SEARCY HIGH SCHOOL PARENT-STUDENT RESPONSIBILITY FORM 2015-2016 Dear Parents and Students

MISSION STATEMENT Because education is a life-long process of paramount importance to the well-being of the individual and the democratic way of life, it is necessary for students to develop positive work habits, adaptability, understanding, and the ability to live and work in a diverse, technological society. OBJECTIVES The school should offer a complete and flexible curriculum providing equal opportunities for all, making provisions for individual differences, and preparing students to become contributing members of society and community, regardless of their chosen field of work. The following have been established as our objectives: 1. To provide an atmosphere, which enhances development of students' talents, abilities, needs, interests, positive self-esteem, and physical and mental health, including stress management. 2. To encourage students to test, investigate, and analyze new ideas by using critical thinking skills so that they may derive valid conclusions. 3. To enable students, through cooperation and participation in school experiences, to assume their responsibilities as family members, consumers, and members of a national society. 4. To present a program of varied extra-curricular activities designed to enhance students' use of leisure time and to develop an appreciation for literature, art, music, and sports. 5. To encourage responsible attitudes and behaviors and endeavor to instill a sense of values and worthwhile ideals. 6. To instill within students a respect for law and order and an appreciation of America's multicultural heritage. 7. To provide opportunities for students to obtain the necessary academics and technology needed for their careers. 8. To emphasize communication opportunities between parents and the school staff for the benefit of the students. 1 2 SEARCY HIGH SCHOOL PARENT-STUDENT RESPONSIBILITY FORM 2015-2016 Dear Parents and Students, We are excited to begin a new school year and have you as a partner/participant in it. As the year progresses, you may have questions that come to mind about what the procedure or protocol is for certain events or why things are done in a certain manner. This handbook is to help you better understand the things that go on in your school. It explains the important concepts you will find taking place in school. Please read the handbook carefully with your child to make sure you both understand our schools‘ rules and regulations as well as the areas of study we will be involved in. At the front of this handbook, just behind this handbook receipt letter, you will find several additional pages on colored paper that are perforated along the bound edge for easy removal from the rest of the handbook. This handbook receipt letter needs to be removed, along with the media release notification form signed by you and your child and returned to your child’s school tomorrow. This form assures us of having the most up-to-date information possible for each child each school year. Also in the perforated, colored pages are information and free/reduced meal applications that are available to all who qualify and would like to apply for this service. Finally, in the colored, removable page section is the school district calendar for this school year. This page is for your information to aid in planning for and keeping up with district calendar events, vacations, etc. during the school year. Again, we are excited to be a part of your child‘s education this year. We look forward to a strong, productive school year for all our students. Thank you for sharing your child with us. Sincerely, Claude Smith Principal NOTICE! Please pay special attention to Attendance Policy and Dress Code Policy. NOTICE! A Student Accident Insurance envelope will be available to your student upon their request. A PARENT/GUARDIAN AND STUDENT MUST SIGN THIS FORM. PLEASE RETURN THIS FORM TO SECOND PERIOD TEACHERS BEFORE AUGUST 19th We have received the Searcy High School Student Handbook and our signatures verify the following: a) Receipt of the Parent-Student Handbook, including student discipline Policies; b) Permission for a child to access computer services. ______________________ Date _________________________________________ _____________________________________________________ STUDENT NAME (print) STUDENT SIGNATURE ____________________________________________ ______________________________________________________ PARENT/GUARDIAN NAME (print) PARENT/GUARDIAN SIGNATURE INFORMATION FOR EMERGENCIES Birthdate: _______________ Tylenol:Yes___ No____ EMERGENCY CONTACT: ________________________________________________PHONE: ___________________ ALLERGIES? ____________________________________________________________________________________ ________________________________________________________________________________________________ DOCTOR PREFERENCE: _________________________ HOSPITAL DOCTOR PHONE: _________________________ PREFERENCE__________________________________ In case of emergency, I give my consent for the school to secure treatment from the doctor of my choice, and to share medical information on a ―need-to-know‖ basis. __________________________________________ _____________________PARENT/GUARDIAN SIGNATURE 3 4 Searcy Public Schools Health History Form _____________ Please complete BOTH SIDES of this form School Year __________________________________________________________________ ___________ ___________ Student‘s Last Name First Middle Birthdate Grade _________________________________________________________________________________________________ Parent Name(s) Address City/Zip Code _________________________________________________________________________________________________ Home Phone Cell phone Work phone _________________________________________________________________________________________________ Doctor Phone # Dentist Phone # PERSON(S) TO BE NOTIFIED OF EMERGENCY OR ILLNESS IF PARENT/GUARDIAN CANNOT BE REACHED NAME RELATION HOME PHONE # CELL PHONE # 1. 2. 3. I request that my child be given the following NON-PRESCRIPTION medications, Acetaminophen (Tylenol), Tums, & topical (triple antibiotic & hydrocortisone). I understand that the school nurse (or trained staff) will determine if the medication is needed, and will administer the age/weight appropriate dose. Generic forms of the medications may be used. I understand that unexpected adverse reactions may occur from any medication, and hereby release the Searcy School District and its employees from any liability related to such unexpected reactions. *As a general rule these medications are not given before 10:00 a.m. or after 2:00 p.m. to reduce the possibility of over- medicating any student. All over-the-counter (OTC) non-prescription medications are available to students on a limited basis. Students who require frequent doses of these OTC meds must bring their own supply, and a parent must come in to discuss the use of OTC medications. Benadryl is given ONLY in cases of acute allergic reactions – no other OTC allergy medications are provided by the school. DO NOT GIVE MY CHILD ANY OVER-THE-COUNTER (OTC) MEDICATIONS AT SCHOOL. In the event of a medical emergency and an ambulance is called, EMS will determine the appropriate care. INSURANCE Private Insurance _________________________Policy # ____________________Phone #__________________ AR Kids / Medicaid #__________________________________________ No insurance With parental consent, the school district can seek federal Medicaid reimbursement for the cost of the health services the school district provides to children who are eligible for Medicaid. In order to seek the federal Medicaid funds for reimbursement, the school district must disclose information from your child‘s education records to Medicaid and Medicaid billing agencies. In compliance with the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) I, ________________________________________________, give permission for my child, _______________________________’s (Parent/Guardian Name) (First and Last Name) personally identifiable information/student education records to be disclosed to ________________________________________ for the purpose of billing Medicaid and/or private insurance. (Name of Third Party) ______________________________________ ________________________________________ ____________ Printed name of Parent/Guardian Parent/Guardian Signature Date Sign 5 Health History Student Name:_____________________________________________________________________________ Please check “Yes” or “No” on all health concerns. If you answer “yes”, please answer the questions associated with that health concern. *(Please ask your doctor to provide written orders for management of this medical condition at school.) Yes No Health Concern Description Medication required?______ Name of Medication:________________________________ ADD/ADHD* Given at school? Doctor‘s name/Phone: Medication/inhaler? ______ Daily? ______ As needed? ______ With exercise? ______ ASTHMA* Name of medication:_______________________________________________________ (Diagnosed by a In nurse‘s office? ___________ Student carries/administers inhaler? _________________ doctor) How often seen by doctor? Last ER visit due to asthma? To what? ______________________________________ Hives/Rash? Yes___ No___ Breathing difficulty? Yes___ No___ Other? ________________________________ ALLERGIC REACTION Has EpiPen? Yes___ No___ Where is EpiPen kept? Nurse‘s Office ___ Carries own ___ Doctor‘s Name/Phone: Any physical limitations?

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