Re-registration 2018-2019

St. Mary's Episcopal School Kindergarten Application
Date

Month Day Year
A $50 non-refundable application fee, if paying by check and $54 if paying by PayPal, must accompany application. The fee must be submitted to the school office within 48 hours of the online application submission. Checks should be made payable to St. Mary's Episcopal School and mailed or delivered to 12291 River Road, Richmond, VA 23238.
Child's Name *

First Name Last Name
Nickname
*

Male Female
Child's Birthdate *

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landline

Area Code Phone Number
Parent/Guardian #1 Name *

Prefix First Name Last Name Relationship to child
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian #1 Cell Phone *

Area Code Phone Number
Parent/Guardian #1 Email *
example@example.com
Parent/Guardian #1 Employer
Business Phone

Area Code Phone Number
Parent/Guardian #2 Name *

Prefix First Name Last Name relationship to child
Address (if different from Parent/Guardian #1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian #2 Cell Phone *

Area Code Phone Number
Parent/Guardian #2 Email *
example@example.com
Parent/guardian #2 employer
Business Phone

Area Code Phone Number
Parents/Guardians are: *

Married Divorced Separated Widowed
Person/persons Having Legal Custody *
Name of non-custodial parent(if applicable)
Should the non-custodial parent/guardian receive school communication?

Yes No
Primary Language used at home, if other than English
Name and Address of preschool(s) attended (if applicable)
If your child has previously attended kindergarten, indicate the name and address of the school and the reason for leaving.
Are you a member of St. Mary's Episcopal Church

Yes No
Name of siblings (birthdate and school)
Please list name, birthdate and school
How did you hear about St. Mary's Episcopal School?
Signature

Clear
Payment Options *

PayPal - $55, includes $5 convenience fee Check - $50
Checks must be mailed or turned into the school :

12291 River Road, Henrico, VA 23238
PayPal

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USD $55
St. Mary's Episcopal School admits students without regard to race, color, religion, or national or ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to the students in the school.
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St. Mary's Episcopal School Kindergarten Application