PARENT

HANDBOOK

CONTENTS

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VISION, MISSION & PHILOSOPHY

At Brighton International School we are committed to the implementation of our vision, mission and philosophy.

VISION

“To provide and equip our students with the requisite knowledge, skills and attitude required to become outstanding global citizens through the empowerment of education. ”

MISSION

“To nurture and develop our students in our local context while fostering an understanding of regional and international cultures and customs while adhering to the best practices of the UK National Curriculum.”

PHILOSOPHY

“We believe that every child is a unique individual who deserves a safe, caring and nurturing environment in which to grow emotionally, intellectually, physically and socially.”

It is our desire as an institution to help our students achieve their full potential by creating an environment conducive to learning which promotes the sharing of ideas, caters and encourages self-discovery and fun learning while supporting a holistic programme geared towards achieving a well-rounded learner.

CORE VALUES - Back to Contents

At Brighton International School we are guided by the following 5 core values; Mutual Respect, Accountability, Open Communication, Quality and Passion. These values apply to our entire ‘learning family’; members of staff, our students, their parents and all stakeholders.

Mutual respect 

Each individual has the right to be treated in the same way as they would like others to treat them.  We are polite and civil with each other at all times and respect that others may have different opinions or views.

A mutually respectful atmosphere will be maintained at all times by our learning family.

Accountability 

Each individual accepts responsibility for their actions.  This includes our students and staff.  Everybody makes mistakes at some time or another - we only grow by owning and learning from our mistakes.

Open communication 

This has two categories; the first is best described by the words of Dr. Seuss, “a person’s a person, no matter how small” meaning everybody has a voice. We encourage all of our students and staff to express their needs, opinions and ideas - nobody is too important to listen to the voice of another.  

The second category covers the way we communicate as a learning family, meaning between students, parents and staff members.  We are transparent and open when we communicate and keep parents regularly updated with their child’s progress through conversations, portfolios, daily care reports and term-based report cards.

Quality

This is what we strive for.  We strive to give your child the best possible education using tried and tested teaching methodologies, child-safe and appropriate resources.  The teachers encourage the children to take pride in their work.  Quality control is an on-going internal review ensuring the school is in line with the legal requirements of the Early Years Foundation Stage Framework and the National Curriculum as defined by Ofsted – the UK’s Office for Standards in Education.

Passion

This is what we have for our job.  The craft of education is not just about teaching children, it is about fostering a love of learning in the child, a feeling of wonderment towards the world in which we live and a desire to explore and experiment beyond their experiences in school.  We are passionate about creating active learners from a young age, confident and curious children who do not fear making mistakes and are eager to learn from new experiences.

REGISTRATION REQUIREMENTS - Back to Contents

Fill out a ‘Registration Form’ and submit it to the school’s office upon registration along with:

1. A copy of your child's birth certificate/passport - alternatively, you may bring in the original so we can scan it.
2. Passport size photos of the:

• Enrolling Student(s)
• Parent(s)/Legal guardian(s)

You may submit the ‘passport size photos’:

• ELECTRONICALLY - via email, Facebook Messenger, Telegram etc.

OR

• HARD COPIES (X2 copies each).

3. A copy of parent(s)/legal guardian(s) ID card or passport - you may bring in the original(s) so we can scan it.

Additional helpful documents you can bring:

4. Health Card (If available – typically received from Cambodian nationals).
   NB - You will also be required to declare details of your child’s medical history upon registration
5. Family Book (If available – typically received from Cambodian nationals)

ALL FORMS MUST BE COMPLETED BEFORE YOUR CHILD CAN START SCHOOL UNLESS OTHERWISE NOTED.

Discrimination

Brighton International School admits students of any race, colour, nationality, religion or ethnicity to all rights, privileges, programs and activities generally accorded or made available to students at the school.

It does not discriminate on the basis of race, colour, nationality, religion or ethnicity in the administration of its educational policies, admission policies and other school-administered programmes.

