registration packet
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
REGISTRATION PACKET Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR
CHECKLIST
Please ensure that EACH of the following forms have been completed as part of this Registration Packet:
Checklist Registration Form Registration Fee Tuition Rates and Payment Agreement Emergency Card (Please use pencil.) Family Enrollment Agreement Academic Agreement Field Trip Driver's Insurance Information
You may print multiple copies of any of these pages if the form requires one form per student. If you are manually filling out the forms please write legibly.
rev020415tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
REGISTRATION FORM
Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR
CHILDREN:
¦
§¦
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
PARENT/GUARDIAN INFORMATION ¡«
¨®©¢¨§
¡åãÛ§åx
°åèá§åx
Ûââ§åx
ÚÚèÛéé ßêï
¬ê×êÛ
³ßæåÚÛ
¦¨¡«
¨®©¢¨§
¡åãÛ§åx
°åèá§åx
Ûââ§åx
ÚÚèÛéé ßêï
¬ê×êÛ
³ßæåÚÛ
¦¢§¦¢¥²¦¢¥w Child/ Children live with:
åêÞ©×èÛäêé
×êÞÛè
¦åêÞÛè
Split time between
©×èÛäêé ë×èÚß×äé
Please specify who is responsible for ALL financial obligations to Our Lady of Grace School (OLG):
×êÞÛè
¦åêÞÛè
åêÞ©×èÛäêé
¬æâßêØÛêíÛÛä©×èÛäêé
¨êÞÛè
The following information is for census purposes only: Hispanic or Latino? Race
Yes
No
Native American/Native Alaskan
Asian
White
Black/African American
Native Hawaiian/Pacific Islander
121714tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
TUITION RATES AND PAYMENT AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME
SCHOOL YEAR Tuition Rates:
Tuition is paid monthly based on the rate at which you qualify. To receive the Our Lady of Grace School Parishioner tuition rate, you must meet the following criteria: 1) Family must be registered AND active at Our Lady of Grace Parish and 2) using weekly envelopes, family must contribute to the General Fund of the church. Status will be determined by participation/contributions from the previous year. Change in parish status requires the signature of the Pastor or Principal. The contributions to Our Lady of Grace Church may not be a tax-deductible item. Select the rate below at which you qualify, followed by the dollar amount relative to the number of children you have enrolled:
§åä©×èßéÞßåäÛè«×êÛ ŊÙÞßâÚşŃōuőŒŎxʼnʼn ŋÙÞßâÚèÛäşŃőuōōŎxʼnʼn ŌÙÞßâÚèÛäşŃŊŋuʼnʼnʼnxʼnʼn ōÙÞßâÚèÛäşŃŊŎuŎŎŎxʼnʼn
©×èßéÞßåäÛè«×êÛ ŊÙÞßâÚşŃōuŊŐʼnxʼnʼn ŋÙÞßâÚèÛäşŃŐuŋŊʼnxʼnʼn ŌÙÞßâÚèÛäşŃŊʼnuŋʼnʼnxʼnʼn ōÙÞßâÚèÛäşŃŊŌuŊŒʼnxʼnʼn
Indicate applicable Registration Fee:
è×äéßêßåä×â¤ßäÚÛèÝ×èêÛäêÞèåëÝÞŏêÞ è×ÚÛŃŌŋŎxʼnʼn©«ÙÞßâÚ ŐêÞ×äÚőêÞ è×ÚÛŃōŋŎxʼnʼn©«ÙÞßâÚ TUITION PAYMENT POLICY Our Tuition Agreement form serves as the foundation for payment of tuition and fees. OLG has monthly financial obligations that must be met, such as teacher salaries, heating and electric bills, building maintenance and improvements; therefore, it is vital that tuition payments must be made on time through the FACTS Tuition Management Program. zEach school family is required to register with FACTS, the tuition management organization that handles Our Lady of Grace tuition payments. Registration should be completed online. An icon on our school website will lead you to the FACTS website. Our tuition payment cycle begins August 1 and ends on May 30. This is a ten (10) month cycle. Twelve (12) month payment plans are no longer available. zA 3% discount will be given for families if tuition is paid in full by the first day of school DELINQUENT TUITION POLICY zA late fee of $30.00 will be added to monthly FACTS payments. If a payment is not received our tuition company will send the family a letter indicating that their payment has not been received. z If a family's tuition balance reaches sixty (60) days outstanding, the school will send a letter notifying them that their payment was not received and will be reminded of this tuition payment policy. Additionally, it is highly recommended that the family contact the Principal to inform the school as to when payment can be expected or to arrange a payment plan, as the student(s) will not be allowed to attend school until tuition payment arrangements have been made. The school reserves the right to pursue collection of tuition and fees. zOutstanding tuition balances from the prior school year must be paid in advance of the new school year. Students will not be allowed to start the new school year until the past-due amounts are settled. Your signature(s) below indicates your understanding and acceptance of the terms indicated in this document. Signature
