2025-2026 EMERGENCY CONTACT CARD

EMERGENCY STUDENT CONTACT CARD

2025-2026
School No./Name
STUDENT ID No.*
Student's Last Name*
Student First Name*
Middle Name
Student Mobile Number
Student Email*
example@example.com
Grade*
Home Address (No City Needed)
Zip Code
Main contact phone number to be used for emergencies and automated messaging:*
REGISTERING PARENT/GUARDIAN'S
Registering Parent/Guardian's Name*

First NameLast Name
Registering Parent/Guardian's - Relation*
Registering Parent/Guardian's - Telephone Number*
Registering Parent/Guardian's - Cellphone*
Email*
example@example.com
Registering Parent/Guardian's - Place of Employment*
NON REGISTERING PARENT/GUARDIAN'S
Non Registering Parent/Guardian's First Name
Non Registering Parent/Guardian's Last Name
Non Registering Parent/Guardian's - Relation
Non Registering Parent/Guardian's - Telephone Number
Registering Parent/Guardian's - Cellphone
Email
example@example.com
Place of Employment
Is either parent in the Military?

YESNO
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.
FIRST EMERGENCY CONTACT
Full Name of the first person to contact in case of emergency that the parents cannot be reached.*
(Relation to Student)*
Example Grandfather, Grandmother, Aunt, or Uncle
( Full Address)*
Phone Number*
SECOND EMERGENCY CONTACT
Full Name of the second person to contact in case of emergency that the parents cannot be reached.*
(Relation to Student)*
Example Grandfather, Grandmother, Aunt, or Uncle
(Address)*
Phone Number*
FAMILY DOCTOR
Family Doctor*
Phone Number*
HOSPITAL INFORMATION
Preference of Hospital*
Hospital Phone Number*
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. All persons picking up must be over 19 and have a valid ID. Eighteen year olds picking up must be a sibling and not a current student. Anyone picking up a student must have a valid ID.
1. Authorized:*
2. Authorized:*
3. Authorized:
4. Authorized:
5. Authorized:
6. Authorized:
7. Authorized:
8. Authorized:
9. Authorized:
10. Authorized:
11. Authorized:
12. Authorized:
13. Authorized:
14. Authorized:
15. Authorized:
16. Authorized:
NOT AUTHORIZED
1. Not authorized:
2. Not authorized:
3. Not authorized:
4. Not authorized:
5. Not authorized:
6. Not authorized:
IT IS THE PARENT'S RESPONSIBILITY 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:

MonthDayYear
Date
Parents/guardians have the right to review the professional qualifications of their child's classroom teacher(s) including the licensing status, degree major, graduate degree(s) and the field of certification. This "right to know", available from your child's school, includes whether your child is receiving services provided by paraprofessionals and, if so, their qualifications.

The Emergency Student Data Form governs early release withdraw of the student. The registering parent/guardian must sign/verify this form and is responsible for providing truthful and accurate information. If the student's parents are divorced or separated, the enrolling parent is responsible for providing information that is consistent with the most recent court order governing such matters as divorce, separation or custody. Additionally, please be advised that early release does not constitute an excused absence from class, students must bring a note in for their absences from any class even if they were picked up early.

Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree under Fla. Stat § 837.06, or whoever makes a false verified declaration is guilty of the crime of perjury, a felony of the third degree, under Fla. Stat. § 95.525, which are punishable as provided in Fla. Stat., §§ 775.082, 775.083 and 775.084.
Registering Parent/Guardian's Signature*

Miami Dade County Public Schools
Media Release Parental Consent Form

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.
Date

MonthDayYear
Date
Student First Name
Student Last Name
Please indicate your preference below*

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.
Contact Person
School Name
School Phone Number
Parent Signature*
Student ID

Acknowledgment of Receipt and Review
Each parent/guardian of a student and each student enrolled in Miami-Dade County Public Schools must sign and return this page to the student’s school to acknowledge that he/she has accessed the online version or obtained a copy of the Code of Student Conduct. In addition, this page serves as acknowledgement that you have reviewed the Code of Student Conduct with your child. Each school will maintain records of such signed statements.

