First Day Forms

We are happy to announce the option of completing most of your first day forms electronically! Please complete this form completely. Please note that we may require additional forms, such as the allergy form, prescription drug form, and cell phone permission form.

Emergency Contact

Gender Male Female

Father's Information

Mother's Information

Sibling Information

Please list other siblings who are currently attending Holy Name School.

Relative/Neighbor Contact Information

In the event that there is an emergency and you cannot be reached, please give the names and numbers of two people authorized to act in your absence. (Phone number needs to be where the person can be reached between 2:30 and 5:30 p.m.).

Pick-up Contacts

As an added security and safety measure, we are asking all Holy Name School parents to list individuals who may pick up your child. This list should coincide with those who have ID cards to pick up your child. This list will be used by your child’s classroom teacher and the school’s extended care personnel. Thank you.

Please list any individuals who are restricted from calling for and/or picking up your child.

Health Information

Please fill in the following information, which is important in case of serious illness or emergency. Please notify the school nurse of any changes in student health history or changes in medication.

If allergies exist, please describe the specific allergic reaction below.

Corrective Lenses Glasses Contacts

Illness, injuries, or surgeries since last year? Yes No

List all medication taken on a regular basis. List dosage, time, and reason the medication is taken.

Please refer to medication administration policy in the student handbook. Medication forms are needed for any medication given to students at school.

Is there any additional information that the school nurse should be aware of? Please explain.

Physician Information

In case of accident or serious illness and the school is unable to contact you, the school will call the physician named below and follow their instructions. If it is impossible to contact the physician, the school will make whatever arrangements are deemed necessary.

Permissions

Typing your name on the signature spaces will serve as your electronic signature.
If no one listed above can be reached, I want my child to be brought to the hospital emergency room.

I give permission for the school nurse to share pertinent medical information with the school staff.

Parent Contact Information Release

Please sign your name under one of the following.

I grant Holy Name School permission to share my contact information with the Diocese of Fall River Catholic Schools Alliance (CSA), for the purpose of contacting me regarding matters relating to my school and/or other schools and diocesan wide news. I understand that my contact information will not be sold or shared with any other party.

I do not grant permission for my contact information to be shared to the Diocese of Fall River Catholic Schools Alliance (CSA).

Student Work/Photo/Video Release

Please sign your name under one of the following.

I grant permission for my student’s work, photo, video, and/or name to be published in school and/or diocese-approved media outlets, including web-generated promotional resources.

I do not grant permission for my student’s work, picture, video, and/or name to be published.

Additional Policies

Please review our computer policy with your child. Signing below indicates that you have read our acceptable use agreement in its entirety. In consideration of Holy Name School granting access to the computer system and/or Internet and/or other technologies, you agree that your student will be governed by the provisions of the agreement.

Please review our student handbook and sign below, indicating that you and your child have read and agree to be governed by this handbook.