CODE OF CONDUCT - Back to Contents

Adults and children entering the school premises are expected to behave in a manner appropriate to a school environment. As such, our team encourages everyone in our school community to promote and maintain appropriate conduct, and this is characterised as behaviour which:

• Values and respects the rights of others, including the right to learn
• Fosters a happy, safe and secure environment
• Recognises that each member of the community is unique
• Treats others fairly
• Expects members of the community to take responsibility for their actions
• Promotes compassion and tolerance
• Develops skills for a peaceful resolution of conflict
• Addresses inappropriate behaviour
• Upholds the School’s mission, objectives and ethos

SCHOOL CALENDAR - Back to Contents

Our academic year runs from August to June. Upon enrolment, you will be given our annual calendar which includes a list of events, public and school holidays. As a reminder, we will post additional ‘Holiday Notices’ on our Facebook page 1-2 days before any holidays.

Please note: Holidays are subject to change in accordance with Government announcements or on rare occasions, the school.

School Cancellation

Should it be necessary to close the school at short notice (e.g. due to severe weather, national emergency etc.) in addition to a Facebook post, both parents will be notified via their ‘preferred method of contact’. For this reason, please ensure you update your contact details as soon as possible.

SCHOOL DAY - Back to Contents

Our typical school day runs from 8:00am - 4:00pm. Upon enrollment, you will receive your child’s ‘Weekly Schedule’. Do get in touch with the administration team should you require another copy or have any questions.

Field Trip Guidelines

Throughout the year there may be field trips or out-of-school activities. For each field trip, we will send a description of the activity and a permission slip which is to be signed by the parent/guardian. Each student must provide a signed permission slip in order to be allowed to go on the field trips or out-of-school activities.

LUNCH, BREAKS & DRINKS - Back to Contents

We believe in healthy, nutritional, balanced diets. As such, all of our meals are prepared on-site and bought from local suppliers. We regularly update the menu and try to provide a varied diet of both eastern and western dishes. This is in order to expose our students to a global diet and encourage a truly holistic education. The school menu is available to parents upon request (monthly) and includes a healthy fruit  snack.

REMEMBER to disclose ALL food ALLERGIES or INTOLERANCES your child may have in the ‘Registration Form’. Please note that as much as we would like to cater to all dietary needs, it is not always possible and we may not be able to provide your child(ren) with Lunch.

For the latest ‘School Lunches Menu’ click HERE or enquire with the school administration team.

School Lunches are optional, as such, students may bring their own lunch and snacks or have them delivered. We encourage our students to eat healthy balanced lunches which should include fruits and vegetables. Lunch boxes should be as compact as possible and as with all belongings, must be clearly labelled with the student’s name and class.

Students should NOT be sent to school with unhealthy snacks such as chocolates, fizzy drinks and/or sweets as it affects their learning and is therefore prohibited. Any unhealthy snacks found are likely to be confiscated and kept in the school office until the end of the school day when students and/or parents can collect them.

If you have any questions please contact the school's administration team.

MATERIALS & SUPPLIES - Back to Contents

Please ensure ALL BELONGINGS ARE CLEARLY LABELLED with your child’s full name.

Students are required to have:

• An extra pair of clothes - particularly for students in our Early Years programme (Nursery - Kindergarten)
• Clothes suitable for Physical Education - running, stretching, sweating etc. (see the schedule for frequency)
• Water bottle
• Toothbrush and Toothpaste (Full day students only)

Students will be supplied with all other necessary classroom materials as included in the Learning Materials fee.

Please refer to our ‘First Day of School Checklist’, found in the ‘Welcome Pack’ provided upon registration, for more details.

EMERGENCY CONTACT - Back to Contents

It is important for the school to have up-to-date contact information for all parents and guardians in the event of an emergency.

If any of the following details change, please inform us as soon as possible in writing via: 077 345 639 or 069 300 152

• Home address
• Telephone numbers (home/work/mobile)
• Preferred method of contact
• Email
• The details of/or the people allowed to pick up your child(ren)

DRESS CODE - Back to Contents

Uniforms 

Uniforms are available to all students and are available for purchase at reception. Although we encourage them to be worn; so as to create equality and uniformity among the students, it is only a requirement in Primary school.

PE Clothing

Student schedules will indicate when the students have Physical Education (PE). Please ensure your child has the appropriate sports attire:

• A pair of shoes (trainers or plimsolls)
• A pair of shorts
• A T-shirt
• A change of clothes

VALUABLES, LOST & FOUND ITEMS - Back to Contents

We ask that students DO NOT BRING valuable items to school.  
Examples: jewellery, iPads, money, mobile/smartphones etc.

