Admin Packet Form

The following are school Policies and Permission Forms that do not need to be filled out but that are included in this Admission/Readmission Packet for the school year of 2020-2021. It is the duty of each parent/guardian to read and be informed concerning these Policies Permission Forms along with the contents of the Parent/Student Handbook that is on the Academy of St. Louis Web Site: www.acadstl.org. Your signatures at the end of this document will give your approval of the following forms:

• Policy A2 Ensuring Approved Student Conduct on Campus Policy
• Bl: Safety Procedure for Pick Up and Drop Off of Student Policy
• B3: Home Work Assignments
• Policy 84: Thursday Folders and Daily Assignment Book Policy
• 85: Student's Phone Calls to Staff
• Policy 86: Parent/Teacher Conference
• Policy C7: High School Credits
• Policy C8: Student Academic Portfolios
• Policy C24: Report Cards and Grading Criteria
• Policy ES: Use of Technology Devices Academy of St. Louis Witness Statement
• Academy of St. Louis Physical Form & Requested Updated Immunization Record
• Academy of St. Louis Uniform Requirements Information Page

Also, new students and students entering grades ist, 3rd, 6th and 9th grades must submit their childrens' updated and signed Physical Examination Form with an updated Immunization Record before the first day of school. This is a state law that we abide by and is required for all new students and students entering 15\ 3 rd , 61h, and 9 th grades.

I acknowledge that I have read and give my approval to all Policies and Permission Forms for the school year 2020-2021 that are listed in this document and are included in the Admission/Readmission Packet provided to me. I have read and understand the Parent/Student Handbook that is on the school web site. All information I have provided is accurate to the best of my ability.

• Student's Name*
• Date*
  Date Format: MM slash DD slash YYYY
• Father/Guardian's Printed Name*
• Father/Guardian's Signature*
• Date*
  Date Format: MM slash DD slash YYYY
• Mother/Guardian's Printed Name*
• Mother/Guardian's Signature*
• Date*
  Date Format: MM slash DD slash YYYY

• This completed packet is to be returned the Office of Administration by Friday, February 28, 2020. Thank you for your time and interest.

• REGISTRATION AND TUITION FEES FOR THE SCHOOL YEAR OF 2020-2021

• Name of Student*

• A $750 NON-REFUNDABLE REGISTRATION FEE is due with the re-admission forms by Friday, February 28, 2020

  TUITION OPTIONS FOR THE 2019-2020 SCHOOL YEAR

  A. Tuition Payment Option #1- "Tuition Payment Program and Fundraising Donation Buy-Out"

  With this option, I choose to pay tuition of $22,000/year and to participate in fundraising by donating an additional $8,000. The $8,000 is due on July 15, 2020, and is non-refundable. In return, I am free of ongoing fundraising obligations to the school including Annual Giving, school parties, and "Return to School Supplies" but not excluding attendance at the Annual Auction Dinner & Hosting a table at Trivia Night. I will make tuition payments in increments of$2,200 to the school on a monthly basis starting July 15, 2020, and ending on April 15, 2021. If after registration and acceptance, my student withdraws from the school, there is a three-month tuition charge that I agree to pay. I am aware that I am obligated to attend the Annual Auction and have a table of eight at the Annual Trivia Night.

  Tuition Payment Option #2- "$22,000 Annual Tuition Payment Program"

  With this option, I am aware that I MUST participate in fundraising on a monthly basis as specified by the Academy "Parent Fundraising Expectations," for the auction. This option payment includes fees for parties, and "Return to School Supplies" but does not exclude attendance at the Annual Auction Dinner & hosting a table and providing a Silent Auction Basket for Trivia Night. I will make tuition payments in increments of $2,200 to the school on a monthly basis starting July 15, 2020, and ending on April 15, 2021. I am aware that if after registration and acceptance, my student withdraws from the school, there is a three­ month tuition charge that I agree to pay.

  2019-2020 Parent Auction Fundraising Expectations - Tuition Option #2

  SEPTEMBER: Goal: Sell 25 Raffle Tickets (Raffle $-TBD) Sign Up for an Auction Committee

  OCTOBER: Goal: Obtain 12 Gift Cards (min Value $25)

  NOVEMBER: Goal : Obtain 1 Extraordinary Item (Value >than $200) Goal: Sign up to donate 3 bottles ofliquor (Sign-Up Genius)

  DECEMBER: Goal: Obtain 5 Ads/Sponsorships (See Donation Form) Goal: Obtain 5 Silent Auction baskets/Items

  JANUARY: ($150 min for each basket)

  FEBRUARY: Please bring in your liquor from Sign-Up Genius Goal : Sell (2) $100 Raffle Tickets (Raffle TBD) Goal: Table of ten Goal: Attend Auction

