STUDENT & PARENT ACKNOWLEDGEMENT FORM

STUDENT/ACTIVITY HANDBOOKrequired

The student and parent/guardian have seen the Student/Activity Handbook. We understand and will abide by the rules and regulations contained in it. This can be accessed on the school website or a hard copy can be obtained from any office.

PARENT PERMISSION FOR COUNSELING SERVICES required

My child has my permission to meet with the Guidance Counselor.

My child does not have my permission to meet with the Guidance Counselor.

PARENT PERMISSION FOR FIELD TRIP SERVICESrequired

My child has my permission to leave the district to participate in a school-directed field trip under the direction of a staff member.

My child does not have my permission to leave the district to participate in a school-directed field trip under the direction of a staff member.

CONSENT FOR MEDICAL TREATMENT

I hereby consent to any medical services that may be required while said child is under the supervision of an employee of Bon Homme School District #04-2 while at school sponsored activities. I hereby appoint said employee to act on my behalf in securing necessary medical services from any duly licensed physician or osteopath.

CONSENT FOR MEDICAL TREATMENTrequiredPlease select up to 1 choice

YES: CONSENT FOR MEDICAL TREATMENT

NO: CONSENT FOR MEDICAL TREATMENT

Please select up to 1 choice

WEB PAGE AGREEMENT

Throughout the year, the school will be updating their website with the possibility of using photographs of classes, class projects, special events, teams, and/or organizations. No last names will be used with any of the photographs. Please read through the following options and check the appropriate box or boxes.

WEB PAGE AGREEMENTrequired

Yes, my child’s picture may be displayed on the school’s website. I understand that no last names will be used.

Yes, my child’s work samples, artwork, or pictures of their completed projects may be displayed on the school’s website.

No, neither my child’s picture, nor any work completed by him/her may be displayed on the school’s website

Student Graderequired

(i.e. 10)

Student Namerequired

First Name

Last Name

Parent/Guardian Namerequired

First Name

Last Name

Daterequired

Must contain a date in M/D/YYYY format

Logo Image

Logo Title

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