Student Handbook Signature Page - Santa Cruz Elementary District

Parent/Student Information

In Case of Emergency You May Contact These People:

May Pick Up My Child Yes No

If you are authorizing a person under the age of 18 to pick up your child, you will need to write a yearly letter signed by you authorizing for your child to be picked up by the designated person.

Medical Information

Does your child have allergies? Yes No

Does your child use an inhaler? Yes No

Does your child have other medical conditions? Yes No

Does your child have special medication? Yes No

If you want your child to take over the counter medication or medicine that a doctor has prescribed please visit the office and provide this medication to the office.

Do you have health insurance? Yes No

I give permission to transport my child in case of an emergency. Yes No

In my absence I give permission to treat my child in emergency. Yes No

Student Transportation

Please Select One I will pick up and drop my child off. They will still follow bus rules when on a bus. My child will ride the Rio Rico/South River Rd bus. My child will ride the Trailer Park/Kino Springs/ North River Road bus.

My child has permission to walk from the bus stop to my home and I assume responsibility for their safety once the driver leaves them at the stop. (Parents who do not sign must be at the stop or we will return their child to school.)

My child has permission to walk from the bus stop to my home. Yes No

My child’s name, age, grade level, and photograph can be displayed in school related events such as school bulletin boards, school/district web site, class web site, local newspaper, yearbook, and community event flyers.

My child’s name, age, grade level & photograph can be displayed. Yes No

School is able to contact me with important school information via an automated emergency system by leaving a message or a text to my phone or email account.

School is able to contact me with important school information. Yes No

I have reviewed the Santa Cruz Elementary District 28 handbook with my child and we both agree to follow the rules set down in the code of conduct, including all school, classroom, and bus rules and procedures. The student handbook is linked at the top of this page for your reference.