2026-2027 Unity Parent Sign-off

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Email *

Parent Name (Last Name, First Name) *

#1 Student Name (Last Name, First Name) *

#2 Student Name (Last Name, First Name)

#3 Student Name (Last Name, First Name)

#4 Student Name (Last Name, First Name)

Consent to Emergency Treatment:

This is to certify that I, parent or guardian of the student(s) listed above, hereby grant permission for the adult supervisors of the school to obtain medical care from any licensed physician, hospital or medical clinic for the student named herein at such time as either parent or guardian cannot be contacted in person or by phone. This authorization shall also include all activities, and we do hereby waive, release, absolve, indemnify, and agree to hold the activity sponsors, organizers, supervisors, and participants, for any claim arising out of injury to the student or accidents that may occur during the activity.

I agree

Required

Consent to Share Medical Information:

I give permission for the nurse to share necessary medical information with teacher(s)/staff as the nurse deems appropriate.

I agree

Required

Student Required Use Policy and Internet Safety Policy (RUP):

I have read and understand the Student Required Use and Internet Safety Policy (RUP), and give my permission for my student(s) attending CUSD #4 to have access to the described electronic resources.

I agree

Required

Student/Parent Handbook:

I will review the student/parent handbook with my child(ren) in an effort to promote a better understanding of CUSD #4's rules and expectations.

I agree

Required

Release of Health Information *

I give permission to the school to obtain, disclose, and discuss health information with my child(ren)'s physician when needed. In case of an emergency or illness, I also give permission for my child(ren) listed to receive whatever medical attention is necessary if we, the parents, cannot be reached.

Release of Health Information

Required

Release of Student Photos *

I give consent for my child(ren)'s picture to appear on a school district web page or shared via social media.

I DO NOT give consent for my child(ren)'s picture to appear on a school district web page or shared via social media..

Required

Damage To School-Owned Electronic Devices *

Checking the box below acknowledges that any damages beyond normal wear and tear to the electronic are the responsibility of the student. Students will be charged accordingly for the repair of the device.

Damage of School-Owned Electronic Devices

Required

Armed Service Personnel (JUNIOR-SENIOR PARENTS ONLY)

I give permission for my child(ren)'s directory information to be released to any armed service personnel.

I DO NOT give permission for my child(ren)'s directory information to be released to any armed service personnel.

School Sponsored Trip Authorization

I agree to allow my student(s) to participate in school sponsored trips to supervised places with a qualified teacher or staff member. These trips will depart and return during the school day. These trips may include, but are not limited to Career Fairs, College Placement Testing, or class field trips. Parents are encouraged to check the school’s website and Facebook page for information on upcoming trips. Any field trip that leaves or returns outside of normal school hours will have a separate permission slip. I understand that my student(s) must ride to and from the destination in the school provided transportation.

Required

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