Application for Enrollment

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1 POLICY
2 STUDENT info
3 FATHER/Guard
4 MOTHER/Guard
5 med Info
6 contacts
7 meds
8 docs
9 pay & submit
Please verify you have read the following documents before continuing.
Student Info
First Name
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Middle Name
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Last Name
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Birth Date
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Gender
Addressyour home / office
Name of person/s with whom child resides
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Phone Number to use for communication regarding this applicationyour full name
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Is there a custody/court order
Please note that we need a copy of the court/custody documents to follow the orders. Only those with legal custody of a child are permitted to enroll that child at Richmond Christian School.
Attach Custody Order
cloud_uploadUpload
Please provide the parent/s or legal guardian's information of which the student lives with and should be contacted for questions, missing information or medical emergencies.
Biological Father/Guardian 1
First Name
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Last Name
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Relationship to Student
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Address
Home Phone
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Work Phone
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Cell Phone
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Biological Mother/Guardian 2
First Name
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Last Name
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Relationship to Student
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Address
Home Phone
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Work Phone
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Cell Phone
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Student Medical Information
Has the student received educational, psychological, or any other type of testing/evaluation?
Please explain
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Has the student been hospitalized or had any inpatient/outpatient surgery?pick one!
Please explain
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Please list special considerations such as: ADD/ADHD, Dyslexia, need for frequent bathroom breaks, vision or hearing impairment, fears, migraines, etc…more details
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Please list medical alerts such as food, and/or environmental allergies, asthma, diabetes, heart conditions, etc:more details
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Does this student require any special accommodations while he/she is in our care?pick one!
Please explainmore details
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Emergency Contact
In the event your child becomes ill or injured and we can not reach you at the numbers provided, we need the contact information of at least two people, not the parent/guardians listed on page one . Please ensure they have consented to the release of their phone numbers and agree to pick up your child if needed.
Contact 1your full name
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Relationshipyour full name
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Homeyour full name
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Workyour full name
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Cellyour full name
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Contact 2your full name
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Relationshipyour full name
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Homeyour full name
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Workyour full name
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Cellyour full name
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Contact 3your full name
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Relationshipyour full name
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Homeyour full name
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Workyour full name
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Cellyour full name
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If deemed necessary by the Richmond Christian School faculty, staff, and/or an EMT, your child will be sent to the emergency room at parental/guardian expense. As a parent/guardian, I authorize medical personnel to render necessary treatment to my child.
Medications
List all medication this student is taking regularly with the dosage & frequency as well as the reason:
Tabularadd content
Attach Transcripts or Report Cards
upload
cloud_uploadUpload
Attach Birth Certificate (If accepted an original birth certificate must be provided later)upload
cloud_uploadUpload
Application Fee
A one time application fee of $100 is required with this application. Enter your credit card information below. Your card will be charged when the application is successfully submitted.
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