  MARCH: Goal: Work day of set up

  APRIL: Goal: Work Day of the auction- set up and clean up

  At the December 2020 meeting of the Board of Directors, tuition payments and fundraising is reviewed. If your family has not met your expected fundraising goals to date, you must convert to the "Tuition Payment Program and Fundraising Donation Option" by donating $8,000. If this request is not fulfilled and/or if tuition payments are not up to date, your child will not be allowed to return in January. Tuition payments are to be made by means of "Automatic Direct Bank Withdrawals" and mailed to (not sent to school):

  Ann Dunn, Business Manager
  73 Burning Tree Drive
  Chesterfield, MO 63017
• We agree to pay the non-refundable $750 Registration Fee, which is due at the time of the return of this packet & tuition amount in the manner stated in Option #1 Please check here indicating that this method is agreed upon by your signatures below.*
• We agree to pay the non-refundable $750 Registration Fee, which is due at the time of the return of this packet & tuition amount in the manner stated in Option #2. Please check here indicating that this method is agreed upon by your signatures below.*
• Print Name of Father*
• Signature Father*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother*
• Signature Mother*
• Date*
  Date Format: MM slash DD slash YYYY
• Office use only: Registration Fee ($750.00)*

• Student Admission Application

• School Year*
• Student's Legal Name
  First Middle Last
• • Male
  • Female
• Address
  Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
• Child prefers to be called*
• D.O.B*
  Date Format: MM slash DD slash YYYY
• Last School Attended*
• Grade entering*
• School District*
• District School*
• Father/Guardian Name*
• Place of Employment*
• Occupation*
• Work Phone*
• Home Phone Number*
• Cell Phone*
• Father's Preferred number for One Call Now notifications*
• Address if different from child's*
  Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
• Father's E-mail address*
• Church/Parish Name*
• Mother/Guardian Name*
• Place of Employment*
• Occupation*
• Work Phone*
• Cell Phone*
• Mother's Preferred number for One Call Now notifications*
• Address if different from child's*
  Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
• Mother's E-mail Address*
• Religious Affiliation*
• Church/Parish Name*
• Pediatrician*
• Office Phone*
• Dentist*
• Office Phone*
• Psychologist*
• Office Phone*
• Other Doctor*
• Office Phone*
• Fears*
• Student's Siblings Names, grades and ages*

• APPLICATIONS MUST BE RECEIVED BY Friday, February 28th, 2020 FOR THE UPCOMING SCHOOL YEAR

  Mail to or send to school:
  Academy of St. Louis
  Georgi Walczyk Administrator
  1633 Kehrs Mill Rd., Bldg. B
  Chesterfield, MO 63021

• Print Name of Father*
• Signature Father*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother*
• Signature Mother*
• Date*
  Date Format: MM slash DD slash YYYY

• The Academy of St. Louis admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs and athletic and other school-administered programs.

  Student Emergency Information

• School Year*
• Student Name*
• D.O.B*
  Date Format: MM slash DD slash YYYY
• Parent's Names*
• Home phone (if applicable)*
• Cell Phone Mom*
• Cell Phone Dad*
• Work Phone Mom*
• Work Phone Dad*

• Emergency contacts (if unable to reach parents):

• Name*
• Home Phone*
• Cell Phone*
• Work Phone*
• Relationship to student*
• Name*
• Home Phone*
• Cell Phone*
• Work Phone*
• Relationship to student*
• Doctor's Name*
• Phone*
• Doctor's Name*
• Phone*
• Emergency Hospital Preference*
• Medical Conditions/ Diagnosis*

• Educational Diagnosis ­
  Current Medications: (Will be attached to this form)

  In case of accident or serious illness, and we and the people we designated are unable to be reached, I hereby authorize the school to call the physician listed and follow his instructions. If this physician is unable to be contacted, the school may make whatever arrangements are deemed necessary.

• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Student's Current Medication List

• Student's Name*
• School Year*
• Weight*
• Date of Birth*
  Date Format: MM slash DD slash YYYY
• Name of Medication Prescribed
• Dosage as prescribed Daily
• Daily Administered Times (be specific)
• Date Medication started
• Have these present Medications been effective?
  • Yes
  • No

• Please List Medications Prescribed in the Past: (Related to Cognition/Behavior Improvement only.)

• Reasons why Medication(s) were discontinued*
• Behaviors staff should monitor related to Medication to assist evaluating for Efficacy of Medications:*

• (The teacher will be given information regarding signs and symptoms of medication side effects on each medication the student is receiving.)

• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Print Name of Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• All medication to be given at a school must be in a container with the medication name, pharmacy number, dosage, frequency of administration, expiration date, and physician's name.

  Permission to Administer Medication at School

• School Year*

• (name of parent) give permission for Academy of St. Louis to administer the following medication/s to my child, (name of child). Please list other medication administration is requested to administer to your child during school hours.

