New Student Enrollment Packet

Child's Health/Emergency Information and Authorization Form for Transportation Providers

(to be completed by the child's parent or guardian)
Child's Name*
Other Name Child Responds to if applicable
Birthdate*

MonthDayYear
Date
Parents/Guardian 1 Name*
Parents/Guardian 2 Name
Address*
Main Phone
Workplace (if applicable)
Workplace (if applicable)

Area CodePhone Number
Secondary Phone
Address where child is to be picked up and returned (if different from above)
Person(s) responsible for meeting child being transported*
In case of emergency and the parent(s)/guardian(s) cannot be reached, please contact one of the following person(s):
Name*
Phone*
Address*
Relationship to child*
Name (2)
Phone
Address
Relationship to child
Please give specific instructions if your child needs special assistance, equipment, or materials when transported.
List any chronic medical condition or allergies your child may have as well as any medications your child may take:
Other important information about your child (please include any developmental or behavioral concerns)
Authorization for Transportation Services
I authorize Sandhills Emergency Physicians to transport my child to and from the following location
name of preferred hospital
Signature of Parent/Guardian

Clear
Date*

MonthDayYear
Date
Authorization for Emergency Medical Care
In case of accident or illness requiring medical attention, the undersigned authorizes Sandhills Emergency Physicians (transportation provider) to call a health care provider to take my child
child's full name
to the nearest hospital or doctor, and it is understood that if possible, their services will be obtained. If neither parents nor preferred health care provider can be contacted, the transportation provider is authorized to contact another health care provider. It is also understood that this agreement covers only those situations, which in the best judgment of the transportation provider, are true emergencies.
The health care provider to call is:*
Name, Address, Phone
My hospital preference is:*
Name, Address, Phone
I authorize emergency treatment deemed necessary by a physician in the event that I cannot be reached for permission. I agree to be responsible for the cost of such emergency medical care.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date

Photo + Video Release
Please select one option below regarding photo and video sharing permissions*

I hereby grant to Graham & Keane, LLC DBA The Garden absolute and irrevocable right and unrestricted permission in respect of photographic portraits, editorial or any pictures or videos taken of me or in which me and/or my child(ren) may be included with others, to copyright the same; to re-use, publish and republish the same in whole or in part, individually or in conjunction with other photographs, and in conjunction with any printed matter, in any and all media now or hereafter known, and for any other purpose whatsoever, for illustration, promotion, art, editorial, advertising and trade, or any other purpose whatsoever with restriction as to alteration; from time to time, or reproductions thereof in color, black and white or otherwise made through any media. I hereby waive any right that I may have to inspect or approve the finished products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied. I hereby release, discharge and agree to save harmless Graham & Keane, LLC DBA The Garden its legal representatives or assigns and all persons acting under its permission or authority, from any liability in connection with the use of the photographs as aforesaid or by virtue of any alteration, processing or use thereof in composite form, whether intentional or otherwise, as well as any publication thereof. I understand that the photographs will be included into stock files. I agree that the photographs, the transparencies thereof and the rights to copyright the same, shall be the sole property of Graham & Keane, LLC DBA The Garden, with full right of lawful disposition in any manner. I hereby grant permission to Graham & Keane, LLC DBA The Garden to use any photographs of the participant(s) during activities in video, audio-visual and printed materials without compensation or approval rights.I do NOT wish to have my child’s photo or video shared in any manner. I do NOT give my permission to have my child’s photo or video taken or shared in any fashion by The Garden or any of it’s employees.I do not wish to have my child's photo or video shared publicly, however, I give permission for my child's photo to be taken and shared with ONLY me and any approved adults listed below.I do not wish to have my child's photo or video shared publicly, however, I give permission for my child's photo to be taken and shared in class emails/newsletters which are
Parent or Guardian Name*
First, Last
Printed Name of Minor(s)*
First, Last
Approved Adults (if applicable)
Respectful Image Sharing Agreement
(all parents are required to sign this portion):

I hereby agree to be respectful of other students' and parents' privacy in regards to any photos or videos that are shared in any fashion with members of The Garden community. I agree not to share photos on my own personal social media accounts or in any other manner without distinct permission from the parents of any child pictured.
Signature of Parent or Guardian*

Clear
Date*

MonthDayYear
Date

Community Handbook Agreement Form

The Garden Community Handbook is an open document intended to acquaint community members with school policies and guidelines. Any new addendum to this handbook will be provided separately. It is imperative that the contents of this handbook be read and carefully reviewed by all community members. Your agreement to abide by the policies contained in this Handbook is indicated by signing and submitting this document in agreement with the statement below. The Garden Community Handbook can be found on our website or a physical copy can be acquired by request only. Please read through the handbook along with any other parents/guardians/caregivers and sign this document electronically below. Together we can work as a team to provide a positive, safe, and effective experience for each member of our community by adhering to these guidelines. Thank you for your support. Please sign the portion below to verify that you have read and agree to all terms, policies, practices, and other items listed here, please note that this is a living document and policies are subject to change; changes will be presented as they are made, and parents will be notified of any changes made and provided with an updated copy of the handbook. Should you have any questions, requests for additions, or edits of this document prior to signing, please contact us.
Access the Community Handbook online here.
Signature*

Clear
Date*

MonthDayYear
Date

MEDICAL FILE

If available now, please upload your child's immunization record, medical report, and/ or emergency care plan. These can also be emailed to us anytime before your child begins school.
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New Student Enrollment Packet

Child's Health/Emergency Information and Authorization Form for Transportation Providers

Authorization for Transportation Services

Authorization for Emergency Medical Care

Photo + Video Release

Community Handbook Agreement Form

Student Accessibility Form

Family Information

Care Needs

Permission/Authorization Agreement

Non-discrimination and accessibility policy

MEDICAL FILE