BSCS Student Information

Student Information Form
Student Name*

First NameLast Name
Physical Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts

Please provide at least one emergency contact other than a parent/guardian who can pick up your student if we are unable to reach you.
Emergency Contact other than a parent/guardian*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email
Second Optional Emergency Contact

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
Authorized Pickups

For your child’s safety, please tell us who is allowed to pick them up from school. Parents/guardians are automatically authorized, but please list anyone else you wish to include. Anyone not listed will not be permitted to take your child without direct parent notification.
Authorized Pickup

First NameLast Name
Phone Number
Format: (000) 000-0000.
Authorized Pickup

First NameLast Name
Phone Number
Format: (000) 000-0000.
Authorized Pickup

First NameLast Name
Phone Number
Format: (000) 000-0000.
Authorized Pickup

First NameLast Name
Phone Number
Format: (000) 000-0000.
Authorized Pickup

First NameLast Name
Phone Number
Format: (000) 000-0000.
Independent Dismissal Authorization

Certain families may wish for their Student to be dismissed at the end of the school day without an adult physically present for pickup. By opting in, Parent authorizes the School to release the Student at dismissal time to walk, bike, drive, or otherwise travel independently.
Do you want independent dismissal for your child?*

Yes, my child is allowed to be dismissed without an adult present.No, my child is not allowed to be dismissed without an adult present.
Parent acknowledges and agrees that:

Release of Custody: Once the Student is released from School grounds at dismissal, BSCS is no longer responsible for the Student’s supervision, safety, custody, or whereabouts.

Assumption of Risk: Independent travel involves inherent risks, including traffic hazards, weather conditions, interactions with the public, and other circumstances outside the School’s control.

Parent voluntarily assumes all risks associated with the Student’s independent travel.

Revocation Rights: The School may revoke independent dismissal privileges if safety, conduct, or community concerns arise.

Parent Responsibility: It is the Parent’s responsibility to ensure the Student is prepared to travel independently and is capable of doing so safely.
Independent Dismissal - signature required:*
Immunizations

BSCS requires all students to have current immunization records on file in compliance with Montana state and local health regulations. Montana law requires students to be immunized against certain diseases before attending school, unless exempt by medical or religious affidavit.
I will:*

Attach my child's immunization record.Attach my child's religious exemption.Attach my child's medical exemption.
Please upload immunization record.*

Cancelof
Please upload your Medical Exemption Statement signed by a qualifying healthcare provider.*

Cancelof
Please upload your Notarized Affidavit of Exemption on Religious Grounds*

Cancelof
I understand that my child may be excluded from school during outbreaks of vaccine-preventable diseases if not fully immunized.*

Yes
Student Medical Information
Does your child have any medical conditions we should be aware of?*

YesNo
Please indicate which medical conditions apply:

AllergiesAsthmaSeizures or EpilepsyDiabetesOther Medical Condition
What type of allergies does your child have?

FoodMedicationEnvironmental
List all Food allergies:
Describe the severity of the reaction:
List all Medication allergies:
Describe the severity of the reaction:
List all Environmental allergies:
Describe the severity of the reaction:
Do they carry emergency epinephrine for this allergy?*

YesNo
Please upload an Allergy Action Plan.*

Cancelof
Please upload an Asthma Action Plan.*

Cancelof
To help us support your child’s health at school, please describe their asthma: common triggers, how symptoms usually present, medications used, and anything else you feel we should know.
Please upload a Seizure Action Plan.*

Cancelof
To help us support your child’s health at school, please describe their seizure history: type(s) of seizures, typical duration, known triggers, how symptoms usually present, medications used, and any steps you would like us to take during or after an episode.
Please upload a Diabetes Medical Management Plan.*

Cancelof
To help us support your child’s health at school, please describe any details we should be aware of (typical symptoms, management routines, triggers, and instructions for emergencies).
Please describe any other health conditions below.
Any dietary preferences or restrictions?
Over-the-Counter Medication
To support student wellness, BSCS may provide limited over-the-counter (OTC) medication when appropriate. Medications are given only when needed and in age-appropriate, manufacturer-recommended doses. I give permission for BSCS staff to administer the following OTC medications to my child as needed:

Acetaminophen (Tylenol)Ibuprofen (Advil/Motrin)Antihistamine (Benadryl/Claritin/Zyrtec)Cough dropsAntacid (Tums, Pepto-Bismol)Topical ointment (hydrocortisone/antibiotic cream)
*

In case of an emergency or minor injury, I, as a parent/guardian, give permission to Big Sky Community School to seek, obtain, and/or administer medical treatment for my child.
Student Learning
Does your child have any suspected or diagnosed learning or attention considerations?*

NoYes
Please share any information that will help us support your child’s learning experience, including any suspected or diagnosed learning or attention considerations, how they present day-to-day, and what strategies have been most effective. Let us know how we can help your child succeed.
Optional: please upload any learning support documents such as an IEP, 504 Plan, school based learning plan, or recent psychological/educational evaluation. BSCS requests these for informational purposes only, so we can better understand your child’s needs and determine how to best support them.

Please note: As an independent school, BSCS does not implement IEPs or 504 Plans.
Cancelof
Liability Waivers from our Community Partners

If you filled this out for your child's shadow day, you do not need to submit it again.
Please sign and upload this BASE waiver.
Upload your signed BASE waiver here.

Cancelof
Please sign and upload the Moving Mountains waiver.
Upload your signed Moving Mountains waiver here.

Cancelof
Family Directory
BSCS maintains an optional family directory to support community connection. The directory is only shared with BSCS families.*

I would like our family’s contact information included in the BSCS family directory.I would like to OPT OUT.
Include parent/guardian name(s)Include student name and gradeInclude email address(es)Include phone number(s)
Anything Else You Would Like Us To Know?
Is there anything else you would like us to know as we prepare to welcome your child?
Authorization to Release Student Records
To support my student’s enrollment and educational planning, I authorize Big Sky Community School to request and receive my child’s educational records from their current and/or previous school(s).

I authorize the release of the following records to Big Sky Community School:
• Academic records and transcripts
• Standardized test scores and assessments
• Attendance history
• Special education records, IEPs, 504 plans, evaluations, and related services (if applicable)
• Discipline records
• Other relevant educational information needed to support my student

I understand these records will be used only for educational and administrative purposes, will be kept confidential in compliance with FERPA, and that I may revoke this consent in writing at any time.
Name

First NameLast Name
Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Student Information Form

Emergency Contacts

Authorized Pickups

Independent Dismissal Authorization

Immunizations

Student Medical Information

Over-the-Counter Medication

Student Learning

Liability Waivers from our Community Partners

Family Directory

Anything Else You Would Like Us To Know?

Authorization to Release Student Records