2022-2023 Student Profile

This form must be submitted by August 31, 2022, either electronically or through the dean’s office. A physical copy and an online form are both available for submission. Students who have not submitted the student profile will not be allowed to attend class or extra-curricular activities beginning Thursday, September 1, 2022.

In order to complete the electronic signature at the bottom of the Student Profile, the Parent-Student Handbook must be read. Click Here to view the 2022-2023 JCA Parent-Student Handbook.

Student Information
Student Name*
First Name Last Name
Grade*
Class of*
Student ID:
Date of Birth*
Ethnicity*
Religious Affiliation*
Church/Parish Affiliation
Student Cell*
Student Email*
Address Information
Parent/Guardian Address Name*
Student Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Parent Guardian 1 Information
Parent/Guardian 1*
First Name Last Name
Relationship*
Employer
Work Phone
Cell Phone*
Email*
Parent Guardian 2 Information
Parent/Guardian 2
First Name Last Name
Relationship
Employer
Work Phone
Cell Phone
Email
Emergency Contacts
Emergency Contact 1*
First Name Last Name
Emergency Contact 1 Phone*
Emergency Contact 2*
First Name Last Name
Emergency Contact 2 Phone*
Report Cards and Mailings
Non-Custodial Parents/Guardians
First Name Last Name
Non-Custodial Parent/Guardians wishing to receive your student's report card at an alternate address should complete the above name section and the below address section.
Non-Custodial Parents/Guardians Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Special Needs
The Dean's Office acts as the center for emergency medical treatment at school. Please list ANY information that would pertain to treating your child in an emergency situation. Please note any pre-existing conditions, allergic reactions, medications, seizures, medical history, etc. NOTE: Each year, the health information is treated as FIRST TIME information. PLEASE DO NOT OMIT EXISTING CONDITIONS BECAUSE YOU MAY HAVE REPORTED THEM IN PREVIOUS YEARS. In any emergency, the Dean's Office will contact the mother and/or father or guardian and take the student to the emergency room at Provena St. Joseph Medical Center, Joliet. Your electronic signature below authorizes such action. Should you wish to direct us otherwise, please notify the Dean's Office in writing.
Publishing Policy
Throughout the year there are many opportunities to feature students, their accomplishments, and more both internally and externally. JCA representatives and employees exercise discretion and care in the use of students' names, likenesses, creative works, etc. Joliet Catholic Academy will photograph/video students and may use any picture, video, creative work, name, likeness, etc. as part of the yearbook, videos, print or web-based publications, social network media, photo gallery, and more. Parents who DO NOT wish for JCA to use their student's information, likeness, creative works, etc. must notify the JCA Communications Office in writing.
Parent-Student Handbook
"We have carefully read the Joliet Catholic Academy Parent-Student Handbook. We pledge our cooperation and support of the policies, procedures, and guidelines therein, and we assume our responsibilities as outlined in the handbook. We acknowledge the right of the JCA administration to change, modify, and interpret the handbook and planner at its sole discretion." We have read and accept the Diocese of Joliet Parent Guid, "Understanding and Preventing Child Sexual Abuse", which is part of the Parent-Student Handbook.
JCA Agreement and Authoriazation For Internet Access and Use
We have read the JCA AGREEMENT AND AUTHORIZATION FOR INTERNET ACCESS AND USE and agree to follow the school rules, procedures, and policies. We further hereby release JCA and its board members, employees, and agents from any claims or damages arising from the use, or inability to use the network, systems, or equipment, and arising from the use of the network in violation of this agreement. As the Parent/Guardian, I grant permission for said student to access and use the network, subject to the terms and conditions stated in the above agreement.
Electronic Signatures
Parent Guardian 1 Signature*
First Name Last Name
Parent/Guardian 1 Electronic Signature*
- I Agree
By signing your name and checking the electronic signature box above you are agreeing to the terms and conditions stated in the above policies.
Parent Guardian 2 Signature
First Name Last Name
Parent/Guardian 2 Electronic Signature
- I Agree
By signing your name and checking the electronic signature box above you are agreeing to the terms and conditions stated in the above policies.
Student Signature*
First Name Last Name
Student Electronic Signature*
- I Agree
By signing your name and checking the electronic signature box above you are agreeing to the terms and conditions stated in the above policies.

2022-2023 Student Profile

2022-2023 Student Profile

Student Information

Address Information

Parent Guardian 1 Information

Parent Guardian 2 Information

Emergency Contacts

Report Cards and Mailings

Publishing Policy

Parent-Student Handbook

JCA Agreement and Authoriazation For Internet Access and Use

Electronic Signatures

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