Signature
Printed Name
Printed Name
Date
rev031316tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
STUDENT EMERGENCY CONTACT FORM Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
SCHOOL YEAR
HOME PHONE:
FAMILY NAME
WORK PHONE:
Emergency Information FIRST NAME AND MIDDLE INITIAL OF EACH CHILD ENROLLED IN SCHOOL
STUDENT:
STUDENT:
STUDENT:
STUDENT:
In the event of illness or injury of my children, please contact the persons listed below in the sequential order that they have been written. Parties indicated below have been authorized to act on my behalf and have been informed accordingly. *Note: Parents/Guardians will always be contacted first. 1. Full Name:
Relation to Student:
Phone:
2. Full Name:
Relation to Student:
Phone:
3. Full Name:
Relation to Student:
Phone:
4. Full Name:
Relation to Student:
Phone:
For the use of our Emergency Community Alert System, please indicate a cell phone number and an email address for the parent(s) or immediate caregiver(s) of the student(s) listed above. Mother/Guardian Name:
Email:
Cell#:
Father/Guardian Name:
Email:
Cell#:
Signature
Printed Name
Date
I authorize first aide to be administered by a person qualified to render such service. I understand that Our Lady of Grace School does not assume responsibility for payment of a physician in any case.
Family Physician Name (please print)
Physician Contact Number
No medication shall be administered by the school without expressed written consent from the parent or guardian. All medication MUST be delivered directly to Our Lady of Grace School office by the parent or guardian with explicit directions for distribution. No student should be in possession of any form of medication at any time at school. Please note here if your child has any known allergic reactions:
010313tsv
1990 Linden Road West Sacramento, CA 95624 916-371-9416 Fax 916-371-1319 www.olgwestsac.com
Print Form
FAMILY ENROLLMENT AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
SCHOOL YEAR:
FAMILY NAME:
At Our Lady of Grace School (OLG), we firmly believe that the parents are the primary educator of their children and that acceptance of a student signifies a partnership between parents and school. Part of this partnership is a fulfillment of parent hours and fundraising that helps us all provide the best possible education for our students. Each family that is accepted at OLG must agree to, and complete, this form. This agreement is renewed each school year and is effective until its end. The terms herein are: 1. Completion of at least thirty (30) Parent Participation Hours In lieu of participation you are given the option of purchasing your participation hours at the rate of $20.00 per hour. You may pay for all thirty (30) hours in advance or reconcile any uncompleted hours at the time of registration or before a student graduates. AND 2. Purchase of at least $2,000.00 in SCRIP Option to buy out scrip at the time of registration at $300. We stock various On-the-Spot scrip that include; grocery, retail stores, restaurants and gas. You can also special order scrip for a variety of merchants. Please see the Merchant Listing by logging onto www.shopwithscrip.com, under the Shop tab. During the summer months scrip will be available in the school office if you call ahead. During the school year scrip is available On-theSpot in the school's office, online at www.shopwithscrip.com, or by completing the Scrip Order form and returning to the School's Office. AND 3. Involvement in at least one (1) of the following major school events: OLG Crab Feed, Auction Night, Jog-A-Thon, Rigatonni Dinner, school theater production, Golf Tournament , or Fireworks Booth. AND 4. Participation in a Work Party on campus
The purpose of this agreement two-fold: not only does it assist our school in generating the necessary funds to compensate the difference between the cost of education per pupil and tuition cost, but to promote the benefit of involvement within OLG's family community. Throughout the school year you will be notified of events at which you may earn Parent Participation Hours and will be updated on the fulfillment of your Family Enrollment Agreement.