This is to avoid unnecessary injury, property damage and/or loss. We keep a ‘lost and found’ box at school which is not managed. At the end of the school year, we will donate the items to charity. In order to avoid your/your child’s belongings ending up in it, we ask that you clearly label all of your child's belongings with his/her name. The school will not accept responsibility for the loss or theft of any valuables or personal belongings.

COMMUNICATION - Back to Contents

As described within our ‘Core Values’, we believe regular, transparent communication between home and school is essential to provide the best for your child’s needs. Outlined below are some of the methods we use.

School Binders

Early Year’s students are provided with a school binder upon enrolment. The school binder is to be returned to the school every morning so that they may be updated. It includes homework, worksheets, important announcements, daily reports and newsletters.

If the binder has been lost, please inform reception or the teacher so that it may be replaced at a cost of USD$5.

Note: Binders will be replaced annually by Brighton International School if damaged through ‘wear and tear’.

Report Cards

Report cards are sent home at the end of each term. After report cards have been received, a Parent-Teacher Conference (PTC) will follow. We strongly encourage parents to attend these meetings in person or online so that you are able to discuss any concerns you may have and gain further insight into how your child is progressing.

Messaging Platforms & Social Media

We use various messaging apps (WhatsApp, Telegram and Facebook Messenger) and social media to update the Brighton community with important news and announcements. We suggest adding our contact and following us on the relevant platforms to stay up to date. Please ask our Admin team for your preferred contact.

We understand concerns about internet safety and respect parent's wishes on whether or not their child's photos are to be put up on social media or school marketing materials.

IF YOU DO NOT WANT US TO PUT YOUR CHILD'S PHOTOS/VIDEOS ONLINE, please complete the ‘Website and Social Media Pages OPT-OUT Form’ and submit it to the Administration team.

Meetings

Please contact the school administration team if you would like to arrange a meeting for any reason (e.g. to discuss any ideas, concerns, issues, regarding your child, the school and/or it’s faculty). We thoroughly encourage dialogue and will be happy to schedule a meeting with the relevant parties as soon as possible.

Please ensure that all important information and requests are given directly to the administration team. Please avoid passing information through other faculty members (e.g. at the gate during drop-off, pick-up time or through social media) so that we may address all concerns appropriately and avoid miss-communication.

Administration Contact:

Mobile: 077 345 639 or 069 300 152

email: info@brightoninternationalschool.com 

ATTENDANCE, PUNCTUALITY & SECURITY - Back to Contents

Security

Upon arrival, visitors are required to report to the security guard before admission. Students and parents should not try to open the gates to other visitors/guests, they will be allowed in by security guards or administrative assistants only.

The school gate will be attended from 07:30AM to 17:00 PM Monday-Friday. Outside of these hours, there will be no security guard on ‘gate duty’ and external parties will not be allowed to enter the property.

Early Drop Off

Parents/Guardians/Authorised people may only leave their child(ren) once the school gates have opened and their children are safely on school grounds.

Attendance Register

Registers are kept to track student attendance, absence and lateness for the school’s records and in case of any emergencies.

Late arrival

It is important that students arrive on time for the start of class so that they don't miss any important lessons and/or activities. This will also minimise disruption of on-going classes. If you are dropping off your child after classes have begun (see; ‘School Day’ for weekly schedule information), please ensure that you advise the school office so they can be registered as present and accompanied to their classroom. Students who arrive 10 minutes after the start of class will officially be registered as late.

Student Absence & Early Dismissal

If a parent wishes for their child(ren) to be dismissed early or to be absent from school, they must inform the administration team as soon as possible so that we may update attendance and prepare any necessary work accordingly.

PICK-UP CARDS - Back to Contents

After enrolment, pick-up cards will be issued to you for added security when collecting your child(ren). These are used as a form of ‘identification’, particularly in the first few months while our staff familiarise themselves with you. Please ensure you present these cards to staff when picking up your child(ren) in accordance with our security procedures. Typically we prefer soft copies, but you may request a hardcopy from the Administration team.

Requirements for ‘Pick-up’ card:

• Photos of three people authorised to pick up your child/children (hard/soft copies accepted)
• Their Full Name

Drop-Off

Please accompany your child to the gate and wait until the teachers have admitted him/her.

If driving a car or a motorcycle, wait for the school guard/teacher to collect your child before driving off.

Unauthorised Pick-Up

Students will not be released to anyone without parental consent.

