Permission Form
Please fill in the form below.
Parent's Full Name
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First
Last
Parent's Full Name
First
Last
Child's Full Name
*
First
Last
Child's Full Name
First
Last
Child's Full Name
First
Last
Child's Full Name
First
Last
Child's Full Name
First
Last
Child's Full Name
First
Last
Parent's Phone Number
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-
Area Code
Phone Number
Please check the box (es) to show that you agree to the following. If you do not agree, please leave box unmarked.
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I give permission for my child to be taken from school grounds for Educational visits within the local area. (i.e. field trips, trips to the park)
I give permission for my child to participate in the pen pal program (if you agree to the pen pal program, please enter below - a current mailing address for your child (Ren) and age/grade of your students.
I give permission for my child to eat STORE BOUGHT food, that other parents bring in, when prior notification is given.
I give permission for my child’s data to be shared, if transferring to another School.
I give permission for my child to eat HOME MADE food, that other parents bring in, when prior notification is given.
I DO NOT give permission for my child(ren) to participate in either of the options above!
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age/grade level of child (ren)
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At Rising Stars Learning Academy (RSLA), we will occasionally, take photograph of the classroom environment, students, on field trips, etc. The pictures that we take can be shared on our social media pages, blog, website, and occasionally included in the e-mail newsletter that will be sent out to parents. Please let us know your preference as we respect your and your child (ren) privacy.
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I agree to my child being photographed to be used for internal school related items only (to post in classroom or in student folder), BUT NOT to be shared publicly on sites that are related to RSLA.
I agree to my child being photographed AND for pictures to be shared publicly, on sites that are related to RSLA only. (See above)
I DO NOT agree to my child being photographed and/or for pictures to be shared publicly, on sites that are related to RSLA at all.
SCHOOL ANTI-BULLYING/HARASSMENT POLICY
We foster a zero-tolerance policy for bullying! By signing this form, I acknowledge and confirm the following:
Harassment and bullying mean any electronic, written, emotional, verbal, or physical act of conduct toward a student which is based on any actual or perceived trait or characteristic of the student and which creates an objectively hostile school environment.Harassment and bullying may include, but are not limited to, the following behaviors and circumstances: Verbal, nonverbal, physical or written harassment, bullying, hazing, or other victimization that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim;Repeated remarks of a demeaning nature that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim.Implied or explicit threats concerning one’s grades, achievements, property, etc. that have the purpose or effect of causing injury, discomfort, fear, or suffering to the victim;Demeaning jokes, stories, or activities directed at the student that have the purpose of effect of causing injury, discomfort, fear, or suffering to the victim;Unreasonable interference with a student’s performance or creation of an intimidating, offensive, or hostile learning environment.Sexual harassment means unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature when: Submission to the conduct is made either implicitly or explicitly a term condition of the student’s education or benefits;Submission to or rejection of the conduct by a school employee is used as the basis for academic decisions affecting that student; orThe conduct has the purpose or effect of substantially interfering with the student’s academic performance by creating an intimidating, hostile, or offensive education environment.Harassment and bullying of students and employees are against federal, state and local policy, and are not tolerated by our school. We are committed to providing all students with a safe and civil school environment in which all members of the school community are treated with dignity and respect. The school prohibits harassment, bullying, hazing, or any other victimization, of students, based on any of the following actual or perceived traits or characteristics: age, color, creed, national origin, race, religion, marital status, sex, sexual orientation, gender identity, physical attributes ,physical or mental ability or disability, ancestry, political party preference, political belief, socioeconomic status, or familial status. Harassment against employees based upon race, color, creed, sex, sexual orientation, gender identity, national origin, religion, age or disability is also prohibited.This policy is in effect while students or employees are on property (and/or are remote/virtual) within the jurisdiction of the school.
Please sign, acknowledging that you have reviewed and received a digital copy of the school's policy agreement.
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