¬®§§¦w
«w
¬®§§¦w
«w
¬®§§¦w
«w
¬®§§¦w
«w
We agree to fulfill the terms of this agreement as described above on or before of this school year. We understand that failure to fulfill this agreement may result in not being allowed to register for the next school year, leaving us with a balance due that must be paid prior to registration.
Signature
Signature
Printed Name
Printed Name
Date rev121315tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
ACADEMIC AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR Enrollment at Our Lady of Grace School is based on the following: * Consistently complete classroom assignments and homework in a satisfactory manner * Participate in the classroom * Student must show respect for both teacher and classmates * Behavior must reflect school policy as stated in the Student/Parent Handbook If the student does not complete classroom assignments, homework assignment, or has become a discipline problem, it is at the discretion of the teacher and Principal to ask the parent to disenroll his/her child from this school. The Academic Agreement is a document renewed annually and must be signed in order to be registered at Our Lady of Grace School. After the first trimester and each subsequent trimester thereafter, the student will be evaluated to see if the appropriate grade level is achieved.
My signature below indicates our understanding and agreement to the terms dictated above and that the student named below will adhere to these conditions as well.
Signature
Date
Printed Name
Printed Student Name
Grade
010313tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
FIELD TRIP DRIVER'S INSURANCE INFORMATION Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME:
SCHOOL YEAR
Any parent who plans on driving for any field trip during the current school year must complete this form and provide a copy of your driver's license and insurance verification. Should any of the information contained herein expire or change during the current school year, you are responsible for notifying the Administration and providing the current copies at least one (1) week prior to the scheduled field trip.
¬êëÚÛäê§×ãÛéw
è×ÚÛw
è×ÚÛw
¬êëÚÛäê§×ãÛéw
IMPORTANT NOTE: if the listed vehicles will be interchangeable between drivers. If so, this MUST be reflected on the proof of insurance.
Please check here
Mother's Information: I, , agree to utilize the vehicle listed below for field trips during the current school year, as reflected on the date I have indicated on this form. ²Û×èw
¦×áÛw
¦åÚÛâw
åâåèw
¥ßÙ©â×êÛňw
Vehicle Insurance
©åâßÙïň
×èèßÛè Agent Name and Complete Address:
¢äéëè×äÙÛ¥ßãßê
©ÞåäÛw
¦ÛÚßÙ×â
¥ß×Øßâßêï
Date
¦åêÞÛèĹé¬ßÝä×êëèÛ Father's Information:
I, , agree to utilize the vehicle listed below for field trips during the current school year, as reflected on the date I have indicated on this form. ²Û×èw
¦×áÛw
¦åÚÛâw
åâåèw
¥ßÙ©â×êÛňw
Vehicle Insurance
©åâßÙïň
×èèßÛè Agent Name and Complete Address:
¢äéëè×äÙÛ¥ßãßê ×êÞÛèĹé¬ßÝä×êëèÛ
©ÞåäÛw
¥ß×Øßâßêï
¦ÛÚßÙ×â Date 010313tsv
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
REGISTRATION PACKET Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR
CHECKLIST
Please ensure that EACH of the following forms have been completed as part of this Registration Packet:
Checklist Registration Form Registration Fee Tuition Rates and Payment Agreement Emergency Card (Please use pencil.) Family Enrollment Agreement Academic Agreement Field Trip Driver's Insurance Information
You may print multiple copies of any of these pages if the form requires one form per student. If you are manually filling out the forms please write legibly.
