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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.) *
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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