The online version of the Code of Student Conduct in English, Spanish, and Haitian-Creole can be located in the Parent Portal or by accessing through the following website address: http://ehandbooks.dadeschools.net/policies/90/index.htm

If you do not have internet access to obtain a copy of the Code of Student Conduct, please visit your child’s school to obtain a copy.

I acknowledge receipt of the notification regarding accessing or obtaining a copy of the Code of Student Conduct through the Parent Portal or via the internet web address and that I have read and discussed the Code of Student Conduct with my child.
Parent Signature: *
Date

MonthDayYear
Date
Date

MonthDayYear
Date
I acknowledge receipt of the notification regarding accessing or obtaining a copy of the Code of Student Conduct through the Parent Portal or via the internet web address and that I have read and discussed the Code of Student Conduct with my parent/guardian.
Student Signature: *

Miami-Dade County Public Schools
Contract for Student Participation in Interscholastic Competitions or Performances per School Board Policy 5845, Student Activities
Do you plan on participating in Interscholastic Competitions or Performances?*
SCHOOL
Student First Name
Student Last Name
Student ID:
List Team and/or Performing Group
A student who participates in interscholastic competitions and/or performance groups should demonstrate high standards of ethics and promote the development of good character and other life skills. A model student participant should exhibit a high degree of decorum demonstrating respect for self, family, and all people regardless of ethnicity, race, religion, gender or physical condition. As a representative of Miami-Dade County Public Schools (M-DCPS), I commit to adhering to the following values and team rules.

Core Values

CITIZENSHIP
I will:
• Comply with school, classroom and interscholastic competition rules.
• Respect all laws and rules of society.
• Use appropriate language at all times.
• Demonstrate behavior that is fair, civil, polite and courteous.
• Abide by and understand the rules of the competition in which I am participating.
COOPERATION
I will:
• Resolve conflicts with peers in an appropriate and lawful manner.
• Adhere to the school dress code.
• Accept responsibility for my own behavior.
• Support classmates and team members in their lawful endeavors.
• Demonstrate school pride in an appropriate manner.
• Cooperate with administrators, teachers, coaches, and sponsors.
COMPASSION
I will:
• Provide support to people who are in need of assistance.
• Demonstrate kindness to peers and adults.
• Assist teachers, coaches, and sponsors in making my school environment a positive place in which to learn.
• Support community outreach programs and charities when possible.
• Make contributions of time and energy that enrich the school environment.
HONESTY and RESPONSIBILITY
I will:
• Tell the truth.
• Live and compete honorably.
• Report any inappropriate or illegal act to an administrator, teacher, coach, or sponsor.
• Complete all work independently.
• Return lost property to the owner.
• Attend school and all classes regularly and on .time.
INTEGRITY
I will:
• Express beliefs and feelings without regard to social pressure and do what's right even when it is unpopular or personally
costly. Help fellow classmates and teammates.
• Support school activities and interscholastic programs.
• Exercise self-control.
• Engage in healthy life-style practices.

EXCELLENCE
I will:
• Put forth maximum effort and complete all academic assignments.
• Maintain a cumulative GPA of at least 2.00.
• Maintain an average conduct grade of at least 2.00 in each semester.
• Commit to being a student first and to getting the best education I can.
FAIRNESS and RESPECT
I will:
• Participate in activities that are safe, respectful and lawful.
• Treat all adults (administrators, teachers, coaches, and sponsors) and peers (teammates) with respect.
• Treat all people the same regardless of ethnicity, race, religion, gender, age or disability.
• Respect the integrity and judgment of competition judges or game officials.
Team Performing Group Rules

