2025-2026 Jasper R-V Enrollment

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Proof of Residency* This field is required.Upload ONE of the following: Current Mortgage Statement, Paid Real Estate Statement (from most recent year), Current Lease/Rental Agreement, Utility Bill (electric, water, or gas- w/in last 30 days) ** DOCUMENT MUST SHOW GUARDIANS NAME & MATCHING STREET ADDRESS- GENERAL MAIL AND DISCONNECT NOTICES CANNOT BE USED**
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Is your student transferring from another school district?* This field is required.
YESNO
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Consent For Release Of Student Records
Name and address of school previously attended
Phone Number
Fax Number
Please Select
Please Select
Yes
No
Has had an IEP in the past
Does the Student have an IEP (Individualized Educational Plan)?
Student Name
Please Select
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Students Grade for 25-26 School Year
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Enrollment Information* This field is required.
Student Name (First & Last)
Student Birthdate
Gender
Please Select
Please Select
Asian
Black/African American
Hispanic/Latino
Native American/Alaskan Native
White
Race
Physical Address
Please Select
Please Select
Parents
Mother
Father
Guardian
Other
With whom does the student reside?
Please Select
Please Select
K
1
2
3
4
5
6
7
8
9
10
11
12
Student Grade
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Legal Guardian #1* This field is required.
Guardian Name
Guardian Place of Employment
Guardian Home Phone Number
Guardian Work Phone Number
Guardian Email
Relationship to Student (Father, Mother, Grandparent, Foster Parent, etc.)
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Legal Guardian # 1Address (if not residing with student)
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Legal Guardian #2* This field is required.
Guardian Name
Guardian Place of Employment
Guardian Home Phone Number
Guardian Work Phone Number
Guardian Email
Relationship to Student (Father, Mother, Grandparent, Foster Parent, etc.)
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Legal Guardian #2Address (if not residing with student)
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Case WorkerIf Applicable
Case Worker Name
Case Worker Phone Number
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Emergency Contacts* This field is required.Please list three emergency contacts
Contact 1 Name
Contact 1 Phone Number
Contact 2 Name
Contact 2 Phone Number
Contact 3 Name
Contact 3 Phone Number
Please Select
Please Select
Go Home As Usual
Other
In case of unexpected, early dismissal due to weather or other emergency, my child should:
If Other was selected, I would like my child to:
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Medical Information* This field is required.
Student's Physician
Physicians Phone Number
Health Insurance Company or Medicaid #
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Medical Information* This field is required.
List any allergies (Documented by Physician)
Please document any important information regarding students health
Does this student have any health conditions (physical or emotional) that requires daily medications? If so, list condition and medications (including name, dosage, frequency)
Please list physical activity restrictions and reason
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Medications* This field is required.
Please Select
Please Select
My child MAY be given generic Tylenol/Ibuprofen at the discretion of the school nurse and has no allergies to these medications.
My child MAY NOT be given Tylenol/Ibuprofen at the discretion of the school nurse and has no allergies to these medications.
Tylenol/Ibuprofen
Please Select
Please Select
My child MAY be given generic antacids at the discretion of the school nurse and has no allergies to these medications.
My child MAY NOT be given antacids at the discretion of the school nurse and has no allergies to these medications.
Antacids
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CONSENT FOR TREATMENT OF A MINOR* This field is required.I herby request and consent to the performance of such medical, surgical and dental procedures (whether or not including local or general anesthesia) as the doctors may deem necessary in the course of treatment of my student. This will be valid for both school accidents and activity trips away from school.
Please Select
Please Select
Yes, I consent to treatment of a minor
NO, I DO NOT consent to treatment of a minor
Select One
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Field Trips* This field is required.I give permission for my student to participate in field trips for this school year
Please Select
Please Select
Yes
No
Select One
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Student Housing Questionnaire* This field is required.This questionnaire is intended to address the McKinney-Vento Act, Title X, Part C of the Elementary and Secondary Education Act (ESEA). The McKinney-Vento Act specifically states that enrollment barriers be removed to provide educational stability. Federal McKinney-Vento Assistance Act ensures education rights and protections for children and youth experiencing housing difficulties or loss of housing. Please indicate the student's current living arrangements (Check all that apply).
Resides with parent/guardian in district or parent/guardian is a district employee
In a shelter, domestic violence shelter, group home, transitional housing or FEMA trailer (NOT Section 8 housing)
In a home of a friend or relative temporarily (due to lack of housing or financial conditions)
In a hotel/motel
In a place NOT considered traditional housing (car, campground, park, abandoned building)
In your own home without adequate utilities (running water, heat, electricity)
Living alone as a minor student(s) without an adult (unaNextccompanied youth)
In a home of a friend or relative permanently
In own home (includes Section 8 housing)
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1:1 Chromebook Agreement
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1:1 Chromebook Agreement* This field is required.The following information must be completed each student prior to being issued a Chromebook.
Student Name
Please Select
Please Select
Agree
Disagree
I agree to abide by all terms listed in the Chromebook 1:1 agreement. I understand that if I am found to be in violation of any terms in this agreement that I could face fines, loss of privileges, or disciplinary actions.
Parent/Guardian Name
Please Select
Please Select
Agree
Disagree
I agree to abide by all terms listed in the Chromebook 1:1 agreement. I understand that if I am found to be in violation of any terms in this agreement that I could face fines, loss of privileges, or disciplinary actions.
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Student Internet Acceptable Use Policy
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Student Internet Acceptable Use Policy * This field is required.The following information must be completed each student prior to student accessing the internet.
