Student Entry Form 2025-2026
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
Sex (as indicated on Birth Certificate)
*
Male
Female
Grade
*
Please Select
Kindergarten
1
2
3
4
5
Student ID # (If known)
Primary Email Address
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
Home Phone
*
Please enter a valid phone number.
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (If different from residential address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parental Authorization for Deviation from Student's Legal Name
Under Fla. Admin. Code R. 6A-10955: Education Records, each school district must develop a form to obtain parental consent whereby parents may specify the use of any deviation from their child's legal name in school. Without this consent, school personnel are obligated to use your student's legal name as it appears on their birth certificate.
This consent authorizes school personnel to use the parent/guardian approved name/nickname, as indicated below, for my student. I understand that this name/nickname will be entered into the Student Information System (FOCUS).
Does the student have a nickname that school personnel are authorized to use?
*
Yes
No
Parent/Guardian approved Nickname:
Leave blank if not applicable.
Ethnicity: Are you Hispanic/Latino?
*
Yes
No
Language spoken at home:
*
English
Spanish
Other
Race: Check at least one. (Note: Hispanic/Latino is not a race)
*
White
African American/Black
American Indian/Native Alaskan
Asian
Native Hawaiian or Pacific Islander
Birthplace
*
City
State / Province
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
How will the student get home from school?
*
Walk
Car
Bus
Other
Has the student ever been expelled from any school, had an arrest which resulted in a charge, had any other Department of Juvenile Justice actions against him/her, or been referred for mental health services?
*
Yes
No
If yes, briefly describe:
Florida Statute 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree.
Migrant/Farm Worker?
*
Yes
No
If yes, do you travel in FL or to other states to find farm work?
Yes
No
Mother's Name on Birth Certificate
*
Father's Name on Birth Certificate
*
Type N/A if not listed on Birth Certificate
Brothers/sisters attending school:
Name
Grade
Student ID (If known)
School
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Has the student been in an exceptional student education (ESE) or any other special education program?
*
Yes
No
Has the student been determined eligible under Section 504 and/or has a Section 504 plan?
*
Yes
No
Has the student been in any ESOL or ELL program or class?
*
Yes
No
Is your family residing in any of the following situations?
*
Sharing the housing of others due to loss of housing or economic hardship
Living in a motel or hotel due to loss of housing or economic hardship
Staying in a shelter
Substandard housing; without electricity, running water, health code violations, etc.
Sleeping in a car, campground, park or public space
None of the Above
Student lives with:
*
Both Parents
Parent & Step Parent
Mother Only (P)
Father Only (P)
In Foster Care
Other
Documentation Required:
Surrogate Parents
Legal Guardian
Guardian Ad Litem
Other
Are you the legal parent or guardian of the student?
*
Yes
No
Has the student repeated any grades? If yes, which grades?
Has the student ever attended a Florida/Polk County school (Pre-K-5)?
*
Yes
No
Give the name, complete address and phone number of the last school attended.
School Name
Street Address
City
State / Province
Phone
Did the student complete kindergarten?
Yes
No
Years in school, including kindergarten, prior to current year:
Did the student complete a VPK program?
Yes
No
Name and location of VPK program:
Enrolling Parent/Guardian Name (Print Name)
*
Enrolling Parent/Guardian Signature
*
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Emergency and Contact Information Form 2025-2026
Student ID # (If known)
Grade
*
Please Select
Kindergarten
1
2
3
4
5
Birth Date
*
-
Month
-
Day
Year
Sex (as indicated on Birth Certificate)
*
Male
Female
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (If different from residential address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
How will the student get home from school?
*
Walk
Car
Bus
Other
Court Order on File?
*
Yes
No
Emergency Contacts
Contact 1 (Must be Parent or Guardian)
*
*
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
*
Parent
Step-Parent
Guardian
Other
Lives With?
*
Yes
No
Contact 2
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Contact 3
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Contact 4
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
*Each parent has the right to pick-up, visit, and meet with his/her student at school, without interference of or the need for consent from the other parent, unless the school has received a certified copy of an enforceable court order that provides to the contrary. In addition, a court order is necessary to deny records access to parents/guardians.