• Medication Name*
• Specific Time to be given*
• Medication Name*
• Specific Time to be given*
• Medication Name*
• Specific Time to be given*
• Medication Name*
• Specific Time to be given*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Permission for the School to Administer Tylenol or Ibuprofen School Year:

  (name of parent) give permission to the Academy of St. Louis to Administer Tylenol or Ibuprofen whenever necessary according to the directions on the bottle label, if requested by my child.

• Name of my child*
• Adult Dosage*
• Child's Dosage*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Permission to Exchange/Obtain Information

  ,(printed name of parent or guardian) give permission for Academy of St. Louis to release and obtain information pertaining to the records of my child, to the board members, staff, consultants, and other persons the school deems necessary. This information could include the following: Student's progress reports, multi­ disciplinary evaluation reports, mental health assessment reports, IEP/ISPs, Behavior Rating Scales, and medical information given with the parent's/guardian's permission to the Academy of St. Louis. Information exchange or obtained may be either verbal or in written form. This information will be exchanged for educational reasons.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Authorization for the Use of Photographs School

  I/We, the undersigned, grant Academy of St. Louis School the right to publish reproduce and display photographic images, video images and/or audio recordings of (Student Name) for use in all media, social media (ie: Facebook, Twitter, etc.) electronic or otherwise, in connection with publications, advertisements and/or web pages of Academy of St. Louis provided that Academy of St. Louis School is not authorized to sell or otherwise distribute such photographic images, video images, or audio recordings to any other person or entity without my/our consent. I/We understand that Academy of St. Louis School may associate the photographic image, video image or audio recording with the first name oflndividual and the name of the school where Individual is a student. I/We further acknowledge and agree that neither I nor Individual, if Individual is a minor has or shall have any ownership interest in any informational or advertising material which utilizes, incorporates or consists of the photographic images, video images and/or audio recordings or in any copyright embodied therein.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• I/We, the undersigned DO NOT grant Academy of St. Louis School Authorization for the Use of Photographs.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Caretaker Permission for Student Pick-Up School

  Please fill out the form below with names of caretakers who have your permission to pick up your child.

  Caretakers who have your permission to pick up your child:

• School Year*
• Name*
• Cell phone*
• Relationship to Student*
• Home phone*
• Name*
• Cell phone*
• Relationship to Student*
• Home phone*
• Name*
• Cell phone*
• Relationship to Student*
• Home phone*
• Name*
• Cell phone*
• Relationship to Student*
• Home phone*

• If caretaker is not listed on the above list, permission must be granted via phone call, email or text with the name of the pick-up driver' s name. He/she will be required to provide a Driver' s License to be photographed and texted to the student's parents for verification.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Permission form for Field Trip Participation Dear Parent or legal Guardian:

  Your son/daughter is eligible to participate in school-sponsored field trips requiring transportation to a location away from the school building. These activities will take place under the guidance and supervision of school personnel from the Academy of St. Louis. School personnel will be the drivers and have been given the criteria for private passenger vehicles. Prior to each school-sponsored field trip, an ASTL Field Trip form is sent to you describing the event, which staff member driving your child, the date and time of departure, approximate time of return, any cost involved, appropriate dress in the event that the school uniform is not appropriate, and the need to bring a sack lunch, if necessary. If you would like your child to participate in this school year's planned field trips as stated in this year's school calendar, and that require transportation provided by the school, sign and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student. · I hereby consent to participation by my child in the field trips described in this year's school calendar. I understand that these trips will take place away from the school grounds, and that my child will be driven by and under the supervision of the designated school personnel on the scheduled dates. I further consent to the conditions that will be stated in the notices sent by the administrator prior to the trip.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Permission to take part in Physical Education: School

  Igive permission for my son/daughter, to participate in the Physical Education Classes described below: Students will possibly participate in Daily fitness with 10 crunches, 10 push-ups, 10 leg lifts, 10 balance exercises, jump roping, laps around the gym: walking, running, skipping, etc., as assigned. Students will also possibly participate in various games including volleyball, basketball, etc. during the gym class.

• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Print Name of Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Permission to take part in Transition/Career Counseling

• School Year*
• Give permission to the Academy of St. Louis for my son/daughter: (Name of my child) to participate in the Transition/Career Counseling program at the Academy of St. Louis. Print*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY

• Neurodiversity Class Participation Permission Form

  Your son/daughter is eligible to participate in a school sponsored class called Neurodiversity. With your permission it will be taught individually to your student on a weekly basis. The goals for each student are: To increase understanding of self Increase understanding of their diagnosis - benefits/strengths and challenges Recognize the signs and symptoms of their diagnosis and learn coping mechanisms Become aware of their own possibilities and limitations Enjoy life more

  Please return this this form if you choose to have your child participate in this class

• I hereby consent to have my child participate in the Neurodiversity Class provided by the ASTL.*
• School Year*
• Print Name of Father/Guardian*
• Signature Father/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY
• Print Name of Mother/Guardian*
• Signature Mother/Guardian*
• Date*
  Date Format: MM slash DD slash YYYY