Please answer select either yes or no for the following
For each question, select the options that best reflect the student's current living arrangements
Please check below to indicate which description applies to your child. Florida Statutes describe military family students as children as options 1-4 of those below.
If divorced or separated:
Health Screenings: Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0056(7)(d). Non-invasive screenings may include vision, hearing, scoliosis, height, and weight. These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption in writing (This exemption will cover all types of screenings).
If you DO NOT want your child to receive the screenings, type the words "Do not screen" in any or all of the boxes that apply
Notice of Technology Acceptable Use Policy For Students: Your child may have access to many school-related activities and District technology resources, including the internet. Internet access at your child’s school is filtered, monitored and is compliant with the Child Internet Protection Act (CIPA) and School Board Policy. Your child will be required to follow the Acceptable Use Policy and guidelines that are stated in Board Policy, the referenced Manual, and be bound to those terms. There is NO expectation of privacy while utilizing the DCPS network, computers, or any device attached to the network. Before your child uses these District resources, he/she will read, be read to, and/or have the documents explained to him/her. You are invited to read this Policy. If you need assistance, you may ask the school for assistance.
The policy is available at:http://www.duvalschools.org/Page/8265
Notice of medical records disclosure: Your child's medical records or medical information that has been provided to the school are student records which are subject to the requirements of FERPA, 20, U.S.C.A. 1232g. Accordingly, that information can be disclosed without the written consent of the parent/guardian as allowed by FERPA, including if used by a teacher or other school official, who has a legitimate educational interest, or if disclosure is to an appropriate party and is necessary to protect the health or safety of the studdent or other individuals.
Parental consent for release of student photograph and information: I hereby give permission for the school or District to use my child's photograph, video, image, writing, voice recording, name, grade level, school name, participation in officially recognized activities and sport, weight and height of members of athletic teams, dates of attendance, diplomas and awards received, date and place of birth, and most recent previous school attended, in annual yearbooks, graduation programs, playbills, school productions, web sites etc. and/or similar school or Disctrict sponsored publications or in school or District approved news media interviews releases, articles, and photographs. I also provide permission for the release by the school or District to the media and governmental entities of my child's name, grade, school name and honors my child has received for public announcement of recognition of my student's accomplishments. I understand that without checking this permission box, my child's name and photograph cannot and will not be included in any publications or presentation, including a school yearbook.
Emergency Contact Information and Authorization for Release of Student from School:
1. Complete all information.2. Select the appropriate relationship to student.3. List all contacts who may act on your behalf in case of sudden illness, accident, or emergency.4. List names in the order they should be contacted.5. The school will also use this information to determine who may pick up your student from school (non-emergency).
I hereby give consent for my child to participate in the School Health Service Program and to receive nursing and emergency care at the school, if needed. Screening and evaluation for problems in the areas of vision, hearing, growth and development, nutrition, dental, scoliosis, communicable diseases, blood pressure, speech and language, or other non- invasive health screenings may be done as part of the program.
In the event of a serious accident or illness, I request that the school contact me. If I cannot be reached, I request designated school personnel to take or send my child to the hospital determined by Emergency Services personnel. I consent to be responsible for all expenses incurred. In case of an accident or illness where immediate medical treatment is not indicated, but where my child is unable to remain in school, I request the school contact me. If I cannot be reached, I request that one of the persons listed above be contacted to remove my child from school and to be responsible for his/her care. These persons listed have transportation and are immediately available to come to school.
The Florida Department of Health-Duval in conjunction with the Department of Education provides school health nursing services for Duval County Public Schools. I understand that all health-related information I provide to the school regarding my child will be shared between the two agencies as needed in the performance of their duties. I further understand that said information will be shared between agencies in compliance with state and federal laws governing student records and confidentiality requirements.
Please download the Medical Administration Authorization form found here (and below). The form is to be completed by student's Primary Physician. After filling it, please upload it below or here in this separate form.
Upload Supporting Documents below such as
If you are unable to upload all of these documents at the time of submitting this application, please use this form to upload the documents later.