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Spirit of St. Anthony Breakfast
Featuring Kerry Fraser
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Scholarship Golf Outing
July 21st at Green Oaks Country Club
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St. Anthony's Admissions Application

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Student's First Name:
Student's Last Name:
Student's Birthday: / / *
Student's Social Security #: - - *
Parent/Guardian Name: *
Parent/Guardian Email Address: *
Main Phone: - *
Work Phone: -
Cell Phone: -
Independent Supports Coordination (I.S.C.):
I.S.C. Contact: Name:

Religious Affiliation:
Name of Parish/Church:
Address of Church:
Date of Baptism: / /
Date of First Communion: / /
Date of Confirmation: / /
Present School:

Date Entered: / /
Address of Present School:
Other Schools Attended: School: Date: / /

School: Date: / /
Special Considerations (medical, behavioral, dietary concerns):
How did you hear about us?:

2000 Corporate Drive
Suite 580
Wexford, PA 15090
Toll-free (844) 782-5437
Local (724) 940-9020
Fax (724) 940-9064
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United Way Donor Option 194