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BERGEN ELEMENTARY WAIVER/PERMISSION
Fill out this form separately for EACH of your students.  Answer each question to allow or disallow permission for your child's participation in various school activities throughout the year.  
Student Last Name *
Student First Name *
My student is enrolled in either Early Learning (PK) or Kindergarten through 5th grade. *
Student's Grade Level for this School Year. *
Parent Last Name *
Parent First Name *
Parent Phone # (###) ### - #### *
Parent E-mail Address *
License Plate of Vehicle - Separate by commas, if more than one.  Ex: ABC-123, DEF-098, GHI-567 *
Make and Model of each car separated by commas if more than one. (For parking lot security purposes.) *
PARENT PERMISSION FOR FIELD TRIPS - Today’s classrooms extend beyond the physical limits of a room and teachers recognize the value of taking students on field trips. On most excursions, children take school buses, however they may walk under specific circumstances.  You will be informed of the method of transportation for each trip your child takes. If you select "yes" in the space below, your child will be allowed to join in these field trips during this school year. Before each field trip, teachers will send home information regarding the place, date, and mode of transportation. At that time, you may refuse permission for your child to go on that specific field trip.   Clicking "yes" below indicates that you have read this information and consent to your child attending field trips. Additionally a paper form must be completed for district compliance. The form will be given out at Open House or sent home by your student's teacher. 

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TRANSPORTATION - It is a privilege for students to ride a Jeffco Public School Bus, and the responsibility of both the driver and the students to do everything possible to make the ride safe. Whether your student will ride the bus to/from school or for a field trip, please review the school rules with your student. Your acceptance below indicates that you have reviewed the Bus Rules and Student Contract with the student listed above, and that you and your student agree to abide by these terms for the school year. Click on the link to view the Bus Rules and Student Contract. *
STUDENT HANDBOOK - The Bergen Elementary student handbook contains important school information and procedures. Your acceptance below indicates that you have reviewed the student handbook with the child listed above, and that you and your child agree to abide by these terms for the school year. Please click on the link to view the handbook. *
PERMISSION TO WALK/RIDE/BIKE TO AND/OR FROM SCHOOL  - the student listed above has permission to walk/bicycle to and from school. I absolve Bergen Elementary School of any liability in case of an accident or injury incurred while walking/biking to or from school. *
The student listed above has a health concern which should be made known to teachers and other staff as necessary. *
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