rev020415tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
REGISTRATION FORM
Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR
CHILDREN:
¦
§¦
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
x¨xx
è×ÚÛêÞßé×ââ
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
¦
§¦
×êÞåâßÙ
PARENT/GUARDIAN INFORMATION ¡«
¨®©¢¨§
¡åãÛ§åx
°åèá§åx
Ûââ§åx
ÚÚèÛéé ßêï
¬ê×êÛ
³ßæåÚÛ
¦¨¡«
¨®©¢¨§
¡åãÛ§åx
°åèá§åx
Ûââ§åx
ÚÚèÛéé ßêï
¬ê×êÛ
³ßæåÚÛ
¦¢§¦¢¥²¦¢¥w Child/ Children live with:
åêÞ©×èÛäêé
×êÞÛè
¦åêÞÛè
Split time between
©×èÛäêé ë×èÚß×äé
Please specify who is responsible for ALL financial obligations to Our Lady of Grace School (OLG):
×êÞÛè
¦åêÞÛè
åêÞ©×èÛäêé
¬æâßêØÛêíÛÛä©×èÛäêé
¨êÞÛè
The following information is for census purposes only: Hispanic or Latino? Race
Yes
No
Native American/Native Alaskan
Asian
White
Black/African American
Native Hawaiian/Pacific Islander
121714tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
TUITION RATES AND PAYMENT AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME
SCHOOL YEAR Tuition Rates:
Tuition is paid monthly based on the rate at which you qualify. To receive the Our Lady of Grace School Parishioner tuition rate, you must meet the following criteria: 1) Family must be registered AND active at Our Lady of Grace Parish and 2) using weekly envelopes, family must contribute to the General Fund of the church. Status will be determined by participation/contributions from the previous year. Change in parish status requires the signature of the Pastor or Principal. The contributions to Our Lady of Grace Church may not be a tax-deductible item. Select the rate below at which you qualify, followed by the dollar amount relative to the number of children you have enrolled:
§åä©×èßéÞßåäÛè«×êÛ ŊÙÞßâÚşŃōuőŒŎxʼnʼn ŋÙÞßâÚèÛäşŃőuōōŎxʼnʼn ŌÙÞßâÚèÛäşŃŊŋuʼnʼnʼnxʼnʼn ōÙÞßâÚèÛäşŃŊŎuŎŎŎxʼnʼn
©×èßéÞßåäÛè«×êÛ ŊÙÞßâÚşŃōuŊŐʼnxʼnʼn ŋÙÞßâÚèÛäşŃŐuŋŊʼnxʼnʼn ŌÙÞßâÚèÛäşŃŊʼnuŋʼnʼnxʼnʼn ōÙÞßâÚèÛäşŃŊŌuŊŒʼnxʼnʼn
Indicate applicable Registration Fee:
è×äéßêßåä×â¤ßäÚÛèÝ×èêÛäêÞèåëÝÞŏêÞ è×ÚÛŃŌŋŎxʼnʼn©«ÙÞßâÚ ŐêÞ×äÚőêÞ è×ÚÛŃōŋŎxʼnʼn©«ÙÞßâÚ TUITION PAYMENT POLICY Our Tuition Agreement form serves as the foundation for payment of tuition and fees. OLG has monthly financial obligations that must be met, such as teacher salaries, heating and electric bills, building maintenance and improvements; therefore, it is vital that tuition payments must be made on time through the FACTS Tuition Management Program. zEach school family is required to register with FACTS, the tuition management organization that handles Our Lady of Grace tuition payments. Registration should be completed online. An icon on our school website will lead you to the FACTS website. Our tuition payment cycle begins August 1 and ends on May 30. This is a ten (10) month cycle. Twelve (12) month payment plans are no longer available. zA 3% discount will be given for families if tuition is paid in full by the first day of school DELINQUENT TUITION POLICY zA late fee of $30.00 will be added to monthly FACTS payments. If a payment is not received our tuition company will send the family a letter indicating that their payment has not been received. z If a family's tuition balance reaches sixty (60) days outstanding, the school will send a letter notifying them that their payment was not received and will be reminded of this tuition payment policy. Additionally, it is highly recommended that the family contact the Principal to inform the school as to when payment can be expected or to arrange a payment plan, as the student(s) will not be allowed to attend school until tuition payment arrangements have been made. The school reserves the right to pursue collection of tuition and fees. zOutstanding tuition balances from the prior school year must be paid in advance of the new school year. Students will not be allowed to start the new school year until the past-due amounts are settled. Your signature(s) below indicates your understanding and acceptance of the terms indicated in this document. Signature
Signature
Printed Name
Printed Name
Date
rev031316tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