In the event that none of your three authorised people is able to pick up your child(ren), ensure you call the administration team to inform us who will be picking up your child(ren) by providing:

• Their full name and relationship to your child(ren)
• Their contact number
• A photo (you may send it directly to our email or school mobile number via Whatsapp/Facebook Messenger/Telegram)

Send Photo to 069 300 152 or 077 345 639

Email: info@brightoninternationalschool.com 

Facebook Messenger: @BrightonInternationalSchoolCam

EARLY DROP OFF & LATE PICK-UP FEES - Back to Contents

Late Pick Up

In the unexpected event that you will be late to pick-up your child, please inform the school office via:

069 300 152; 077 345 639 or Telegram, WhatsApp.

In addition to encouraging good communication, it will enable us to plan and act more efficiently to provide the appropriate care for your child(ren). We also request that you'll be considerate to our staff with regards to being on time.

Students who are dropped off early or are late being picked up from school require additional school supervision and their parents will be charged accordingly for the service (see table below).

‘Early/Late Fees’ begin according to the table above and are invoiced monthly. For more information on our ‘Late Fees’, please see our ‘Early and Late Pick Up Policy’.

Emergency Procedures

Fire Drill, Evacuations and Lockdown exercises are carried out throughout the year. Any parents visiting should familiarise themselves with the emergency procedures posted around the school.

CURRICULUM - Back to Contents

Brighton International School facilitates learning through the use of the UK National Curriculum for its Primary School, and the Early Years Foundation System (EYFS) for its young learners; both of which involve benchmarking against international standards through:

“The maintenance of a student portfolio mapping the learning of each student in all areas according to the specifications of Ofsted”

(https://www.gov.uk/government/organisations/ofsted/about)

On-going formative assessment is at the heart of our Early Year's processes enabling us to support children’s learning and development by closely matching what we provide to a child’s current needs. This is facilitated through Observation, Assessment and Planning.

The EYFS curriculum focuses on the following areas of Learning and Development:

We facilitate each area of focus through the main Characteristics of Effective learning:  

• Playing and Exploring (Engagement)
• Active Learning (Motivation)
• Creating and Thinking Critically (Thinking)

(The British Association for Early Childhood Education, www.early-education.org, 2012)

BILLING and PAYMENTS - Back to Contents

Brighton International School is a non-profit school. All profits are reinvested back into the school, its faculty and its community. As a condition of student admission and continuing enrolment, parents and guardians confirm their obligation and ability to meet all terms and conditions of payment outlined in the Billing and Payment Policy.

1. Invoices will be given upon registration and sent according to the selected billing option thereafter. Non-receipt of an invoice is not grounds for waiver of charges on late payment. If you would like to update your billing options, contact the school Administration.

2. Accounts should be settled on or before the due date stated; typically the last working day of the month, unless otherwise agreed beforehand in writing with the Administration Office.

3. Liability: parents/legal guardians are jointly and severally liable for prompt payment of fees & charges due, irrespective of any third party responsibility for payment.

4. Due dates: the last working day of the month or as stated on the invoice where otherwise agreed.

5. Late payments are subject to a penalty fee of US$5 per day. Up to 10 working days payment delay (grace period) may be granted without penalty with prior written agreement from the Administration Office.

6. Education Services may be revoked after two weeks late payment. Students may be excluded from examinations or assessment and may have their attendance privileges revoked until the account is made current. The school reserves the right to disenroll a student with fees more than 10 working days overdue and to refer the debt for recovery through legal action or third party collection agents, including internationally where necessary.

If you have any questions or require any clarification, please call or visit us at the office. Our administration team will be happy to answer your questions.

Refunds

Tuition, materials or enrollment fees are non-refundable. In exceptional circumstances, for example, due to prolonged personal illness of the student or which have been deemed as such by the school’s senior management team, the annual, biannual or quarterly tuition fee may be eligible for refunds. A refund will only be considered if submitted in writing, with appropriate evidence to the school office. After which, the management team will deliberate and may take up to 15 working days to process the request.

Deductions/Credits for Holidays/Vacations

Periods of absence due to sickness or travel will not be deducted from your account. Attendance and payment are expected for the entire 11 months of school and will not be prorated in the event of longer school/public holidays. 

