SEC New Student Packet

EMERGENCY CONTACTS
Please complete the following information for medical conditions: Emergency contacts mus be over 18 years old – They have authorization to check your child out of school but cannot excuse tardies. We will contact parent/guardians first. In the event they are unavailable please list below emergency contacts in order of preference.
First Emergency Contact

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Relationship
Second Emergency Contact

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Relationship
Third Emergency Contact

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Relationship
Fourth Emergency Contact

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Relationship

MEDICAL INFORMATION
Medical alert and life-threatening medical condition: (Please full details including symptoms and frequency of episodes)
Have you provided the school with a Medication Authorization Form signed by physican for any medicine to be taken during school hours or in the event of emergency (bee sting kit, etc.)?
List medication(s) if required and the dosage(s)
Medical Insurance Provider
Name of Insured
Policy/Group Number
Phone Number

Area CodePhone Number
Hospital of Choice
Doctor's Name

First NameLast Name
Phone Number

Area CodePhone Number
We will call 911 for any student in acute distress. Please list any specific emergency procedures you would like us to follow:
Does your student ride the school bus?

Medication Clearance Form

PLEASE COMPLETE ENTIRE FORM
Phone Number

Area CodePhone Number
Student Name

First NameLast Name
Date of Birth

MonthDayYear
If your child is currently taking any prescription or over the counter medication that is to be taken on a PRN basis, Stockton Education Center, Inc., requires that we have a signed statement indicating that your child is or is not capable of asking for prescribed or over the counter PRN medications.
My child is capable of asking for over the counter medication on a PRN basis.
My child is capable of asking for the following prescribed medications on a PRN basis. (Please list medications below.)
Please List All Medication Here

Functional/Life Skills Community Outing Permission Slip

PLEASE COMPLETE ENTIRE FORM
ACTIVITY DESCRIPTION:

Per our Functional/Life Skills Curriculum, students at the Stockton Educational Center will participate in Community Outings at various sites throughout the City of Stockton. These sites include but are not limited to: Library, Bus-Stop/Bus Ride, Restaurants (including Fast Food), neighborhood clean-up, and picnics at the park, grocery shopping, and clothing shopping.
Permission Slip

I ACCEPT the terms of this permission slipI DECLINE the terms of this permission slip

Physical Education Permission Slip

PLEASE COMPLETE ENTIRE FORM
ACTIVITY DESCRIPTION:

Students at the Stockton Educational Center will participate in Physical Education at Van Buskirk Park and Recreation Center.
Permission Slip

I ACCEPT the terms of this permission slipI DECLINE the terms of this permission slip

Video Tape Permission Slip

PLEASE COMPLETE ENTIRE FORM
Dear Parents/Guardian:

We are participating in a project requiring a short videotape of lessons taught in your child's classroom.

The purpose of this session is to use the recorded instructional activities as a training tool.

The primary focus will be on the teacher's instruction and the student's responses. In the course of taping, your child's first name will also appear on the videotape.

Your child's first name will appear on any materials that are submitted and all materilas will be kept confidential. The form below will be used to document your permission for this taping and use of videotape.
Permission Slip

I ACCEPT the terms of this permission slipI DECLINE the terms of this permission slip

Emergency Contact Form