Brothers/sisters attending school:
Name
Grade
Student ID (If known)
School
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Additional Contacts
Contact 5
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Contact 6
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Contact 7
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Contact 8
Select One
Notify if Sick/Injured
Yes
No
Receives Automated Emergency Calls
Yes
No
Notify if Absent
Yes
No
Pick Up Allowed
Yes
No
Records Access Allowed
Yes
No
Personal Contact Allowed at School
Yes
No
Relationship to Student:
Parent
Step-Parent
Guardian
Other
Lives With?
Yes
No
Notice: You are required to complete the Emergency and Contact Information Form and update information annually or at any time the information changes. School personnel will contact you to pick up your child if he/she is unable to remain at school due to illness or accident. If school personnel are unable to reach you, one of the adults listed on the Emergency and Contact Information Form designated to pick up your child will be contacted. School personnel will contact Emergency Medical Services in an emergency to take whatever action is deemed necessary for the health and safety of your child. Parents are financially responsible for any emergency care and/or transportation your child needs. Also, it is your responsibility to notify your child's school of any changes in the information recorded on this form and to provide the school with information if there are any custody restrictions involving your child. Forms must accurately reflect your child's court order, if applicable.
I certify that the information provided on this Emergency and Contact Information Form is accurate, true, and correct.
Enrolling Parent/Guardian Name (Print Name)
*
Enrolling Parent/Guardian Signature
*
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Confidential Medical Information Form 2025-2026
Parent or Guardian must complete and sign this form. Please mark the checkbox next to any condition or illness that applies to your child. Note: For medication questions, please mark the "yes" box only if the child is taking medication now.
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
Birth Date
*
-
Month
-
Day
Year
Sex (as indicated on birth certificate)
*
Male
Female
Student ID # (If known)
Grade
*
Please Select
Kindergarten
1
2
3
4
5
Teacher
Bus #
Home Phone # 1
*
Please enter a valid phone number.
Phone # 2
Please enter a valid phone number.
Physician's Name
Physician's Phone Number
Please enter a valid phone number.
Does the student have any known allergies? If yes, allergy information MUST be detailed below.
*
Yes
No
Allergies
Yes
List Specific Allergies
Food Allergy
Medicine Allergy
Allergy to ants, wasps, bee stings, environmental or other
Specify reaction(s) to allergy or allergen:
Rash
Swelling
Hives
Trouble Breathing
Vomiting
Diarrhea
Other
Does child take medication for any allergies?
Yes
No
Name medication(s) taken for allergies.
Does child need a special diet? (If yes, the school will require a Diet Modification Form from a doctor. Obtain the Diet Modification Form online or from the School Nutrition Manager.)
*
Yes
No
Asthma
History of Asthma
Under doctor's care
List Triggers:
Takes medication for asthma
Name Medication(s)
Complete all that apply.
Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
ADD/ADHD
Takes medication
Name Medication(s).
Complete all that apply.
Autism Spectrum Disorder
Autism Spectrum Disorder
Diagnosed by Medical Doctor
Takes Medication
Name Medication(s)
Complete all that apply.
Autoimmune Disease (Lupus, etc)
Autoimmune Disease
Explain Autoimmune Disease:
Complete all that apply.
Blood Disorders
Blood Disorder
Sickle Cell Anemia
Bleeding condition
Please Specify:
Complete all that apply.
Cancers
Cancer
Explain Cancer(s):
Complete all that apply.
Cystic Fibrosis
Cystic Fibrosis
Takes Medication
Name Medication(s)
Complete all that apply.
Diabetes
Diabetes
Does child require insulin?
Does child require insulin AT SCHOOL?
Takes Medication
Name Medication(s)
Complete all that apply.
Yes
No
Yes
No
Hypoglycemia (low blood sugar)
Hypoglycemia
Takes Medication
Name Medication(s)
Complete all that apply.
Digestive Disorders
Digestive Disorder
Explain Digestive Disorder(s):
Complete all that apply.
Head Injury (serious)
Head injury
Explain Head injury:
Complete all that apply.
Hearing Problems
Hearing problems
Uses Hearing Aid
Right ear
Left ear
Other Information
Complete all that apply.
Heart Condition
Heart Condition
Under doctor's care for this condition
Explain Heart condition:
Physical Restrictions
Explain Physical Restrictions:
Complete all that apply.
