Amanda-Clearcreek Local Schools
Publicity Permission
2016-2017 School Year
I hereby give permission for the school to release any positive
publicity, or pictures, to the media, newsletters, and yearbook,
(and/or websites) relating to the accomplishments of:
_______________________
Student Name
_____________________
Parent Signature
If you do not want publicity of your child released, please sign
below:
Parent Signature
Date __________________
Permission to Participate in Fundraisers
2016-2017 School Year
My signature below will allow my child to participate in
school fundraisers.
Amanda-Clearcreek Local Schools
Field Trip Permission Form
2016-2017 School Year
This is to certify that _______________________________
(student’s name)
has permission to attend all field trips throughout the 20162017 school year. All field trips will utilize school buses and
will be chaperoned by school employees. I realize that school
rules will be in effect and that the school cannot be held liable
for my child’s negligence. If for some reason my student may
not participate in a particular field trip, I will notify the school
in writing.
Parent Signature __________________________________
Date ________________________
Student Handbook
Parent Acknowledgement
2016-2017 School Year
My signature below indicates that I have received and read
the 2016-2017 student handbook.
Parent Signature___________________________________
___Yes ___ No
Signature_________________________
Date_______________________
Date _________________
Directory Information for 2016-2017
Student Name ____________________________ Grade ____
School districts receiving federal funds are required to provide, upon
request, to military recruiters, colleges and universities access to names,
addresses and telephone numbers of secondary students. However, you
may request that this information NOT be released, or not released without
prior written parental consent. This form must be completed for all
students and signed by the parent/guardian. Please check the appropriate
line.
Military Recruiters
__ Do not release information at any time
__ Do not release information without prior written consent
Colleges, Universities or Institutions of Higher Learning
__ Do not release information at any time
__ Do not release information without prior written consent
Directory Information:
In addition, the following information is considered as “directory
information” and may be disclosed without prior consent. The parent has
the right to refuse any or all of this information to be released: Student’s
name; address; birth date; extra-curricular participation, student’s
achievement awards or honors; and student’s weight and height if a
member of an athletic team.
__ Yes, you may release the directory information
__ No, do not release the following: ________________________________
Parent Signature _____________________Date __________
Adult Student Signature _______________Date __________
Notification of School Closings/Delays
My signature below indicates that I want to participate in the district’s
automated calling system in case of school closures or delays; and
acknowledge the fact that those calls may come late in the evening, or very
early in the morning, outside of the normal protocol for making phone calls.
_____ Yes, include me on the list for automated notification
_____________________________________
Signature
_____________________
Date
ACCEPTABLE USE AGREEMENT POLICY SIGNATURE
As a student, I have read, understand, and agree to abide by the terms of
the Acceptable Use Policy and Agreement. Should I commit any violation or
in any way misuse my access to the Amanda-Clearcreek’s computer
network and the internet, I understand and agree that my access privilege
may be revoked and disciplinary action may be taken against me.
As the parent or legal guardian of this student, I have read, understand and
agree that my child or ward shall comply with the terms of AmandaClearcreek’s Acceptable Use Policy and Agreement for the students’ access
to the District’s computer network and the internet. I understand that
access is being provided to the students for educational purposes only.
Student Signature and date
__________________________________________________
Parent/Guardian Name _______________________________
Parent/Guardian Signature ____________________________
_____ I am 18 or older. I have read, understand, and agree to abide by the
terms of the Acceptable Use Policy and Agreement
Student Signature (if student is 18 years or older)
__________________________________________________
Date ______________________