Parent Consent and Acknowledgment 
Please read the statements below.
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Email *
Please list your student(s) names and grade: *
1. Regulations require parental consent before administering any medications to a student. I give permission for my child to be given over-the-counter (Tylenol, Ibuprofen, CoughDrops, skin creams/ointments) medications at school, according to dosage guidelines on product labels. *
2. I authorize the school to conduct basic health screenings. *
3. In the event of an emergency and I cannot be reached, I authorize transportation and all necessary medical treatment for my child. I understand that transportation and/or treatment will be at my expense. *
4. I give permission for my child to participate in any school sponsored field trips throughout the year. I release Coon Rapids-Bayard Community School and individuals from liability in the case of accident during activities related to field trip. *
6. I give permission for my child/children to be photographed and/or displayed on the school website/social media. *
7. I give my permission for the school to share information relevant to my child’s health with appropriate school personnel. This includes Heartland Area Education Agency staff and health care providers, when needed to meet my child’s health and safety needs at school. *
Is the child considered "homeless"? 

The term “homeless children and youths”—

(A) means individuals who lack a fixed, regular, and adequate nighttime residence (within the meaning of section 103 (a)(1)); and

(B)  includes—

(i) children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals1;

(ii) children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings (within the meaning of section 103 (a)(2)(C));

(iii)  children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and

(iv) migratory children (as such term is defined in section 1309 of the Elementary and Secondary Act of 1965) who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses

(i) through (iii). (42 U.S.C. § 11434a(2)).

 *
Applicable to ALL 7-12th grade students:  By typing your name (parent name) AND have your student also print their name.

By printing both names, you electronically verify that you have reviewed the concussion fact sheet.  

If you don't have a 7-12th grader, please fill in N/A below. 
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Acceptable Use Policy/ Student Contract
Acceptable Use Policy: I have agreed to submit this application by electronic means. By signing this application electronically, I verify that I have read and completed this form. Please type your name below as your electronic signature. *
K-12 iPad Loan Agreement
K-12 iPad Loan Agreement
iPad Loan Agreement: I have agreed to submit this application by electronic means. By signing this application electronically, I verify that I have read and completed this form. Please type your name below as your electronic signature. *
Home Language Survey: What language is most frequently spoken at home? *
Migrant Education Parent Form: Has your family moved in order to work in another city, country, or state in the last three years? *
Migrant Education Parent Form: Has anyone in your family been involved in one of the following jobs, (Agriculture; planting/picking fruits and vegetables; planting, growing, detasseling or farm labor; processing/packing agricultural products; dairy/poultry/egg/livestocks; meatpacking/meat processing; fishing or fish farms) either full or part-time or temporarily during the last 3 years? *
I have agreed to submit this whole form by electronic means. By signing this form electronically, I verify that I have read and completed this form entirely. Please type your signature below. *
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