Grant Public Schools Enrollment Form & Emergency Medical Form Page 4
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4Permissions (Blanket Parental Permission/Release Form):
_____ I give permission for my child to be filmed or photographed by Grant staff or the news media on issues
pertaining to school-related activities and/or educational issues. Film or photo can be used for district-sponsored
publications, media/cable productions and the internet.
_____I do not give permission for my child to be filmed or photographed (this does not include the yearbook).
_____My child has permission to attend school sponsored field trips.
_____My child does not have permission to attend school sponsored field trips.
_____I hereby give my permission for emergency care to be given to my son or daughter as necessary in the event
of an accident or other medical condition that should occur while attending an event or activity sponsored by Grant
Public Schools. The parent or guardian will be contacted as soon as possible in case of any emergency. I hereby
give my permission to release pertinent information to appropriate professional staff of Grant Public Schools.
Release: I agree to release the Board of Education and its individual member, agents, employees, and trip
supervisors form any and all claims that I or the student may have for any losses, damages, or injuries arising out of
the student’s participation in the field trip or the rendering of emergency medical procedure or treatment if any.
_______________________________________________________________
__________________________
Signature of Parent or Guardian
Date
• If you object to any particular field trip or class excursion, you should contact the principal in writing at
least 2 days prior to the activity so alternate learning opportunities can be made available for your child.
In case my child becomes ill or is injured at school and needs emergency care and none of the emergency contacts
can be reached, please take my child to the nearest hospital. By signing below, I agree to assume the responsibility
for the expenses incurred by the handling of any emergency care.
Please check one: _____ I agree _____ I do not agree Signatures ______________________________________
has been/has not been
The undersigned affirms that ___________________________
suspended or expelled
from any public or private school in Michigan or any other state for an offense involving weapons, alcohol or
drugs, or for the willful infliction of injury to another person or for any act of violence against persons and/or
property committed on school premises, at any school-sponsored activity, or on a public or private conveyance
providing transportation to and from a school or school-sponsored activity.
If you chose Has Been to the above question, please explain the circumstances in detail. Include the school dates
of suspension or expulsion, and a description of the incident.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
By signing this document you are stating this information is accurate:
Signature of Student: __________________________________________
Date: _________________________
Signature of Parent: ___________________________________________
Date: _________________________
SCHOOL USE ONLY
Locker Number:
Counselor:
Homeroom Number:
Homeroom Teacher:
Pick-up Bus:
Take-home Bus:
Sitter Name:
Address:
Home:
Address:
Grade:
Class Section:
Child Lives With:
Certified Birth Certificate Presented? Yes or No
Immunization Record on File? Yes or No
Non-Resident Code:
Year of Graduation:
Date Enrolled:
Date Dropped:
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