KIC Tribal Scholars Re-Enrollment Application

KIC Tribal Scholars Enrollment Application

Student Information:
Last Name First Name
Middle Initial
Grade Entering in the new school year

9th Grade (Freshman)10th Grade (Sophomore)11th Grade (Junior)12th Grade (Senior)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday

MonthDayYear
Date
Age
Gender

MFOther
City of Birth State of Birth
Guardian Information:
Guardian #1 name Relationship
Home Phone Work Phone
Cellphone Email
Guardian #2 name Relationship
Home Phone Work Phone
Cellphone Email
I have reviewed this application and hereby give permission for my student to participate in the Tribal Scholars Program. I agree to help ensure that my student arrives at the Tribal Scholars Program at 615 Stedman at 8:00am daily. I acknowledge that per their learning plan through Tribal Scholars, students will return to Kayhi before 12:30pm M-F. In order to ensure that the Tribal Scholars Program has the information needed to plan for my student's learning, I authorize the release of information (including special education services documentation) from previous KGBSD Program to the Tribal Scholars teachers. (Please sign below)*

Clear
Date

MonthDayYear
Date
Field Trip/Community Experience Permission Form
I hereby give my permission for Student name , who attends the Tribal Scholars Program, to participate in various field trips related to the individual learning program designed for Student name during the 2023-2024 school year. Field trips will be supervised by qualified adults employed by the Ketchikan Gateway Borough School District and/or the Ketchikan Indian Community. Field trips may include, but are not limited to, trips to cultural sites, visits to the Ketchikan Public Library, Totem Heritage Center, various parks, agencies or businesses within the community. Transportation for field trip activities will be provided by, KGBSD District bus/vehicle, KIC bus/vehicle, public transportation, or Laidlaw contracted bus services.

In the event of an accident or injury, as parent, or legal guardian, I authorize a qualified physician to examine the above-named student and in the event of injury to administer emergency care and to arrange for any consultation by a specialist, including a surgeon, as deemed necessary to insure proper care of any injury. I understand that every effort will be made to contact parent or guardian to explain the nature of the problem prior to any involved treatment. In the even it becomes necessary to the Tribal Scholars staff-in-charge to obtain emergency care for your students, neither the staff-in-charge, the Ketchikan Gateway Borough School District, or Ketchikan Indian Community assumes financial liability for expenses incurred because of accident, injury, illness, and/or unforeseen circumstances.
Student Physical Address
Student Home phone

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Any medical conditions the student may have including allergies:
Parent/Guardian contact numbers-- home, work, cell, etc.
In the event of an emergency, two contacts-names and phone numbers, in case a parent/guardian cannot be contacted
I have read the attached permission form and understand that the Tribal Scholars Program will make every reasonable effort to provide a safe environment during any field trip. As the parent/guardian of the above named student I understand that there are inherent risks associated with participation in these activities including physical injury, and/or other consequences. I acknowledge that school rules apply on all field trips. This permission form expires at the end of the 2023-2024 school year. (Please sign below)

Clear
Date

MonthDayYear
Date
Should be Empty:

KIC Tribal Scholars Enrollment Application

Field Trip/Community Experience Permission Form