High Blood Pressure (Hypertension)
High Blood Pressure
Takes Medication
Name Medication(s)
Complete all that apply.
Kidney or Bladder disorders
Kidney or Bladder Disorder
Explain disorder:
Requires catheterization
Explain / Type of catheterization
Complete all that apply.
Mental Health Conditions
Mental Health Condition
Specify Condition:
Takes Medication
Name Medication(s):
Complete all that apply.
Migraines
Migraines
Under doctor's care
Takes Medication
Name Medication(s):
Complete all that apply.
Muscle/Bone/Mobility Disorders
Muscle/bone/mobility disorder
Explain disorder:
Complete all that apply.
Seizure Disorders
Seizure disorder
Type of seizure(s):
How long ago was the last one?
Takes Medication
Name Medication(s):
Complete all that apply.
Vision Problems
Vision Problems
Explain Vision Problems:
Complete all that apply.
Other Medical Conditions not listed
Other Medical Condition
Explain Other Medical Condition(s):
Complete all that apply.
Other Medications taken not listed above
Other Medications taken
Name other Medication(s) taken not listed above:
Complete all that apply.
Please confirm that the information provided on this form is complete and accurate.
*
All of my child's conditions, illnesses, and/or medications have been accurately described on this form.
My child does NOT have any of the listed conditions or illnesses.
Additional comments or other health information:
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Parent Consent for School Health Services School Year 2025-2026
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
Student ID # (If known)
Grade
*
Please Select
Kindergarten
1
2
3
4
5
Teacher
The Florida Department of Education and the Florida Department of Health work in cooperation to coordinate the School Health Services Program as mandated in Florida Statute sections 381.0056, 281.0057, and 402.3026. Pursuant to Florida Statute 1001.42: A parent/guardian MUST opt-in yearly for their child to receive school Health Services/Clinic Services. Please indicate if you want your student to be able to receive the services indicated below. Check “Yes” or “No".
I want my child to be able to access care in the clinic due to illness or injury. School health/clinic services may include: first aid, emergency care *, health appraisals, nursing assessment, health counseling, referral and follow-up, health promotion, disease and injury prevention, basic health education provided in the clinic, and health consultations. ***If "NO", the student will NOT receive health/clinic services as outlined above, including, but not limited to, temperature checks, first aid, etc.
*
Yes
No
I want my child to participate in individual student screenings related to learning, behavior and/or social emotional well-being as needed by the school problem-solving team to ensure proper instruction and intervention in these areas. This may also include an individual vision and/or hearing screening to rule out vision difficulties affecting learning.
*
Yes
No
* There is not an option to withhold/decline consent for emergency care. In emergency situations, school personnel will contact Emergency Medical Services and provide emergency care until EMS arrives. Once EMS arrives, they will take whatever action is deemed necessary for the health and safety of your child. Parents are financially responsible for any emergency care and/or transportation your child needs.
This consent DOES NOT AUTHORIZE invasive screening or procedures (COVID-19 testing, blood draw, vaccinations, etc.), preventative health care, medication administration, mental health counseling, therapy (physical therapy, occupational therapy, etc.) or other services that require specific parental direction and consent (administration of medication, medical procedures, medical management of chronic health conditions, etc.)
For your child to receive any medication or medical treatment at school, you must consent to health services/clinic visits and provide a new Authorization for Medication/Treatment signed by you and your child’s doctor each school year. All medications must be brought to school by an adult. All medications and/or treatment, equipment or supplies must be supplied by the parent/guardian.
You are also required to complete the Emergency and Contact Information Form and update information annually or any time the information changes. School personnel will contact you to pick up your child if he/she is unable to remain at school due to illness or accident. If school personnel are unable to reach you, one of the adults listed on the Emergency and Contact Information Form designated to pick up your child will be contacted.
NOTICE: The following state mandated health screenings are provided: vision screening in grades PreK, K, 1, 3, 6; hearing screening in grades PreK, K, 1, 6; growth and development/Body Mass Index (BMI) screening in grades PreK, 1, 3, 6; blood pressure screening for Head Start PreK; and scoliosis screening in grade 6. If you do not want your child to participate in any of the screenings above, please complete the School Health Screening Opt-Out Form available at your child’s school. You may also access the form from the district’s website (https://polkschoolsfl.com/policiesandforms). The opt-out form must be completed and submitted each school year that you do not want your child to participate in the mandatory health screenings.
