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24-25 Oakland-Craig Public School Bright Knights Application
Email *
Name of Student: *
Grade in the Fall of 2024: *
Teacher: *
Date of Birth: *
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/
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/
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Age: *
Gender: *
Parent/Guardian Names: *
Address (Street, City, Zip) *
Home Phone: *
Cell Phone: *
Work Phone:
Email Address *
Emergency Contact Information
Emergency Contact must be filled out in case of not being able to get ahold of parent/guardian.
First Emergency Contact Name: *
First Emergency Contact Phone: *
Second Emergency Contact Name:
Second Emergency Contact Phone:
Days of Attendance
They must attend at least 1 day a week or a minimum of 5 days per month, with a minimum of one hour each day attending.
Mark the days your child will participate in Bright Knights.
 *
Required
Dismissal from Bright Knights
Your child will NOT be allowed to ride home unless they are listed on this application or we have a written note or phone call. 
How will your child be dismissed from Bright Knights? *
Required
My child may ride with: (list names)
STUDENT MEDICAL INFORMATION
*Emergency medications used during the school day are not accessible after school dismisses.  Arrangements will need to be made with Bright Knights staff to disperse medication.
Allergies or Restrictions:
Medications:
Special Circumstances/Concerns 
*Please list any information that would be helpful for our staff to know.
Doctor's Name: *
Doctor's Phone Number: *
MEDICAL RELEASE/CONSENT TO SHARE INFORMATION:

I hereby authorize Bright Knights staff to take my child to the above-named physician or to the nearest medical facility for medical treatment in the event of an emergency in which neither parent can be reached.  I also give my consent and authorization for all Oakland-Craig Public Schools staff and Bright Knights staff to share interchangeably necessary information, medical reports, and history concerning my child’s health, medical condition and treatment during the school day.  This authorization pertains only to information that is necessary to protect the health or safety of my child or other individuals.

By typing your name below you are agreeing to the above terms.

Name of Parent/Guardian giving authorization: *

I authorize the following:

  • I give permission for my child to be enrolled in the Bright Knights program activities. I understand that program participation is optional and contingent upon terms and conditions.
  • I understand that the Bright Knights program does not carry health or accident insurance for my child, and that I as guardian will be primarily responsible in the case of injury where bills are incurred.
  • I give permission for the Bright Knights program to transport my child for the purpose of medical care and other program activities.
  • I give permission for the Bright Knights program to use my child’s name, any photographs, videos, writings, artwork, etc. for the purposes of marketing, publicity for program and activities, and documentation of instructional evaluation.
  • I understand that the Bright Knights program closes at 5:00 pm. Monday-Friday.  There will be a five-minute grace period.  In addition, I understand that failure to pick up my child could result in suspension from the program and/or notification to law officials when necessary.
  • I agree to all the terms and conditions listed here with-in and understand that my child may be suspended or dismissed for failure to follow rules, failure to participate and failure to follow general operating procedures of the Bright Knights program.  As the parent/guardian, I will read the Parent Handbook and work as a partner with Bright Knights program staff to ensure my child is successful in the program.
By typing your name below you are agreeing to the above terms.

Name of Parent/Guardian giving authorization: *
The Bright Knights program provides an equal opportunity for enrollment for all children and will not discriminate on the basis of origin, faith, race, disabilities, or gender.
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