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Registration Check List
Explanation & Check List
2009-2010 Academic Year
For registration to be complete, registration sheets must be completed
and on file in the school office by Friday July 31, 2009.
Please allow time to read carefully and complete each sheet.
Medical Paperwork
Forms 1, 2, 3, 4, 5 and 6 as instructed on the Medical Paperwork Completion Information sheet.
To help insure that your son or daughter has a safe and healthy year at St. Bernard Prep School we will need
parents or guardians to complete the required medical forms.
All students will need to complete and submit the following on a yearly basis:
________ Form #1
Contact Information & Release for Medical Treatment (Page 1)
________ Form #2
Contact Information & Release for Medical Treatment (Page 2)
________ Form #3
Annual Physical Examination Record (bottom portion to be completed by physician and top portion to be
completed by parents (before giving to physician).
________ Form #4
School Medication Prescriber/Parent Authorization*
________ Form #5
Self-Medication Agreement (Resident Students Only)
________ Form #6
Alabama School Immunization Certificate (Blue Slip) Requirements listed on the reverse side.
New Students: to be completed by physician.**
* Day and Boarding students who will be on prescription medications, and will either keep some of the
prescription medications in their dormitory room or will have them dispensed from St. Bernard personnel,
will need to complete the School Medication Prescriber/Parent Authorization form. Please note that
this includes students who keep insulin supplies, and spare Epinephrine pens in the Infirmary or with the
Dorm Director. Medication will not be dispensed without written order from physician.
** An Alabama School Immunization Certificate (Blue Slip) must be completed for every new student.
For international and out-of-state students, please have your medical provider record immunization
information and we will place the information on the Alabama form. Up-to-date immunizations are
required by law for school attendance and must be on file in the Student Health Center.
__________ State Athletic Physical Form
Alabama law requires every student who participates in athletics to have a pre-participation physical annually.
If you have any questions regarding completion of these forms, please contact St. Bernard Prep School at (256) 739-6682, ext. 7122 or 7115. 1600 St. Bernard Drive SE • Cullman, AL 35055 • (256) 739-6682 • FAX: (256) 736-6487 • www.stbernardprep.com
Existing Students should provide records of any new immunization.
________ Make a copy (front and back) of Health Insurance Card. We require a photocopy of your medical insurance card and your pharmacy card (front and back).
____Form B: Parents’ Permission and Indemnity
This form allows St. Bernard to seek medical attention for a student when a parent is unavailable.
All families must complete this sheet; a neighbor or friend can witness the parent’s signature.
____Form D: Transportation Permission
Town permission is very important for boarding students. You must indicate “yes” to allow a
student to travel to town by school transportation. Please talk with your teenager about your rules
regarding traveling with other students and adults. Read the Student/Parent Handbook very carefully as it
applies to transportation. A student who drives a vehicle on campus must complete this sheet before the
vehicle can be brought on campus. This applies anytime during the year a student begins to drive. If
multiple vehicles are used, all must be registered. A key to enter each vehicle and access codes for each
vehicle must be left with the School office (Mrs. Rice). The School is also required to have a current
Certificate of Insurance on file. Students sign Form D along with parent/guardian.
____International Boarding Student Contact Information(International only)
Please complete one form per student. To be completed by parent or guardian.
____Media Permission
Please complete one form per family.
Terms and conditions as stated in the Student/Parent Handbook. This form also requests email
addresses for school communication. Parent/Guardian and student signatures are required.
____Standardized Test Scores and Achievement-Trust Program
State law requires that written permission be on file for test scores to be available to School
administration and faculty. The form must be signed by student and parent.
You will find a copy of the Student/Parent Handbook online which details the academic
expectations and social guidelines of St. Bernard Prep School. You may request a copy to be kept at
home. Boarding students will receive a copy for the dorm. Both the parent/guardian and student must
sign this sheet.
____Substance Abuse Consent & Release of Liability
Student and parent/guardian are required to sign form. (A copy of the policy is included.)
____Weekend Expectations (Resident students only)
Student and parent/guardian are required to sign form.
____Telephone Use and Request: (Resident students only)
If you would like a private phone for your student please return the form and check with your
registration materials.
Seniors, parents/guardians and administration are required to sign this statement of requirements.
Thank you for working through these materials carefully. God bless each of
you. Please print and mail to:
Mrs. Pam Rice
St. Bernard Prep
1600 St. Bernard Drive, SE
Cullman, AL 35055
Supply List
Math In General
TI-83 or TI-84
Calculator
* Listed below
Have sufficient supplies to
take notes the first day of
class; teachers will go over
needs for each course
Math Supplies:
These items will be required the first day of school, August 10, 2009.
· Single subject notebook (color coded below)
•
1” 3 ring binder (color coded below)
Algebra I-Green
Algebra II-Blue
Pre-Calculus-Red
Calculus-Black
· 6 inch ruler
· pencils
· highlighter
· pencil pouch
· packet of graph paper
· retractable eraser
· package of loose leaf paper
· protractor (geometry classes only)
· compass (geometry classes only)
