24-25 Consent to Share

EDMONDS SCHOOL DISTRICT CONSENT TO SHARE ELIGIBILITY INFORMATION FOR OTHER SCHOOL PROGRAMS 2024 - 2025 SCHOOL YEAR
If you qualify for free or reduced - price meals based on household size or income or, if you receive Basic Food, Temporary Assistance for Needy Families (TANF), Food Distribution on Indian Reservations (FDPIR), or have been Directly Certified as eligible for free or reduced meals, you may be eligible for decreased fees to participate in other school programs.

This form is optional and submitting / not submitting this form will not affect your student's eligibility for free or reduced priced meals, or milk.

Individuals or programs receiving the information you authorize for release on this form will not share the information with any other entity or program. An updated consent must be filed with the school district every school year.
By checking the boxes and signing below, you are authorizing the release of student names(s) and eligibility status only, no other information or demographics will be shared.*

Associated Student Body (ASB) - Fees / Dues Includes: Cards, Athletics, Clubs, Dances, Performances, Trips & All Other Extracurricular Non-Credit ActivitiesAcademic - Fees / Dues Includes: Classes, Curricular Program, Instrument Rentals, Supplies, Testing (PSAT, SAT, ACT) & Technology Fees, Field Trips / CampsSchool Parking - FeesGraduation Tickets
Print Student(s) First and Last Name & Student ID number if known:
Student #1:*
Student #1 ID Number:
Student #2:
Student #2 ID Number:
Student # 3:
Student #3 ID Number:
Student #4:
Student # 4 ID Number:
Student # 5:
Student #5 ID Number:
Student # 6:
Student #6 ID Number:
Parent / Guardian First and Last Name*
Signature of Parent/Guardian*

Clear
Date

MonthDayYear
Email*
Phone Number
Please enter a valid phone number.
USDA is an equal opportunity provider and employer
Please verify that you are human*
Should be Empty:

EDMONDS SCHOOL DISTRICT CONSENT TO SHARE ELIGIBILITY INFORMATION FOR OTHER SCHOOL PROGRAMS 2024 - 2025 SCHOOL YEAR

Print Student(s) First and Last Name & Student ID number if known: