Application

Admission

Application

Thank you for your interest in James River Day School. Please complete an application for each child seeking admission. The application may be submitted online below, or if you would prefer you can download this pdf, print it, and fax or mail it to us at the number or address below.

Please Note: There is a non-refundable one time application fee of $50, which can be paid by mailing a check to:
James River Day School
5039 Boonsboro Road
Lynchburg, Virginia 24503

Address*:

City*: State*:

Zip Code*:

Phone*:

Birthdate*:

Family Information

Parent/Guardian #1

Full Name*:

Relationship to Applicant*:

Has Legal Custody?*

Yes No

Address*:

City*: State*:

Zip Code*:

Phone*: Cell:

E-Mail*:

Parent/Guardian #2

Full Name:

Relationship to Applicant:

Has Legal Custody?

Yes No

Address:

City: State:

Zip Code:

Phone: Cell:

E-Mail:

Applicant’s Siblings

Full Name:

Birthdate:

School/Grade:

Full Name:

Birthdate:

School/Grade:

Please list the names of any relatives who have attended JRDS and their relationship to the applicant:

Full Name:

Relationship:

Full Name:

Relationship:

Applicant’s Current School

Name of School:

Present Grade:

Years Attended:

School Address:

City: State:

Zip Code:

Director:

Phone:

Is the applicant able to meet the essential performance requirements of the program, either with or without reasonable accommodations?

Yes No

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Application Fee Acknowledgement*

I understand that the $50 application fee is required, and that my application will not be process until the fee is paid.

Information Acknowledgement*

I (we) attest that all of this information provided in this application is true and correct to the best of our knowledge. Further, I (we) understand and accept that falsification of deception in any aspect of the application process may result in an immediate review and possible revocation of admission.

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Statement of Policy:

James River Day School is an independent, non-sectarian, kindergarten through grade eight day school open to qualified students of any race, creed, national or ethnic origin. It does not discriminate in the administration of its personnel policies, admission policies, scholarship programs, or athletic or other school administered programs.