All interscholastic athletics and school activities are meant to contribute to the overall academic excellence achieved by a student
participant. The following rules and consequences are seen as the basic conditions that must be met by a student who wishes to
represent his or her school through interscholastic competitions or performances:
1) A student must maintain a cumulative 2.00 GPA or higher as specified by s. 1003.43(1) Florida Statutes.
2) A student must receive a minimum 2.00 in conduct in the preceding semester.
3) If a student is assigned to Indoor Suspension/School Center for Specialized Instruction (SCSI), he or she will be unable to
participate in interscholastic competitions or performances on the day(s) on which he or she is assigned. If the assignment
to SCSl takes place on/or includes a Friday, the student will be unable to participate in interscholastic competitions or
performances on the weekend.
4) A student who is serving an Outdoor Suspension or is assigned to the Student Success Center (SSC) cannot practice
or participate in interscholastic competitions or performances and may be subject to further sanctions or penalties.
5) A student who has a total of eleven (11) cumulative days of suspension (indoor, outdoor/SSC) will not be allowed to
participate in interscholastic competitions or performances for the remainder of the school year.
6) A student who has ten (10) or more cumulative absences will not be allowed to participate in interscholastic competitions
or performances for the remainder of the school year. (Outdoor suspension is considered an absence.)
7) A student who has twenty (20) or more cumulative tardies will not be allowed to participate in interscholastic competitions
or performances for the remainder of the school year.
8) A student must be reported as present for the school day in order to participate in interscholastic competitions or
performances, including practices.
9) A student who participates in interscholastic competitions or performances and has not performed at grade level as defined
by the Florida Department of Education may seek two (2) hours per week of academic tutoring.
10) Any student who is arrested for conduct occurring on or off sc hool grounds will be prohibited from participating in all
interscholastic competitions or performances for a minimum of ten (10) days, including practices.

I have read and understand the requirements of the Contract for Student Participation in Interscholastic Competitions or Performances. I understand that participation in interscholastic competitions or performances is a privilege and not a right. I understand that I am expected to perform according to this contract and the team/performing group rules. I understand that there may be sanctions or penalties, which may include suspension or dismissal from the team/performing group.

This contract is in effect for one (1) calendar year from the date of signature.
Student Signature*
Parent Signature*

RESPONSIBLE USE OF TECHNOLOGY BY STUDENTS
The Miami-Dade County school district provides students technological resources for the purpose of enhancing and supporting the educational environment. Students are encouraged to use these technological resources to enhance their learning experience and to ultimately benefit their education. When using these technological resources, students are expected to use these resources in a safe, legal, and responsible manner. The following guidelines describe what the District considers to be responsible use of its technological resources and what constitutes appropriate conduct on social media (Facebook, Instagram, SnapChat, etc.):

Click on this link to download a copy of the agreement
Student First Name
Student Last Name
Grade Level
Parent Name

First NameLast Name
STUDENT AND PARENT/GUARDIAN ACKNOWLEDGEMENT:
We have reviewed and familiarized ourselves with the School Board’s Student Responsible Use of Technology, Social Media, and District Network Systems Policy 7540.03. We agree to comply with the School Board’s Student Responsible Use of Technology, Social Media, and District Network Systems Policy 7540.03., and to follow the above listed “Responsible Use” guidelines, while using District computer equipment and connecting to the District’s network and online systems. I understand that violation of School Board Policy 7540.03 may result in disciplinary action, up to and including, termination of network privileges, expulsion, civil or criminal prosecution.
Student Signature*
Parent Signature*
You must take a picture of your drivers license to verify information parent information.*

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Miami Palmetto Senior High School Honor Code
You May Download the Miami Palmetto Honor Code Agreement Here
Honor Agreement
Having read the Miami Palmetto Senior High Honor Code, on my honor, I accept the terms of the Honor Code and promise not to commit any act of academic misconduct. I understand and accept my responsibility as a member of the Miami Palmetto community to maintain my honor and integrity at all times. All members of the Palmetto community are bound by the Honor Code; failure to sign does not release a member from this commitment.
Student Signature*
Email
example@example.com
Should be Empty:

EMERGENCY STUDENT CONTACT CARD