Polk County Public Schools will only share student medical information from education records in accordance with law. It may be necessary to share some information about your child with the School Board’s health care partners to provide and evaluate health services or obtain emergency medical treatment. Your child’s education records may also be shared with school officials who have a legitimate educational purpose for accessing such treatment records. Therefore, it is your responsibility to notify the school of any changes in the information recorded on this form.
I certify that I consent to or decline Health Services/Clinic Services as indicated above, that the information on the Medical Information Form is accurate, and that I understand the school keeps all medical information and records in accordance with Florida law.
Enrolling Parent/Guardian Name (Print Name)
*
Enrolling Parent/Guardian Signature
*
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LWCS Physical Education Participation/Restriction Form
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
Grade
*
Please Select
Kindergarten
1
2
3
4
5
School
The following information is required regarding any physical education restrictions of your child. This will enable us to plan for the most appropriate physical activities for your child.
*It is recommended that a student be given a physical examination each year by his/her physician.
Physical Condition of the Student:
*
My child is physically able to participate in the physical education program in the Lake Wales Charter Schools.
My child is NOT physically able to participate in the physical education program in the Lake Wales Charter Schools.
*In the event that your child is NOT able to take part in the regular physical education program, an additional form will need to be completed by your physician. Copies of the Physical Education Restriction Form are available in the main office to take to your physician.
Enrolling Parent/Guardian Name (Print Name)
*
Enrolling Parent/Guardian Signature
*
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OPTIONAL: Directory Information Opt-Out Form
Student's Legal Name
First Name
Middle Name
Last Name
Suffix
Student ID # (If known)
School
Grade
Please Select
Kindergarten
1
2
3
4
5
Birth Date
-
Month
-
Day
Year
The District shall make available, upon request, certain information known as "directory information" without prior permission of the parents or the eligible student. Directory information means information contained in an education record of a student that would not generally be considered harmful or an invasion of privacy if disclosed.
The Board designates as student "directory information": a student's name; photograph; address; telephone number, if it is a listed number; e-mail address; date and place of birth; participation in officially-recognized activities and sports; height and weight, if a member of an athletic team; dates of attendance; grade level; enrollment status; date of graduation or program completion; awards received; and most recent educational agency or institution attended.
The primary purpose of directory information is to allow The Lake Wales Charter Schools, Inc. (LWCS) to include information from your child's education records in certain school publications. Examples include: a playbill, showing your student's name in a drama production; the annual yearbook; Honor roll or other recognition lists; graduation programs; sports activity sheets, such as for wrestling, showing weight and height of team members.
If you DO NOT WANT Lake Wales Charter Schools, Inc. (LWCS) to disclose (release) directory information from your child's educational records in accordance with federal law*, please make your selection(s) below.
DO NOT RELEASE my child's directory information to any outside entities with the exception of colleges, universities, and military. Directory information will still be provided in school/district publications, yearbooks, and media unless specified below.
Cancel Selection Above
DO NOT RELEASE my child's directory information, which includes name and photo/video image, for use in the YEARBOOK.
Cancel Selection Above
DO NOT RELEASE my child's directory information, which includes name and photo/video image, for use in MEDIA (the various means of mass communication, including television, websites, radio, magazines, and newspaper).
Cancel Selection Above
DO NOT RELEASE my child's directory information to any military recruiter.
Cancel Selection Above
DO NOT RELEASE my child's directory information to higher education colleges and universities.
Cancel Selection Above
Parent Signature - Required for any selections made above.
I understand that by completing and submitting this form, LWCS will restrict the release of this type of information from my child's educational records and that LWCS has no further obligation to contact me on a case-by-case basis to request my consent for the disclosure of directory information. If you DO NOT make any selections above, it will be assumed that the above information may be released to the extent disclosure is permissible by the Family Educational Rights and Privacy Act (FERPA). Please note that, in certain situations, federal and state law may permit or require the disclosure of the information listed above to authorized persons or entities even if you have opted out of its disclosure as directory information. Selections made will remain in effect until a change is submitted.