Student Name
Please Select
Please Select
Agree
Disagree
I agree to abide by all terms listed in the Chromebook 1:1 agreement. I understand that if I am found to be in violation of any terms in this agreement that I could face fines, loss of privileges, or disciplinary actions.
Parent/Guardian Name
Please Select
Please Select
Agree
Disagree
I agree to abide by all terms listed in the Chromebook 1:1 agreement. I understand that if I am found to be in violation of any terms in this agreement that I could face fines, loss of privileges, or disciplinary actions.
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Parent/Guardian Permission for Computer/Internet Access * This field is required.I hereby give permission for my child to use computers in the school district and to access the Internet for educational purposes.
Please Select
Please Select
Agree
Disagree
Parental/Guardian Consent- As the parent or guardian of this student, I have read the Jasper R-5 School District Internet Acceptable Use Policy and I agree to the guidelines/rules contained in this policy.
Please Select
Please Select
Agree
Disagree
Student Agreement- My student has read the Jasper R-5 School District Internet Agreement. I agree to use the Internet/Information Network for educational purposes. I understand that if I violate the policies my user account can be terminated and I may face disciplinary measures as specified in the district’s policies.
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Permission for use of Pictures, Voice, Work or Video* This field is required.Images are used to promote and celebrate work completed in our school district. This permission will be in effect until consent is withdrawn. You may withdraw your consent at any time by sending a written letter. Please be aware if your student attends a school activity (i.e. class party, homecoming, field trips, super kids field day, etc.) pictures may be taken outside of the school's control. We can't be held responsible for pictures taken by other community members and what they do with those pictures. Please indicate if you do or do not give permission for your students in each of the areas.
Please Select
Please Select
Yes
No
Individual picture in the newspaper or on television (which may be posted online at times)
Please Select
Please Select
Yes
No
Group photo in the newspaper or on television (which may be posted online at times)
Please Select
Please Select
Yes
No
Work, picture, or name used on school grounds (i.e. hallway, assembly video, etc)
Please Select
Please Select
Yes
No
Work, picture, or name in the class or school newsletter or throughout the community
Please Select
Please Select
Yes
No
Name and pictures in the school yearbook
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Acknowledge Concerning Use of Student Lockers* This field is required.Student lockers are the property of the School District. 2. Student lockers remain at all times under the control of the School District. 3. I am expected to assume full responsibility for my school locker. 4. The School District retains the right to inspect student lockers for any reason at any time without notice, without student consent and without a search warrant.
Please Select
Please Select
Agree
Disagree
My student and I understand and will abide by the locker policy
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Acknowledge Concerning Use of Student Parking Lots* This field is required.I acknowledge and understand that: 1. Students are permitted to park on school premises as a matter of privilege, not of rights. 2. The School District retains authority to conduct routine patrols of student parking lots and inspections of the exteriors of student automobiles on school property. 3. The School District may inspect the interiors of student automobiles whenever a school authority has reasonable suspicion to believe illegal or unauthorized materials are contained inside the automobiles. 4. Such patrols and inspections may be conducted without notice, without student consent, and without a search warrant. 5. If I fail to provide access to the interior of my car upon request by a school official, I will be subject to school disciplinary action.
Please Select
Please Select
Agree
Disagree
My student and I understand and will abide by the locker policy
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Jasper R-V School District Student Activities Drug Testing Policy* This field is required.I, the undersigned participant in the extracurricular activities program in the Jasper R-V School District, Jasper, Missouri, am willing and consent to take a drug-screening test for illegal substances in accordance with District policies and procedures. I understand that my failure to consent to such a screening will cause me to be ineligible to participate in activities. I also understand that the results of such tests will be considered toward determining my continued eligibility for participation in activities. I consent to allow a specimen of my urine to be collected by the drug testing collection agency designated by the Jasper R-V School District and to have a drug testing collection agency and/or testing laboratory designated by the District perform a substance abuse analysis on the specimen. I also consent to the release of the results of the analysis by the drug testing collection agency and/or testing laboratory to the authorized district personnel via electronic or other means, i.e. telephone, facsimile, computer, etc.
Please Select
Please Select
Consent to Drug Testing Student
DO NOT Consent to Drug Testing
Student and Parent/Guardian Consent
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Elementary Student HandbookPrinted copies may be requested from the office.
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High School Student HandbookPrinted copies may be requested from the office.
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FERPA DIRECTORY INFORMATION OPT-OUT FORMIn accordance with the Federal Educational Rights and Privacy Act of 1974 (FERPA), as amended, a student’s education records are maintained as confidential and, except for a limited number of special circumstances listed in that law, will not be released to a third party without the parent/student’s prior written consent. The law, however, does allow schools to release student “directory information” without obtaining the prior consent of the parent/student. If you do not want the release of certain types of directory information without your prior consent, you may choose to “opt-out” of this FERPA exception by signing the Form below. Directory information of a student who has opted-out from the release of directory information, in accordance with this policy/procedure for opting out, will remain flagged until the student requests that the flag be removed by completing and submitting a revocation of the opt out to the School.
I request the withholding of the following personally-identifiable information identified as Directory Information under FERPA. I understand that upon submission of this Form, the information checked cannot be released to third parties without my written consent or unless the School is required by law or permitted under FERPA to release such information without my prior written consent; and that the checked directory information will not otherwise be released from the time the School receives my Form until my optout request is rescinded. I understand that I may not opt out of use of my student ID number because it is necessary identifying information for the School. I further understand that if directory information is released prior to the School receiving my optout request, the School may not be able to stop the disclosure of my directory information. I understand that I may request and challenge how my directory information is used by contacting the School.
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Signature* This field is required.I hereby certify that, I have received a student handbook and to the best of my knowledge, the provided information is true and accurate
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