Value Added Tax

In accordance with Cambodian Law, a Value Added Tax (VAT) of 10% is added to all fees charged other than tuition. These include but are not limited to; school registration, school supplies, field trips etc. This is subject to change in accordance with Cambodian Law. Parents/Legal Guardians will be notified of any changes as soon as possible.

WITHDRAWAL OF SERVICES - Back to Contents

Brighton International School reserves the right to dismiss a child from our program in the judgement of the Teacher, Principal and Director on any of the following grounds:

• A child is aggressive towards other children or the staff and causes harm to others or self.
• An inordinate amount of the teachers' time is needed to attend to a particular child's special situation, to the extent that it is depriving the other children in the classroom the level of care and concern to which they are entitled. In such a situation the child may have to leave the school temporarily for security reasons.
• Repeated uncontrollable behaviour can lead to discontinuation of services. In that case, a two-week notice may be given before termination of services in order to allow parents to find alternative childcare. It should be noted however that in extreme cases, where a child must be removed from our faculty immediately, the two-week notice will be waived.
• The tuition account becomes delinquent and/or accounts have not been settled.
• If a parent, guardian or adult is rude, threatens, intimidates, racially abusive or disrespectful towards a member of staff, child or another adult within the school community.
• The School reserves the right to require a parent to remove a pupil from the School if they knowingly fail to disclose important information about their child’s special educational, medical and social needs. Such information should be advised in writing before a pupil joins the School.
• Students may be disenrolled and have their attendance privileges revoked if attendance and/or punctuality are deemed unsatisfactory by the Teacher/School Management Team (absences greater than 10%). Parents/guardians are called on a daily basis (if a student is late/absent without prior consent) by the school Administration Team and will be required to attend a meeting if poor attendance/punctuality are frequent.
• Failure of parents/guardians to honour the obligations of any rules or regulations set in the school policies, terms and conditions provided by Brighton International School.

MEDICAL INFORMATION - Back to Contents

Medicine

If your child needs to take medicine during school hours, we encourage parents to administer it themselves when possible. If not, please ensure that you have filled in a ‘Medical Administration Authorisation Form’

and leave clear instructions with our office staff before leaving any medicine.

DO NOT leave medicine with teachers or guards when dropping-off your child as miscommunication may occur.

Allergies/ Illness /Conditions

Any allergies, food intolerances, vaccines, operations, medication, illnesses and/or health conditions should be disclosed in the ‘Registration Form’ upon enrolment. If any are diagnosed thereafter, it is important to inform the school in writing as soon as possible so that we are aware and may try to adjust to any new needs your child may have.

AGREEMENTS, AUTHORISATION, RELEASE,
& WAIVER OF LIABILITY - Back to Contents

All parents/guardians are required to fill in a ‘Registration Form’ prior to enrollment at Brighton International School. By doing so, they are agreeing on behalf of their child(ren) and themselves to all of the school’s Policies, Terms and Conditions outlined within this document ‘Parent Handbook’.

These documents are reviewed regularly and are subject to change. The school will endeavour to inform all stakeholders of any changes in a timely manner and parents should be aware they may request the latest Policies, Terms and Conditions from the School's Administration team at any time.

1. Brighton International School is a ‘Smoke-Free Zone’. There should be no smoking by students, staff or visitors in the building or on any part of the school premises at any time. The use or charging of electronic cigarettes on site is prohibited. Any person smoking cigarettes or electronic cigarettes will be reminded of the ‘Smoke-Free’ policy and will be asked to leave the premises.

2. I understand that while attending Brighton International School, my child will be supervised by its employees. I understand that the school has attempted to create an injury free environment for all stakeholders. However I acknowledge that children may get hurt while playing with other children and while engaging in various activities within the school, and that there is a risk of property damage, serious injury and/or death inherent in my child participating in any school activities and/or classes (on or off the school grounds). I also understand that there are risks inherent in any physical activity program, including the use of equipment such as those provided for use at Brighton International School, which may or may not be obvious and which may pose serious threats to any person if used improperly.

3. If a pupil requires special medical attention while at school, every effort will be made to obtain the prior consent of the parents or guardian. However, should this be impossible, the School will act “in loco parentis” should consent be required for urgent treatment (including anaesthetic or operation) recommended by a doctor/medical professional. This includes and is not limited to; permission to call an ambulance/or take my child(ren) to an available physician or hospital at my expense to obtain medical treatment as soon as possible.

