Student/Parent Acknowledgement and Permission Form Tetzlaff Accelerated Learning Academy – 2016-2017 Please return this form on Registration Day – August 23, 2016 Please carefully read the following information/forms and acknowledge your understanding by initialing in the columns to the right, both student and parent/guardian. The following information/forms are available on our school’s website at

https://tms-abcusd-ca.schoolloop.com/

and/or the Student and Parent/Guardian Handbook (SPG Handbook) from the district. (Hard copies of all forms are available in our school office for review.) Student & Parent Initials

(Enclosed) Letter, Calendar of Events, Registration Day Information, & PTA Letter

Information/Form from website/District Handbook

1 2 3 4 5 6 7 8 9 10 11 12 13

TB Requirements (website) Dress Code/Cell Phone/Textbook Guidelines (website) Physical Education/Dance Guidelines (website) Student Acceptable Use Policy (website) Recommended Student School Supply Lists (website) Student Drop-Off & Pick-Up Guidelines (website) Nutrition Services Information (website & SPG Handbook) Acknowledgement of Receipt (website & SPG Handbook) Code of Conduct (website & SPG Handbook) Parent Permission to Tape/Photograph Students (website & SPG Handbook) Textbook and Library Materials (website & SPG Handbook) Type 2 Diabetes Health Risks (website SPG Handbook) Voluntary Participation for Student Accident/Health Insurance (website & SPG Handbook)

indicating that you have read and understand (agree with) the information contained in each form. Parent Student Initial Initial



After reading the following, If any applies to your child, please complete the applicable form(s) contained in the District Handbook and return on Registration Day along with this form: A Comprehensive Sexual Health Ed. And HIV/AIDS (website & SPG Handbook) B Medical Statement to Request Special Meals (website & SPG Handbook) C Migrant Education Program (website & SPG Handbook) D Nutrition Services Guidelines – Permission to Release Student Information (website & SPG) E Parent Notification of Pesticides (website & SPG Handbook) F Parent Request for Individual Pesticide Application (website & SPG Handbook)

Print Student Name

Student Signature

Grade

Print Parent/Guardian Name

Parent/Guardian Signature

Mr. Song Principal

Parent Phone # (best number)

Parent e-mail address (frequently used)

Please return this form on Registration DAY - August 23, 2016