Enrolling Parent/Guardian Name (Print Name)
Enrolling Parent/Guardian Signature
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Lake Wales Charter Schools Code of Conduct Consent Forms
The complete Code of Conduct is available online (lwcharterschools.com) or in every LWCS school office.
Student's Legal Name
*
First Name
Middle Name
Last Name
Suffix
School
Grade
*
Please Select
Kindergarten
1
2
3
4
5
MANDATORY: Acknowledgement of Code of Conduct
I am aware of the contents of the Code of Conduct adopted be the Lake Wales Charter Schools. I know that compliance with the Code of Conduct is mandatory.
Copies of the Code of Conduct are available online via the link below or in the office.
Enrolling Parent/Guardian Name (Print Name)
Enrolling Parent/Guardian Signature
*
OPTIONAL: Student Image & Technology Opt-Out
Your student automatically has the privileges listed below UNLESS this optional section is signed. ("Published" includes viewable by the public or within the school system through a variety of print/electronic media, including websites, television, video, newspapers, etc.)
1. My child does NOT have my permission to access school/LWCS networked computers, including the internet. By checking #1, your child will not have access to important educational resources such as the online library card catalog, email, instructional software and resources for research and printing.
cancel above selection
2. My child does NOT have my permission to be photographed or videotaped. By checking #2, your child's photograph/image will not be published in the yearbook or used in any school publicity/promotion; nor will he/she be videotaped for the school news show or other school or LWCS video productions, publicity, etc.
cancel above selection
3. My child does NOT have my permission to have his/her work published, or to have his/her first and last name appear with any work produced, photo, and/or video image. By checking #3, your child's photo and name together will not be included in news about honors, awards, and accomplishments.
cancel above selection
Enrolling Parent/Guardian Name (Print Name)
Enrolling Parent/Guardian Signature
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Janie Howard Wilson Attendance Contract
This contract is to inform parents/guardians of student attendance policies at Janie Howard Wilson Elementary.
As the parent/guardian, I acknowledge my awareness of the following student attendance requirements:
1. Florida Statute 1003.26 requires regular school attendance of children between the ages of 6 and 16.
2. Florida Statute 1003.24 makes parents and legal guardians responsible, and criminally liable, for ensuring that their children attend school.
3. It is the parent's responsibility to notify the school of the student's absences.
4. Polk County Schools can require a doctor's note to excuse absences if a child has exhibited a pattern of nonattendance.
5. Referral to a School Social Worker for assistance may be made if a child presents a pattern of nonattendance.
6. Parents may be required to attend school meetings to discuss patterns of nonattendance.
7. Five UNEXCUSED TARDIES or early PICK-UPS in a grading period will count as one absence and the student will not be eligible for perfect attendance as per the student agenda.
8. SPECIAL NOTE: Out of zone students who attend Janie Howard Wilson Elementary are expected to be in compliance with ALL ATTENDANCE AND BEHAVIORAL POLICIES. Those students NOT in compliance will be dismissed back to their zoned school.
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Janie Howard Wilson Check Out Procedures Acknowledgement
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For the safety and health of your student, please review the following policies and procedures.
Policies
If a student becomes ill during the day, the teacher will give the student a pass to the clinic. The school nurse will assess the situation and contact parents/guardians using only phone numbers from their EMERGENCY CONTACT AND INFORMATION FORM.
*Note: If you have changed your phone number, it is imperative that you let us know AS SOON AS POSSIBLE.
If a parent/guardian needs someone other than those designated on the EMERGENCY CONTACT AND INFORMATION FORM to come to sign a student out, prior authorization from parent/guardian (written notice), before school must be presented. Otherwise, a call to parent will be placed for verification. If parent/guardian cannot be contacted, the student will not be signed out. Also, this NEWLY AUTHORIZED PERSON MUST HAVE A VALID ID before checking your student out.
*Note: If you have changed your phone number, it is imperative that you let us know AS SOON AS POSSIBLE.
Any afternoon checkouts must be processed prior to 2:15 pm.
Any changes to end of day transportation must be reported to the office prior to 2:15 pm.
Procedures
If a student has an appointment during school, parent/guardian must come to the office and sign student out personally. A doctor's note must be presented upon the student's return to school the same or next day.
Students with fever of 100.4 or higher will be sent to the clinic to be sent home. Students must be checked out from the clinic immediately by parent/guardian after they have been called.
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