Yearly Student Information Form Page 2
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1
2Emergency Contacts
Please designate (3) relatives/neighbors/friends (if you cannot be reached) to authorize us to release your child in case of illness or
emergency. These contacts are for emergency/illness use only.
Contact 1
Name
Relationship
Phone
Cell Home Work Alternate Phone
Cell Home Work
Contact 2
Name
Relationship
Phone
Cell Home Work Alternate Phone
Cell Home Work
Contact 3
Name
Relationship
Phone
Cell Home Work Alternate Phone
Cell Home Work
Parent/Guardian Automatic Email Reports
You will need to set up a Parent account with Powerschool. If you need assistance setting up your account, please contact
your school.
:
The following Email Reports are available through Powerschool
Summary of current grades and attendance
Detailed report of attendance
Detailed report showing all assignment scores for each class
School announcements
Balance Alert (Note: Will only be sent when a student is low on funds)
Connect 5 System Please indicate the contact numbers you wish to have in the Connect 5 System
This is the automated system for school delays, closing, and announcements
Phone #1: _________________________________
# 1 Contact Name: ___________________________________
Phone #2: ________________________________
# 2 Contact Name: ___________________________________
Phone #3: ________________________________
# 3 Contact Name: ___________________________________
E-mail # 1(if desired
E-mail # 2(if desired
) _____________________________
) ___________________________________________
Health Information
MEDICATION:
Is medication needed at home?
Yes
No
Medication name & dosage
Is medication needed at school?*
Yes
No
Medication name & dosage
*If your child needs prescription medication during the school day, please contact the school office for necessary
forms for you and your doctor’s office to complete as required by state law.
Also, non prescription medications kept at school will need completion of necessary forms by a parent/guardian.
Please indicate below any allergies or medical conditions that the school should be aware of in regards to your student.
I will make arrangements for proper care in case my child should meet with an accident or become too ill to remain at school at
a time I am away from home. In case of EMERGENCY our procedure will be to contact the parent at home or work. If
unable to contact parents, I authorize the principal, teacher or health room personnel to call 911.
Form completed by: __________________________________________ Relationship to student: ________________
Parent/Guardian Signature: __________________________________________________ Date: ________________
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