STUDENT EMERGENCY CONTACT FORM Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
SCHOOL YEAR
HOME PHONE:
FAMILY NAME
WORK PHONE:
Emergency Information FIRST NAME AND MIDDLE INITIAL OF EACH CHILD ENROLLED IN SCHOOL
STUDENT:
STUDENT:
STUDENT:
STUDENT:
In the event of illness or injury of my children, please contact the persons listed below in the sequential order that they have been written. Parties indicated below have been authorized to act on my behalf and have been informed accordingly. *Note: Parents/Guardians will always be contacted first. 1. Full Name:
Relation to Student:
Phone:
2. Full Name:
Relation to Student:
Phone:
3. Full Name:
Relation to Student:
Phone:
4. Full Name:
Relation to Student:
Phone:
For the use of our Emergency Community Alert System, please indicate a cell phone number and an email address for the parent(s) or immediate caregiver(s) of the student(s) listed above. Mother/Guardian Name:
Email:
Cell#:
Father/Guardian Name:
Email:
Cell#:
Signature
Printed Name
Date
I authorize first aide to be administered by a person qualified to render such service. I understand that Our Lady of Grace School does not assume responsibility for payment of a physician in any case.
Family Physician Name (please print)
Physician Contact Number
No medication shall be administered by the school without expressed written consent from the parent or guardian. All medication MUST be delivered directly to Our Lady of Grace School office by the parent or guardian with explicit directions for distribution. No student should be in possession of any form of medication at any time at school. Please note here if your child has any known allergic reactions:
010313tsv
1990 Linden Road West Sacramento, CA 95624 916-371-9416 Fax 916-371-1319 www.olgwestsac.com
Print Form
FAMILY ENROLLMENT AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
SCHOOL YEAR:
FAMILY NAME:
At Our Lady of Grace School (OLG), we firmly believe that the parents are the primary educator of their children and that acceptance of a student signifies a partnership between parents and school. Part of this partnership is a fulfillment of parent hours and fundraising that helps us all provide the best possible education for our students. Each family that is accepted at OLG must agree to, and complete, this form. This agreement is renewed each school year and is effective until its end. The terms herein are: 1. Completion of at least thirty (30) Parent Participation Hours In lieu of participation you are given the option of purchasing your participation hours at the rate of $20.00 per hour. You may pay for all thirty (30) hours in advance or reconcile any uncompleted hours at the time of registration or before a student graduates. AND 2. Purchase of at least $2,000.00 in SCRIP Option to buy out scrip at the time of registration at $300. We stock various On-the-Spot scrip that include; grocery, retail stores, restaurants and gas. You can also special order scrip for a variety of merchants. Please see the Merchant Listing by logging onto www.shopwithscrip.com, under the Shop tab. During the summer months scrip will be available in the school office if you call ahead. During the school year scrip is available On-theSpot in the school's office, online at www.shopwithscrip.com, or by completing the Scrip Order form and returning to the School's Office. AND 3. Involvement in at least one (1) of the following major school events: OLG Crab Feed, Auction Night, Jog-A-Thon, Rigatonni Dinner, school theater production, Golf Tournament , or Fireworks Booth. AND 4. Participation in a Work Party on campus
The purpose of this agreement two-fold: not only does it assist our school in generating the necessary funds to compensate the difference between the cost of education per pupil and tuition cost, but to promote the benefit of involvement within OLG's family community. Throughout the school year you will be notified of events at which you may earn Parent Participation Hours and will be updated on the fulfillment of your Family Enrollment Agreement.
