizon Community Church
Hyde Park United Methodist Church
Immaculate Heart of Mary
Life Church
Lifespring Christian
Loveland UMC
Mariemont Community Church
Mt. Carmel Baptist
Mt. Washington Presbyterian
Nativity of Our Lord
New City Presbyterian
New Thought Unity Center
Northstar Community Church
Old St. Mary's Church
Our Lady of Lourdes
Our Lady of the Rosary
Our Lady of the Sacred Heart
Peoples Church
Redeemer
St. Agnes
St. Andrew
St. Angela Merici
St. Anne's Episcopal
St. Anthony
St. Antoninus
St. Bernard
St. Cecilia
St. Cecilia, Independence
St. Columban
St. Elizabeth Ann Seton
St. Francis de Sales
St. Gertrude
St. Ignatius of Loyola
St. James White Oak
St. John Fisher
St. John Neumann
St. John the Baptist
St. John the Evangelist
St. Joseph
St. Margaret of York
St. Margaret-St. John
St. Martin of Tours
St. Mary's
St. Maximillian Kolbe
St. Michaels
St. Monica - St George
St. Patrick
St. Peter & Paul
St. Peter in Chains Cathedral
St. Peter, New Richmond
St. Rose
St. Savior
St. Stephen
St. Suzanna
St. Teresa
St. Teresa of Avila
St. Teresa, Bright, Indiana
St. Theresa, Southgate, KY
St. Thomas Episcopal
St. Thomas More
St. Timothy's Episcopal
St. Veronica
St. Vincent Ferrer
St. Xavier, Downtown
Summerside United Methodist
The Good News Church of God in Christ
Vineyard
Other. Please email Jana Widmeyer at jwidmeyer@gscmontessori.org with name of church
Emergency Contact - #1 In case parent(s) cannot be reached*
Emergency Contact - #1 Phone*
Emergency Contact - #2 *
Emergency Contact - #2 Phone*
Besides parents, who is authorized to pick up student?*
Contact Information for Each Authorized Pick-Up*
Medical Insurance Company*
Medical Group Number*
Medical Policy ID*
Medical Subscriber Name*
Physician Name*
Physician Address*
Physician Phone*
Permission to Transport to Hospital*
Yes
No
Preferred Hospital
Dentist Name*
Dentist Address*
Dentist Phone*
Allergies - List or enter None*
Dietary Restrictions - List or enter None*
Do you want to be included in PTO Directory?*
Yes
No
Permission to Photograph*
Yes
No
Permission to Publish Photo in Yearbook*
(None Selected)
Yes
No
Permission to Publish Photo in Newsletter or Marketing Materials*
(None Selected)
Yes
No
Permission to Publish Photo on Social Media*
(None Selected)
Yes
No
Father's Name*
Father's Phone and Email*
Mother's Name*
Mother's Phone and Email*
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