Deubrook Elementary PS-6 Permission Forms

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Name of Parent/Guardian Completing Form *

By entering your full name below, you are indicating that you are the person you say you are and this electronic signature indicates you are providing permission, consent, and/or information for the questions that follow.

Parent/Guardian Last Name *

Parent/Guardian First Name *

Student Last Name *

Student(s) First Name *

If you have more than one student, enter all first names in the space below (please separate names with a comma and start with your oldest child).

Grade(s) of Student *

If you have more than one elementary student, please select all that apply.

Kindergarten

Preschool

Required

Acceptable Use Policy *

Please read and review the following link pertaining to the Deubrook Area School District's: Acceptable Use Policy

We accept the conditions of Deubrook Area Schools District 5-6 Acceptable Use Policy and plan to access the district’s system/network.

We do not accept the conditions of the Deubrook Area Schools District 5-6 Acceptable Use Policy and will not access the district’s system/network.

Parent Portal Acceptable Use Policy *

Please read and review the following link pertaining to the Deubrook Area School District's: Parent Portal Acceptable Use Policy

We accept the conditions of Deubrook Area Schools District 5-6 Parent Portal Acceptable Use Policy and plan to access the district’s parent portal.

We do not accept the conditions of the Deubrook Area Schools District 5-6 Parent Portal Acceptable Use Policy and will not access the district’s parent portal.

NAME Permission for Deubrook Web Pages *

Do you give permission for your child(ren)’s NAME to appear on school web pages?

Yes

PHOTO Permission for Deubrook Web Pages *

Do you give permission for your child(ren)’s PHOTO to appear on school web pages?

Yes

VIDEO Permission for Deubrook Web Pages

Do you give permission for your child(ren) to be audio or video recorded for classroom or extracurricular purposes.

Yes

Clear selection

Student of Active Military Parent *

Please check yes if these conditions are met: A parent is a member of the Armed Forces on active duty. This also includes full-time members of the National Guard Reserve that are activated and deployed. (Army, Navy, Air Force, Marine Corps and Coast Guard)

Yes

Student Health Conditions *

Please identify any health conditions your child has that may at some time pose a problem for him/her in the classroom or at school-related activities (examples—asthma, epilepsy, diabetes, allergies, etc.). If YES, check other and list child's name and health condition.

No, my child does not have any health conditions.

Other:

Required

Emergency Medical Information *

If parents cannot be located in an emergency, please list your doctor's and dentist's names and phone numbers.

Permission Form *

Do you grant permission for your child(ren) for the following:

Yes

Over-the-counter Medication Permission *

If my child is ill, he/she has permission to receive the following: Please check all that apply. (It will be given as directed on the bottle.)

Equate brand Jr. Strength acetaminophen 160 mg. chewable

Equate brand acetaminophen 325 mg (regular strength).

Equate brand acetaminophen 500 mg (extra strength).

Equate brand Ibuprofen 200 mg.

Equate Antacid tablet.

No, my child does not have permission for medication.

Required

Physical Education Form *

Please read and review the following: Elementary PE Letter . I have received your letter and am submitting the following information for the classification of this student in the Deubrook Elementary Physical Education program. I have filled out this form fully and completely and have listed all crippling diseases such as broken bones, polio, epilepsy, asthma, diabetes, hemophilia, etc. as well as other medical issues or history the physical education teacher should be aware of. Please select one of the following options:

My child may participate fully in physical education class.

My child is not allowed to participate in physical education class.

Other:

Required

Acknowledgment of Review of Student Handbook *

Please read the contents of the student handbook. The direct link to the handbook is Elementary Student Handbook. If you would like a hard copy, please contact rhonda.Kruse@k12.sd.us If you have any concerns or questions, please contact the principal. Each student/learner and parent is expected to review and understand the contents of applicable student handbooks.

We (student and parent) have reviewed a copy of the handbook and understand student responsibilities, rules, and regulations set forth in the student handbook.

Online Registration Acknowledgement *

There are 2 parts to our Online Registration: this Permission Form AND the portion in your Parent Portal that updates contact and emergency information. These both need to be completed before school starts. Please choose the appropriate response below. Thank you!

I have already completed the contact information portion of Online Registration through my Parent Portal

I will continue to Part 2 of online registration through my Parent Portal > Menu > MORE > Online Registration

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of State of South Dakota K-12 Data Center. Report Abuse

Forms