Does your child have any specific health need or chronic health condition? 

If yes, please explain

Does your child have an allergy (food, medication, other)

If yes, please explain

If yes, are you aware of any side effects from the medication (please share side effects below)

The School Health Program provides the services listed below:

·Assessment and evaluation of sudden illness while in school

·Basic First Aid

·Medication Administration (Medication Authorization required)

·Vision, Hearing and Scoliosis Screening

·Health and Nutrition Education

·Referral for illness: injury not suitable for treatment in the school

·Asthma management (Asthma Health Plan and Medication Authorization required)

·Diabetic management/Glucose monitoring (Diabetic Health Plan and Medication Authorization required)

·Seizure management (Seizure Health Plan and Medication Authorization required)

·Allergic Reaction management (Allergic Reaction Health Plan and Medication Authorization required)

 If an emergency arises requiring treatment for your child, every effort will be made to contact you immediately. In the event of a life threatening situation, 911 will be called.   Doctors and hospitals are very conscious of liability suits and will not treat a child without parental consent. Your signature gives us authority to seek emergency medical treatment. The Clayton County Public School System assumes no financial responsibility for actions taken to preserve the health and well-being of the said student.

I UNDERSIGNED, HEREBY GIVE THE PERMISSION TO CLAYTON COUNTY PUBLIC SCHOOLS FOR MY CHILD TO PARTICIPATE IN THE ABOVE SERVICES OF THE SCHOOL’S HEALTH PROGRAM.

THE HEALTH CARE TECHNICIAN/DESIGNEE HAS MY PERMISSION TO CONTACT MY CHILD'S PHYSICIAN FOR FURTHER MEDICAL INFORMATION AS NECESSARY. I UNDERSTAND THAT I CAN REVOKE THIS PERMISSION AT ANY TIME BY WRITTEN NOTIFICATION TO THE SCHOOL.

Jackson Elementary Uniform Dress Code Contract

We hereby acknowledge receipt of the current and complete School Uniform Dress Code.

We understand the stated reasons for a uniform dress code policy school environment, and agree to support the school’s position in all dress code and enforcement policy matters.  We further acknowledge that the final decision in all dress code related matters ultimately rests with the school’s administration. 

We understand that dress code enforcement begins at home. As parents/guardians, we will ensure that your child understands the dress code policy, and arrives at school in complete and correct uniform, adhering to all dress and grooming guidelines.  We recognize the importance of parental encouragement in matters of dress code, and agree to partner with the school in support of these policies. 

We have completely read the school’s Uniform Dress Code Policy, and understand that there is not a grace period for dress code offenses and that enforcement of this policy begins the first day of the 2022-2023 school year. The prefered Jackson Elementary uniform for the school year: Navy tops with Navy or Khaki bottoms. 

The follow are permissible :

White or Yellow Shirts

Navy or black pants

We agree to comply with the district’s dress code offense consequences, including providing our child appropriate clothing during the school day, as necessary.  We realize that continued non-compliance with the dress code policy may result in lost class time, missed learning opportunities, zero grades on missed assignments/tests, detention and suspension.

We understand that these consequences, like those of all school and classroom rules, are simply a method of communicating the importance of following established rules and of respecting authority.