Online Registration Form




Registration Form

Child’s Name

Does your child require an Epi-Pen?  Yes No

Mother’s Information

Father’s Information

Authorization

Emergency Contacts(2)

(Must live in the Richmond area and be someone other than the parents)

Other Siblings Enrolling

Child #2

Medical Information

Medical Information: list any physical problems, Pertinent Developmental Information, Special accommodations needed:

Does your child require an Epi-Pen?  Yes No

Child #3

Medical Information

Medical Information: list any physical problems, Pertinent Developmental Information, Special accommodations needed:

Does your child require an Epi-Pen?  Yes No

Child #4

Medical Information

Medical Information: list any physical problems, Pertinent Developmental Information, Special accommodations needed:

Does your child require an Epi-Pen?  Yes No

Web Permission

Saint Benedict Catholic School has a website and will occasionally put pictures of students on the site. Children’s names will not accompany their pictures. Please indicate below whether your child’s picture may or may not appear on our web site.

Does your child have permission to be pictured on the Saint Benedict School’s web site?  Yes No

Sunscreen and Bug Spray Policy

The state mandates that we provide, in writing our policy regarding sunscreen and bug spray.
Policy: If needed, parents are to apply sunscreen and/or bug spray, on their child prior to arriving at school. If you feel that your child needs reapplication of either sunscreen or bug spray during school hours, please follow the guidelines listed
below.

  • Label bottles with your child’s names.
  • Put in writing a dated permission slip stating that your child’s teacher is allowed to apply either substance.
  • Give bottles to your child’s teacher (the bottles may not be transferred via backpacks).

We suggest that you buy bottles to keep at school. These items are to be kept in locked cabinets.

I have read the Summer Guild‘s policy regarding sunscreen and bug spray.

Field Trip Permission

My child, has permission to walk to and from the VMFA, Historical Museum, Humphrey Calder, and to Cary town with the Summer Guild Staff on field trip days.

My child, does not have permission to go on any field trips.

Please enter the name and email address of the main contact for this application: