Student Parent Notifications

STUDENT PARENT NOTIFICATIONS

Student Information

Student Name:

Date of Birth:    Student ID:

Parent / Guardian Information

Emergency Contact & Medical Information

Notification Preferences

Select the types of notifications you authorize the school to send regarding the student:

Attendance alerts (absences, tardies)

Academic progress and grade reports

Discipline or conduct matters

Health office notifications and medication reminders

Schedule changes, closures, or transportation notices

Emergency notifications (safety alerts, evacuations)

Preferred delivery method(s):

Automated phone calls to primary phone

SMS / text messages to primary phone

Email to primary email

Postal mail to mailing address

Additional Authorized Recipients

List any additional persons authorized to receive the student's notifications (name, relationship, phone, email). If none, leave blank.

Acknowledgment and Consent

I certify that the contact information provided on this form is accurate and that I am authorized to receive educational and emergency notifications for the named student. I authorize the school district and its agents to send notifications to the methods and recipients indicated above. I understand that messages may be delivered using automated dialers, prerecorded messages, and/or text messaging systems where applicable.

I understand that I may withdraw or modify this consent at any time by providing written notice to the school's office. I acknowledge that the school will make reasonable efforts to update contact methods after receiving notice but cannot be held liable for messages sent prior to processing my request.

I further authorize, where permitted by law, the release of directory or limited educational information to those designated on this form for the purpose of delivering notifications. This authorization does not extend to the release of confidential records beyond what is necessary to provide the indicated notification services.

I understand that message and data rates may apply for SMS notifications and that the school is not responsible for costs incurred by the recipient.

Opt-Out / Restrictions

If you wish to opt out of specific notification types while retaining others, indicate restrictions below. The school will honor reasonable restrictions consistent with safety and legal obligations.

Certification

By signing below I certify under penalty of perjury that I am the parent or legal guardian of the student named on this form, or I am the student if of legal age, and that I have authority to provide the consents set forth herein. I understand that providing false information may subject me to disciplinary or legal action consistent with applicable policy or law.

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