Emergency Student Data Form English

Emergency Student Data Form
School Name *
I.D. No. *
Grade *
Student's Last Name *
APP
Student's First Name *
Middle Name
Address *
Main contact phone number to be used for emergencies and automated messaging: *
Registering Parent/Guardian's Name *
Place of Employment
Relation *
Telephone
Cellphone *
Email
Non Registering Parent/Guardian's Name
Relation
Place of Employment
Telephone
Cell Phone
Email
example@example.com
Is either parent in the military? *

Yes No
If yes, what branch?
Emergency Contact Information

I authorize the school district to provide or secure any necessary emergency care for my child. It is the parent's legal responsibility to assume medical and transportation expenses for your child. In the event that parents of child cannot be reached, provide contact information below of two persons, by order of priority.
Name *
Relation to Student *
Address *
Phone *
Name
Relation to student
Address
Phone
Family Doctor
Phone
Preference of Hospital
Phone
Student health/allergy data which should be known in an emergency:
Authorization for release of students from school

Please provide the names of persons authorized or NOT authorized to take your child from school during the school day. Note that persons listed as emergency contacts are not authorized to pick up your child, unless listed in this section.
Authorized:
Authorized
Authorized
Authorized
Authorized
Authorized
Not authorized:
Not authorized
Not authorized
It is the parent's responsibilty

to inform the school in person of any changes in the information listed on this form. Under penalties of perjury, I declare that I have read the foregoing (document) and that the facts stated in it are true.
Date: *

Month Day Year
Date
Printed Registering Parent/Guardian's Name *
Registering Parent/Guardian's Signature *

Clear
Miami-Dade County Public School Media Release Parental Consent Form
School Name *
Date *

Month Day Year
Date
Dear Parent: Please be advised that during the year your child may be photographed, videotaped or interviewed at various school sponsored events. With your consent, the photograph, video or interview may be reproduced, and released for use in the media, i.e., newspapers, brochures, videos, television, the internet, and Miami-Dade County Public Schools websites and social media platforms such as Facebook, Twitter, etc.
Student's Name *
Student's ID *
Yes. *

Yes. My child's photograph/video/interview MAY be reproduced and released for use in the media. No. My child's photograph/video/interview MAY NOT be reproduced and released for use in the media.
Parent's Signature *

Clear
Date *

Month Day Year
Date

Felix Varela Senior High School Student Social Media Policy 2022-2023
This policy provides guidance for all FVSH student officers and/or school leadership positions in the use of social media, which should be broadly understood for purposes of this policy to include blogs, wikis, microblogs, message boards, chat rooms, social networking sites such as Twitter, Facebook, Instagram, Snapchat, text messaging, Whatsapp, etc. that permit users to share information with others over the Internet.
Student Responsibilities:

1. Students must adhere to all M-DCPS School Board Rules when posting online.

2. Students should be aware of the effect their actions/postings when using social media may have on their image, as well as the school’s.

3. Students must realize that after-school and after-hours online activity that violates the M-DCPS policies may be subject to disciplinary action.

4. Students must realize that any posts that are brought to the administration’s attention could result in disciplinary action if the post violates M-DCPS rules.

5. Students need to know that although not an exclusive list, some specific examples of prohibited social media conduct include posting commentary, content or images that are defamatory, pornographic, proprietary, violent, harassing, libelous, or can create a hostile school environment.

6. Students must use technology responsibly and also respect copyrights, trademarks, etc.

7. Students are to adhere to the Code of Student Conduct policies in their online postings.

8. Students are responsible for anything they post that can potentially affect another student or the school in a negative fashion.

9. Students should follow the policy “When in doubt, do not post.” They are to exercise sound judgement and common sense, and if there is any doubt, DO NOT post it.

10. Students must realize that the Internet is permanent. Once information is published online, it is essentially part of a permanent record, even if deleted or removed, it is still available for future view.

11. Students should protect themselves and be careful of any personal information they share online.

12. Students are to honor differences. There is to be no discrimination (including age, sex, race, color, creed, religion, ethnicity, sexual orientation, gender identity, national origin, citizenship, disability, or marital status) posted.

13. Student comments including, but not limited to the following, if deemed inappropriate may result in the student facing disciplinary action and the removal from the club/officer/captain status:

a.       Abusive or hurtful comments

b. Foul language

c.       Hate speech

d. Personal attacks

e.       Defamatory statements

f. Violation of privacy of an individual

g. Comments that suggest or encourage illegal activity

h. Violent images or suggestions

i. Alcohol or tobacco

j. Cyberbullying
I, blanks have read and understand the above Social Media policy. As such, I will abide by the policy as long as I am a Felix Varela Senior High School student/officer/captain or hold any other leadership position in the school environment which makes me a role model and a representative of the school. I understand if I am found using social media in an inappropriate fashion, I could face disciplinary action and the removal from the club/team/officer status and participation in school-sponsored events and competitions.
Student Signature

Clear
Parent Signature

Clear
Date

Month Day Year
Date
Should be Empty:

Emergency Student Data Form

Emergency Contact Information

Authorization for release of students from school

It is the parent's responsibilty

Miami-Dade County Public School Media Release Parental Consent Form

Felix Varela Senior High School Student Social Media Policy 2022-2023