Emergency|Medical Form | Glacial Hills Elem

Student First name

Student Last name

Grade

Field Trip Permission The above named student has my permission to accompany his/her class on school sponsored field trips during the 2024-2025 school year.

Yes

No

We have adequate medical insurance to protect the above named student in case of an accident.

Yes

No

Internet and Web Page Release options. Must choose one.

I DO authorize the release of my child’s picture to be used on the GHES website, Facebook page and other social media.

I DO NOT authorize he release of my child’s picture to be used on the GHES website, Facebook page and other social media.

please choose one

I DO authorize the release of my child’s artwork, poetry, essays, performances, etc. to be used on the GHES website, Facebook page and other social media.

I DO NOT authorize the release of my child’s artwork, poetry, essays, performances, etc. to be used on the GHES website, Facebook page and other social media.

please choose one

I DO authorize the release of my child’s picture to be used in printed publications.

I DO NOT authorize the release of my child’s picture to be used in printed publications.

please choose one

I DO authorize the release of my child’s artwork, poetry, essays, performances, etc. to be used in printed publications.

I DO NOT authorize the release of my child’s artwork, poetry, essays, performances, etc. to be used in printed publications.

GHES will NOT use the following:

The last name of any student.
Personal student email addresses.
Names on pictures identifying students

Computer Resource Policy and Internet Consent & Waiver

As a parent/guardian of the student signing below, I grant permission for my child to access networked computer services such as electronic mail and the internet. I understand that individuals and families may be held liable for violations on the network. I understand that some materials on the internet may be objectionable, but I accept full responsibility for guidance of internet use.

As a student and user of Glacial Hills Elementary School’s internet network I hereby agree to comply with the policies of GHES. Should I commit any violations my access may be revoked, school disciplinary action may be taken and/or appropriate legal action may be taken.

Please mark both to acknowledge reading the policy.

Parent/Guardian Signature

Signature field is empty.

CENSUS

Please list all children under 18 in your household.

Thank you for completing the required forms for your student! We will be in contact with you shortly.