Student Compliance Sheet

Student Compliance Sheet

Student Information

Parent / Guardian (if applicable)

Emergency & Medical Information

Medication Administration: I authorize school health personnel to administer prescription medication to the student in accordance with written instructions from a licensed prescriber and submitted medication authorization form. I understand medication must be provided in original labeled container and that emergency medications (epinephrine, inhaler) will be carried or stored per school policy.

No Medication at School: I affirm that the student will not carry or require medication during school hours except as documented above.

Policy Acknowledgments

Student Code of Conduct: I have received, read, and agree to comply with the Student Code of Conduct. I understand violations may result in disciplinary action up to suspension or expulsion.

Attendance Policy: I acknowledge the attendance policy, including requirements for reporting absences and potential consequences for excessive unexcused absences.

Acceptable Use of Technology: I accept and will abide by the school's acceptable use policy for computers, networks, and electronic devices. Unauthorized access, hacking, or distribution of prohibited content may result in disciplinary and legal action.

Academic Integrity: I understand and agree to the academic honesty standards; cheating, plagiarism, and fabrication will result in academic sanctions.

Transportation and Bus Conduct: I acknowledge rules for school transportation and agree that violations may lead to loss of riding privileges.

Field Trip and Activity Safety: I understand participation in off-campus activities requires adherence to safety rules and that separate written consent may be required for each event.

Photo/Media Release: Consent Decline (check one)

Immunization Status: I certify that the student's immunizations are current as required by applicable law and school policy, or that a valid exemption is on file.

Privacy Acknowledgment: I acknowledge the school's student privacy practices and understand directory information may be disclosed unless I submit a written objection in accordance with school procedures.

Accommodations and Special Education

Does the student have an active IEP or 504 plan? Yes No

Acknowledgment and Certification

By signing below, I certify that the information provided on this Student Compliance Sheet is true and complete to the best of my knowledge. I acknowledge receipt of and agree to comply with the policies identified above. I understand the school may take disciplinary action, including suspension or expulsion, for violations of applicable policies. I authorize school staff to contact emergency medical personnel if necessary and to share student information with health providers and authorized personnel in the event of an emergency or as required by law.

I further acknowledge that school officials may conduct reasonable searches of student property and lockers in accordance with school policy and applicable law. I understand that this form does not waive any rights afforded by law but documents the student's agreement to comply with institutional rules and procedures.

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