Education Day Ready Form

EDUCATION DAY READY FORM

Use this form to certify that the student is prepared for regular school day activities, to authorize routine care and emergency treatment, and to provide necessary medical, contact and transportation information. Complete all applicable sections and sign at the end. In signing, the undersigned certifies that the information is true and authorizes the limited consents described below.

Student Information

Student Name:

Date of Birth:    Student ID:

Parent / Guardian Contact

Emergency Contacts (Other than Parent)

Health, Medication & Medical Release

I authorize school personnel to administer the above prescribed medication in accordance with the provider instructions and school medication policy: Yes No

I authorize school staff to provide routine first aid and non-prescription items (e.g., bandage, antiseptic, acetaminophen/ibuprofen) as appropriate: Yes No

Transportation & Authorized Pickup

Usual arrival/departure method: School Bus Parent/Car Walk/Bike Other

Media, Activity & Policy Acknowledgements

Media Release — I consent to the school photographing or recording the student for educational, informational or promotional materials under school control. I understand materials may be used by the school in printed and electronic formats: Permit Do Not Permit

Activity Acknowledgement — I understand the student will participate in routine daily activities including physical education, supervised outdoor recess, classroom-based projects and brief supervised neighborhood walks if applicable. I acknowledge the student is expected to follow school rules and safety directions.

Immunizations & Communicable Disease — I confirm that, to the best of my knowledge, the student's immunizations are current or a valid exemption is on file, and I will notify the school promptly of changes in health status that affect attendance or care.

Consent, Certification and Release

Certification of Accuracy: I certify that all information on this form is accurate and complete. I will update the school immediately if any information changes.

Medical Authorization: If I cannot be reached in an emergency, I authorize school officials to seek emergency medical treatment and transportation for the student. I authorize licensed medical professionals to provide necessary emergency care. I understand the school will make reasonable efforts to contact me prior to such action when practicable.

Release: To the extent permitted by law, I release and hold harmless the school, its employees and agents from claims arising from ordinary negligence in the performance of routine care and administration of emergency treatment consistent with this authorization. This release does not apply to willful misconduct or gross negligence.

Confidentiality: Medical and contact information provided on this form will be maintained in the student's educational record and shared with school personnel as necessary to provide care and ensure student safety.

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