Education Info Sheet

EDUCATION INFO SHEET

Student Information

Student Name:

Date of Birth:   Student ID:

Parent / Guardian (if applicable)

Emergency Contacts

Emergency Contact 1 Name:   Phone:

Emergency Contact 2 Name:   Phone:

Medical Information

Academic History

IEP    504 Plan    Other (describe below)

Permissions, Releases, and Acknowledgments

By signing this form I certify that the information provided is true and complete to the best of my knowledge. I acknowledge that knowingly providing false information may result in administrative action by the institution.

Emergency Treatment Authorization: In the event of a medical emergency, I authorize school personnel to obtain and consent to emergency medical treatment for the student if I am not available. I also authorize release of relevant medical information to medical personnel.

Release of Educational Information: I authorize the release of educational records and communications related to attendance, academic progress, and health to the persons listed on this form for school-related matters. This authorization is limited to the contacts and purposes identified herein.

Media and Photograph Release: I consent to the use of photographs or videos that may include the student for educational, promotional, or informational purposes by the institution.

Financial Responsibility Acknowledgment: I acknowledge any fees, deposits, or tuition obligations associated with enrollment and accept responsibility for timely payment according to institutional policy.

Additional Notes

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