¬®§§¦w
«w
¬®§§¦w
«w
¬®§§¦w
«w
¬®§§¦w
«w
We agree to fulfill the terms of this agreement as described above on or before of this school year. We understand that failure to fulfill this agreement may result in not being allowed to register for the next school year, leaving us with a balance due that must be paid prior to registration.
Signature
Signature
Printed Name
Printed Name
Date rev121315tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
ACADEMIC AGREEMENT Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME SCHOOL YEAR Enrollment at Our Lady of Grace School is based on the following: * Consistently complete classroom assignments and homework in a satisfactory manner * Participate in the classroom * Student must show respect for both teacher and classmates * Behavior must reflect school policy as stated in the Student/Parent Handbook If the student does not complete classroom assignments, homework assignment, or has become a discipline problem, it is at the discretion of the teacher and Principal to ask the parent to disenroll his/her child from this school. The Academic Agreement is a document renewed annually and must be signed in order to be registered at Our Lady of Grace School. After the first trimester and each subsequent trimester thereafter, the student will be evaluated to see if the appropriate grade level is achieved.
My signature below indicates our understanding and agreement to the terms dictated above and that the student named below will adhere to these conditions as well.
Signature
Date
Printed Name
Printed Student Name
Grade
010313tsv
1990 Linden Road West Sacramento, CA 95691
916-371-9416
Fax 916-371-1319
www.olgwestsac.com
Print Form
FIELD TRIP DRIVER'S INSURANCE INFORMATION Forms accessed on the web may also be filled using your home computer; however, NONE of this information is saved so please PRINT a second copy for your records.
FAMILY NAME:
SCHOOL YEAR
Any parent who plans on driving for any field trip during the current school year must complete this form and provide a copy of your driver's license and insurance verification. Should any of the information contained herein expire or change during the current school year, you are responsible for notifying the Administration and providing the current copies at least one (1) week prior to the scheduled field trip.
¬êëÚÛäê§×ãÛéw
è×ÚÛw
è×ÚÛw
¬êëÚÛäê§×ãÛéw
IMPORTANT NOTE: if the listed vehicles will be interchangeable between drivers. If so, this MUST be reflected on the proof of insurance.
Please check here
Mother's Information: I, , agree to utilize the vehicle listed below for field trips during the current school year, as reflected on the date I have indicated on this form. ²Û×èw
¦×áÛw
¦åÚÛâw
åâåèw
¥ßÙ©â×êÛňw
Vehicle Insurance
©åâßÙïň
×èèßÛè Agent Name and Complete Address:
¢äéëè×äÙÛ¥ßãßê
©ÞåäÛw
¦ÛÚßÙ×â
¥ß×Øßâßêï
Date
¦åêÞÛèĹé¬ßÝä×êëèÛ Father's Information:
I, , agree to utilize the vehicle listed below for field trips during the current school year, as reflected on the date I have indicated on this form. ²Û×èw
¦×áÛw
¦åÚÛâw
åâåèw
¥ßÙ©â×êÛňw
Vehicle Insurance
©åâßÙïň
×èèßÛè Agent Name and Complete Address:
¢äéëè×äÙÛ¥ßãßê ×êÞÛèĹé¬ßÝä×êëèÛ
©ÞåäÛw
¥ß×Øßâßêï
¦ÛÚßÙ×â Date 010313tsv
