Back to School Paperwork 25-26

Family Handbook Parent Confirmation

Signing below is your acknowledgement of receipt of the Family Handbook, and your agreement that your family will abide by the policies laid out in the handbook. Any and all updates to the Family Handbook will be provided to parents/legal guardians in writing.
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Signature

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Media Acknowledgement Form 2025-2026

The Pathfinder School posts photos/videos on Social Media, our Website, and in advertisements. We will not publish a photo of a child along with their name without prior confirmation of parents/guardians. This form is solely for the use of photos/videos that do not individually identify your child.
Please fill in the following information for each child attending The Pathfinder School.
Student Last/First/MI (Please Print)*
Birth Date*

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Grade
Student Last/First/MI (Please Print)
Birth Date

MonthDayYear
Date
Grade
Student Last/First/MI (Please Print)
Birth Date

MonthDayYear
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Student Last/First/MI (Please Print)
Birth Date

MonthDayYear
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Grade
PHOTO RELEASE

I hereby grant The Pathfinder School permission to use my child's likeness in a photograph, video, or other digital media ("photo") in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of The Pathfinder School and will not be returned. I hereby irrevocably authorize The Pathfinder School to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child's likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge The Pathfinder School from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, AS EVIDENCED BY MY SIGNATURE BELOW.

I acceptI do not accept
Parent Signature

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This consent can be revoked at any time in writing.

The Pathfinder School

Consent for Disclosure of Immunization Information to Local and State Health Departments
Immunizations are an important part of keeping our children healthy. Schools and State and Local health departments must monitor immunization levels to ensure that all communities are protected from potentially life-threatening diseases and, if necessary, respond promptly to an emerging public health threat. It is important that disease threats be minimized through the monitoring of students being immunized. Sharing immunization and personally identifiable information including the students name, Date of Birth, gender, and address with local and state health departments will help to keep your child safe from vaccine preventable diseases. The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, requires written parental consent before personally identifiable information from your child's education records is disclosed to the health department. If your child is 18 or over, he or she is an "eligible student" and must provide consent for disclosures of information from his or her education records.

You may withdraw your consent to share this information in writing at any time.
I authorize The Pathfinder School to release my child's immunization record to Michigan Department of Health and Human Services and Local Health Department. I understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally identifiable information from the school.*

I ConsentI Do Not Consent
Name of Parent/Guardian
Parent/Guardian Date of Birth

MonthDayYear
Date
Signature of Parent/Guardian

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I agree to provide the school with an up-to-date copy of my child's immunization records or current immunization waiver form before the first day of school. I confirm that my child is in good health to the best of my knowledge, and their immunizations are up-to-date and that the immunization record or waiver is on file at school and will be updated annually.
Signature of Parent/Guardian

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AGREEMENT FOR APPROPRIATE USE OF THE PATHFINDER SCHOOL COMPUTING AND INTERNET COMMUNICATION SYSTEM

You are being given access to the School's electronic communications system. Through this system, you will be able to communicate with other schools, colleges, organizations, and people around the world through the Internet. You will have access to hundreds of databases, libraries, and computer services all over the world. With this educational opportunity comes responsibility. Inappropriate system use will result in the loss of the privilege to use this educational tool. Please note that the Internet is a network of many types of communication and information networks. It is possible that you may run across some material you (or your parents) might find objectionable. While the School will take reasonable steps to restrict access to such material, it is not possible to absolutely prevent such access. It will be your responsibility to follow the rules for appropriate use.

You will be assigned an individual account and are responsible for not sharing the password for that account with others. The account is to be used for identified educational purposes. You will be held responsible at all times for the proper use of your account, and the School may suspend or revoke your access if you violate the rules. You will be held responsible for any postings to a social networking site that would "materially disrupt classwork, involve substantial disorder, or interfere with the rights of others." [Tinker, 393 U.S. at 506.]

