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 Application
Students First Name: _____________________________ Last Name: _______________________
Baptized: Yes / No If yes: Date Baptized _______________ Church Name _______________________
Mother/Step Mother or Guardian
Mailing Address:
Baptized: Yes / No If yes, Church Membership: ________________________________
Occupation: _______________________________ Employer: _____________________________
Father/Step Father or Guardian
Mailing Address:
Baptized: Yes / No If yes, Church Membership: ________________________________
Occupation: ______________________________ Employer: ___________________________
I agree to uphold the school’s regulations. I pledge my cooperation with and loyalty to the school and its employees. I will live in harmony with the school’s Christian principles.
_____________________________ _____________________________________________ Date Student’s Signature
I hereby agree to support school regulations and to help my child observe them. I agree to supply all necessary forms, documents and to accept all financial educational obligations for my child while attending
____________________________ ____________________________________________ Date Parent/Guardian’s Signature
Ozark Adventist School Photo/Video Permission:
I give permission for my child ______________________________________ to be
______________________________________________ _____________________________ Parent/Guardian Signature Date
Y N CONSENT TO WALK / RIDE A BICYCLE to and from school and realize that the school cannot be responsible for the safety of the student after leaving the school or before arriving at the school. All students are expected to follow the guidelines for cyclists in the OAS handbook.
Y N FIELD TRIP CONSENT: I understand that all reasonable precautions will be taken to assure my child’s safety and adequate supervision will be provided. I further understand that I will be notified in advance of the nature and destination of trips involving my child, and that I may revoke this permission with written notice to the school.
Y N My child has permission to have a cell phone at school. Cell phones are not to be
Attendance: Students of the Ozark Adventist School are subject to the compulsory attendance laws of the State of Arkansas. Parents are legally accountable to see that the child meets attendance requirements. The only excusable reasons for a student’s absence are the student’s illness; medical and dental services; death in the immediate family. When a student is absent for any reason, the State requires a written excuse signed by the parent or guardian which states the date of the absence and the reason for the absence. A phone call does not negate the need for a written note.
A note from a doctor may be required in some cases. These must be submitted to the teacher when the child returns to school. Students with excused absences will be permitted to make up any work that was missed on the basis of two school days to make up assignments for each day of excused absence.
If you know that your child will be missing school for medical or personal reasons, please notify the teacher in advance so academic assignments may be arranged.
Absence Policy: School is in session 180 days during the school year.
Consent To Treatment Form 2009 - 2010
Student’s Name: _________________________________
Age: ______ Date of Birth: _______________ SS#: _________________________
Address: _________________________________ ____________________ ________ _________ City State Zip
Father/Guardian Name: _______________________________________________________
Home Phone: ________________ Cell Phone:_________________ Work Phone:___________________
Home Phone: __________________Cell Phone:________________ Work Phone:___________________
Please describe allergies to substances and medication: __________________________________________
If on regular medication, please specify: _____________________________________________________
In the event that your child has to take prescribed medication or frequent doses of over-the –counter drugs, please inform the office and bring the medication in the original container, plainly marked with dispensing directions and your child’s name. Please check below permission to dispense over-the-counter drugs.
Tylenol: Yes ( ) No ( ) Ibuprofen: Yes ( ) No ( ) Tums: Yes ( ) No ( )
Physician’s Name: _________________________________ Office Telephone # ____________________
Hospital Preference: ___________________________________ Telephone # _____________________
Dentist’s Name: _______________________________________ Telephone # ____________________
Please give the names of two relatives or friends who have consented to assume the responsibility of your son or daughter in case of illness or accident until you can be reached. In case of any changes in the named persons, notify the school in writing.
1. Name ___________________________________________ Home Phone: _____________________
Cell Phone: __________________________ Work Phone: __________________________
Cell Phone: __________________________ Work Phone: __________________________
If emergency service involving medical action or treatment is required and neither the parent nor the family physician can be reached for consent, the parents hereby consent to the rendering of such emergency medical service for the above named student as shall be necessary in the medical opinion of the doctor rendering the service. This authorization is given pursuant to the local state Civil Code.
Signature of Parent or Guardian: ____________________________________ Date: _________________ |
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