4. I am aware that the school opens at 7:30am and closes at 5:00pm. I understand that if I drop off my child earlier than 7:30am and/or pick up my child later than 5:30pm, there will be no faculty members on duty/shift to safeguard my child(ren) and that I do so at my own and my child(ren)’s risk.

5. I agree to follow any instructions or rules established by Brighton International School with regard to my child’s activities both at school and at home.

6. In exchange for the services provided by Brighton International School and the use of its facilities, I agree to hold harmless, waive, release, indemnify, defend, and discharge Brighton International School and the entirety of its District* from all liability and claims arising from my own and my child’s participation in the activities of Brighton International School. I agree to these actions to the fullest extent allowed by law, which includes liability and claims arising from negligent acts.

7. I understand that every child is in a unique developmental stage and that I am most familiar with my child’s capabilities and limitations. As such, I agree to inform Brighton International School of any concerns that I have about my child, including those which I think may affect his/her ability to safely participate in any activity/class and/or the use of any items/equipment upon enrollment or as soon as possible.

8. All parents/guardians undertake to ensure that their enrolled child attends school regularly throughout each term (dates of which will be published in advance). All pupils are required to participate in all school subjects including games and other out of school activities, including Saturday matches for school teams/events. Failure to meet minimum attendance requirements may result in student exclusion.

*"District" includes its Board of Directors including the individual members thereof, and it’s Director, Principal, Teachers and Staff. "Liability and claims" means demands for any value or benefit, such as lawsuits, tort claims, insurance claims, causes of action, fines, fees, costs (e.g. medical costs and attorney fees). I have the legal authority to waive, discharge, release, and hold harmless the released parties on behalf of myself and my child.

PARENT/GUARDIAN OPT-OUT FORM: - Back to Contents

Brighton International School understands that some parents/guardians do not want their children to participate in certain activities or to receive any medical treatment from other people.

As such, please mark (✘) any of the boxes below if you DO NOT grant permission to any of the following:

My child may be given non-prescribed medication as indicated on the packaging/container. This may include but is not limited to; sunscreen, antibacterial and antiseptic first aid cream, hot/cold compress, ice pack, plasters and bandages. Prescription medications must be current and a  ‘Medical Administration Authorisation Form’ is required with each medication.

Other: ___________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

        _________________________________________________________________________________

        _________________________________________________________________________________

_________________________________________________________________________________

I HAVE READ THIS DOCUMENT AND AGREE TO ALL OF ITS TERMS. I UNDERSTAND IT IS A LEGALLY BINDING AGREEMENT AND WAIVES CERTAIN LEGAL RIGHTS OF MINE, INCLUDING, BUT NOT LIMITED TO A RELEASE, WAIVER, PROMISE NOT TO SUE, AND A HOLD HARMLESS FOR ALL CLAIMS. THIS AGREEMENT SHALL BE BINDING UPON MYSELF, MY CHILD, AND OUR ESTATE, SUCCESSORS AND ASSIGNEES.

Parent/Guardian Printed Name:______________________________________________________

Parent/Guardian ID Number:______________________________________________________

Date (dd/mm/yy): ___________________________________

Parent/Guardian Signature:_________________________________________________________

Website and Social Media Pages - Back to Contents

Brighton International School uses social media to communicate with our families.

Stay connected by following us on our Facebook page; https://www.facebook.com/BrightonInternationalSchoolCam/

The goal of our Facebook page is to provide reminders for important events, highlight school awards and show the personal side of the many activities that occur at Brighton International School. As such, group pictures and/or videos of school activities and events may be posted to our Website and/or Facebook page. If you DO NOT want your child’s picture or video to appear on our website and/or social media page, please complete and return the opt-out form below and return it to the School Administration Team.

If you have any questions or feedback, please contact us at: info@brightoninternationalschool.com

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Website and Social Media Pages OPT-OUT Form – 2020 - 2021

I, __________________________________________________________ (Parent’s First and Last Name), DO NOT want my child’s photo or video to appear on Brighton International School’s Social Media page(s) and/or website.
Date:        _______________________________________________________________________

Student’s Name (First Name, Last Name):         _________________________________________

Year/Grade:         _________________________________________________________________ 

Teacher’s Name:   ______________________________________________________________

Parent Name:         _________________________________________________________________

Parent Signature: ______________________________________________________________