Using the system for any illegal purpose. Borrowing someone's account (with or without permission Posting personal information about yourself or others (such as addresses and phone numbers Downloading or using copyrighted information without permission from the copyright holder. Posting messages or accessing materials that are abusive, obscene, sexually oriented, threatening, harassing, damaging to another's reputation, or illegal. Using personal electronic mail accounts. Wasting school resources through the improper use of the computer system. Gaining unauthorized access to restricted information or resources.
CONSEQUENCES FOR INAPPROPRIATE USE:
Suspension of access to the system; Revocation of the computer system account; or Other disciplinary or legal action, in accordance with The Pathfinder School Conduct Policies and applicable laws.

I understand that my computer use is not private and that the School will monitor my activity on the computer system. I have read this document and agree to abide by its provisions. I understand that violation of these provisions may result in suspension or revocation of system access.
The Pathfinder School's computers and facilities are intended to support and enhance the educational and administrative work of the school; therefore, their use must be consistent with The Pathfinder School's educational goals. User cooperation is expected at all times; supervising faculty and administrators reserve the right to examine email and/or any file stored or created on school computers. Users are reminded that the use of the school's computers and systems is a privilege that may be revoked temporarily or permanently if abused.
Student Name (please print)
I have read and fully understand the conditions and terms of this Appropriate Use Policy (AUP I agree to be a responsible user of The Pathfinder School computer -Student Signature

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Student Name (please print)
I have read and fully understand the conditions and terms of this Appropriate Use Policy (AUP I agree to be a responsible user of The Pathfinder School computer -Student Signature

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MonthDayYear
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Student Name (please print)
I have read and fully understand the conditions and terms of this Appropriate Use Policy (AUP I agree to be a responsible user of The Pathfinder School computer -Student Signature

Clear
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MonthDayYear
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Student Name (please print)
I have read and fully understand the conditions and terms of this Appropriate Use Policy (AUP I agree to be a responsible user of The Pathfinder School computer -Student Signature

Clear
Date

MonthDayYear
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I have read and fully understand the conditions and terms of this Appropriate Use Policy (AUP I agree to be responsible for my child's use of The Pathfinder School computer system when my child is accessing the system. I hereby give consent to The Pathfinder School to access my child's electronic communications on the system, as it deems necessary for compliance with this agreement and any applicable laws. I hereby release The Pathfinder School, its personnel, and any institutions with which it is affiliated, from any and all claims and damages of any nature arising out of my child's use of, or inability to use, the system, including, but not limited to claims that may arise from unauthorized use of the system. I understand it is impossible to restrict my child's access to all potentially controversial materials. I agree not to hold The Pathfinder School responsible for any information or materials acquired by my child on the system. I fully understand that if my child's The Pathfinder School account is suspended, terminated or revoked, The Pathfinder School will not refund any user fee, or portion thereof. I further understand and agree that I am fully responsible for any financial obligations arising from my child's use or unauthorized use of the system to purchase products or services. I hereby give my permission to issue an account for my child.
I understand my responsibilities as a parent/legal guardian:

I understand and acceptI do not understand and do not accept
Parent/Guardian Name (please print)*
Parent/Guardian Signature*

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Date*

MonthDayYear
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Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

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MonthDayYear
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Child Information Record
1st Child's Name*

First Name & Middle InitialLast Name
1st Child's Date of Birth:

MonthDayYear
Date
1st Child's Allergies, Special Needs and Special Instructions (Please email additional information if needed).
Type N/A if there are no known allergies or special needs and/or special instructions.
2nd Child's Name:

First NameLast Name
2nd Child's Date of Birth:

MonthDayYear
Date
2nd Child's Allergies, Special Needs and Special Instructions (Please email additional information if needed).
NKAType N/A if there are no known allergies or special needs and/or special instructions
3rd Child's Name:

First NameLast Name
3rd Child's Date of Birth:

MonthDayYear
Date
3rd Child's Allergies, Special Needs and Special Instructions (Please email additional information if needed).
NKAType N/A if there are no known allergies or special needs and/or special instructions.
4th Child's Name:

First NameLast Name
4th Child's Date of Birth:

MonthDayYear
Date
4th Child's Allergies, Special Needs and Special Instructions (Please email additional information if needed).
NKAType N/A if there are no known allergies or special needs and/or special instructions.
Name of Children's Physician or Health Clinic
Physician or Health Clinic's Phone Number
Please enter a valid phone number.
Hospital Preferred for Emergency Treatment
1st Parent/Legal Guardian Name*

First NameLast Name
1st Parent/Legal Guardian Home Phone Number*

Area CodePhone Number
1st Parent/Legal Guardian Cell Phone Number*
Please enter a valid phone number.
1st Parent/Legal Guardian Address*

Street Address

CityState

Zip Code
1st Parent/Legal Guardian Email*
example@example.com
1st Parent/Legal Guardian Employer*
If self-employed or stay-at-home parent, please type those labels as your Employer. If unemployed, please type "none".
1st Parent/Legal Guardian Work Phone Number*
Please enter a valid phone number. If working from home, please list best number to reach you during work hours.
2nd Parent/Legal Guardian Name

First NameLast Name
2nd Parent/Legal Guardian Home Phone Number

Area CodePhone Number
2nd Parent/Legal Guardian Address

Street Address

CityState

Zip Code
2nd Parent/Legal Guardian Phone Number

Area CodePhone Number
2nd Parent/Legal Guardian Email Address
example@example.com
2nd Parent/Legal Guardian Employer
2nd Parent/Legal Guardian Work Phone Number
Please enter a valid phone number. If there is not a specific work phone number, please provide the best number to reach you during work hours.
Emergency Contact & Release of Child:

List all individuals, including parents/legal guardians, in order of preference, to be contacted in an emergency. If possible, include at least one person other than the parents/legal guardians to be contacted in an emergency and to whom the child can be released. The second phone number column can be left blank. (If more individuals, please email list to receptionist@thepathfinderschool.org).
#1 Emergency Contact & Authorized Release*

First NameLast Name
#1 Emergency Contact Phone Number*
Please enter a valid phone number.
#1 Emergency Contact Secondary Phone Number
Please enter a valid phone number.
#2 Emergency Contact & Authorized Release

First NameLast Name
#2 Emergency Contact Phone Number
Please enter a valid phone number.
#2 Emergency Contact Secondary Phone Number
Please enter a valid phone number.
#3 Emergency Contact & Authorized Release

First NameLast Name
#3 Emergency Contact Phone Number
Please enter a valid phone number.
#3 Emergency Contact Secondary Phone Number
Please enter a valid phone number.
Release of Child Only

List all individuals, other than the parents/legal guardians, to whom the child may be released. (If there are additional individuals please email receptionist@thepathfinderschool.org).
Release of Child Only - #1

First NameLast Name
Release of Child Only - #1 Phone Number
Please enter a valid phone number.
Release of Child Only - #2

First NameLast Name
Release of Child Only - #2 Phone Number
Please enter a valid phone number.
Release of Child Only - #3

First NameLast Name
Release of Child Only - #3 Phone Number
Please enter a valid phone number.
Release of Child Only - #4

First NameLast Name
Release of Child Only - #4 Phone Number
Please enter a valid phone number.
initials* I give permission to The Pathfinder School* licensed by the Department of Licensing and Regulatory Affairs to secure emergency medical treatment for the above named minors whil
I certify that I accurately completed this form and if anything changes, I will notify the provider by updating this form. Signature of Parent/Legal Guardian:*

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Should be Empty:

Family Handbook Parent Confirmation

Media Acknowledgement Form 2025-2026

PHOTO RELEASE

2025-2026 Acknowledgments and Permissions

FAMILY EMAIL INFORMATION

PESTICIDE ADVISORY

Volunteer Screening Statement

Field Trip Permission Slip

Child Placement Contract

The Pathfinder School

CONSEQUENCES FOR INAPPROPRIATE USE:

Child Information Record

Emergency Contact & Release of Child:

Release of Child Only