Gordon Parks School Application Form

MaleFemalePrefer Not to Say

Please enter a valid phone number.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

This is the address where the child resides and where school transportation will pick them up and drop them off

Please enter a valid phone number.

In case of emergency, who will be notified? Please answer the fields below:

Please enter a valid phone number.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

MorningAfternoonBothNo transportation needed

Required Legal Documentation

All students must provide the following information at the time of enrollment:

Adoption Papers
Foster Care Information
Order of Protection/Restraining Order
Parenting Plans/Custody Agreements
Any other legal documents signed by a judge pertaining to child custody

All the legal documents have already been provided to Gordon ParksI do not have any legal documentation on my child that the school needs to be aware of.Yes, I do have legal documentation that Gordon Parks Elementary needs to keep on file. A copy of those documents are attached to this application

Public Information Release:

Gordon Parks strives to publicize and promote the accomplishments of its students, including awards, human interest stories, and other events that highlight the many successes within our school. Should the opportunity arise for students to be featured in media-related projects, only children with completed releases will be considered. Students may be interviewed on radio, photographed, and/or videotaped for use in news stories, and/or promotional material about/for Gordon Parks Elementary, new organizations, or agencies representing the school.

Yes, I give my permission and consentNo, I do NOT give my permission and consent

Field Trip Release

During the school year students will go on field trips to different destinations in the area. Information for each field trip will be provided by the teachers. In order for your student to participate in these field trips, a parent/guardian must indicate that they agree to the following:

I give my permission on consent for my student to go on field trips throughout the school year.
In case of emergency I understand that I will be notified as quickly as possible.
The prinicipal or staff member in charge can make immediate arrangements for any medical treatment for my student
If the school is unable to contact me, I authorize treatment at the nearest hospital.

Yes, I give my permission and consentNo, I do NOT give my permission and consent

Counseling Program Release

Gordon Parks Elementary employs a counselor licensed by the State of Missouri to work with students. The counselor will offer individual support when needed and lead classroom programming on topics such as conflict resolution, relationships, and community building. No individualized therapy is conducted without prior consultation with the caregiver.

Yes, I give permission for the counselors at Gordon Parks to work with my studentI do NOT give my permission for the counselors at Gordon Parks to with my student

Mentor Program Release

I give permission for my child to participate in the School Mentoring Program. I understand that participation in this program is entirely voluntary, and my child is not required to take part. Additionally, I acknowledge that the mentors in this program are volunteers and not employees of Gordon Parks Elementary School.

All meetings between my child and the mentor will take place during lunch hours and will always be held on school grounds. Mentors must be at least 21 years old and are required to complete an application, sign a waiver, and pass a comprehensive background check before participating. Each mentor undergoes screening and will be supervised during their visits to Gordon Parks.

I understand that I can withdraw my consent at any time by providing written notice to the principal, at which point my child will no longer participate in the mentoring program.

Please sign below so that we can send this request to your previous school.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please enter a valid phone number.

Please answer the following questions. An explanation must be provided if you answer "yes" to any of the questions.

Doctor's OfficeEmergency RoomCommunity Health ClinicOther

Private or Employer PolicyMedicaidNo insurance

Medications Policy

1. Medication will not be administered at school without a written order from the student's physician

2. Please bring all medication tot he office where they will be kept in a locked cabinet.

3. All medication, including inhalers, must be accompanied by a prescription and provided in a manufacturer labeled container and labeled with your student's full name.

4. Please provide any necessary items needed to adminster the correct dosage

5. Students with asthmamust have an Asthma Action Plan on file

My student is taking medications that will need to be administered during regular school hours.My student is NOT taking medications that will need to be administered during school hours.

By MouthInhalationInjectionTopical

Hour Minutes

AM/PM Option

Hour Minutes

AM/PM Option

Over-the-Counter (OTC) Medications

Over-the-Counter (OTC) Medication will be administered sparingly when indicated to make your child more comfortable and able to remain at school. For example, the medication may be used for dental pain, mild headaches, or orthopedica pain related to a recent injury. You may still be contacted for further care of your child. If your child does have a fever (100.00 F or higher), he/she will be sent home from school and not allowed to return until fever-free without medication for 24 hours.

School personnel must have parental consent to administer OTC medciations. If parents send their own OTC medications to be administered them at school, they mus complete the "Authorization for Medication" form which can be obtained from the school nurse.

Tier 1: Language Background

The school is required to assess the English language proficiency of all students who indicate, or are suspected of having, a first language other than English. If the results of the assessment show a student needs language support, you will be notified in writing and the school district will provide language support as deemed appropriate by district staff.

School Application Form

SPECIAL EDUCATION INFORMATION

Parent/Guardian's Information

Transportation Information

Legal Documentation

Federal Programs

Permission Forms

Previous School Records Release

Safe School Form

Health Questionnaire

Medication Information

Language Use Survey