Student Profile

If I am a parent/guardian completing this form on behalf of a minor student, I acknowledge that I have reviewed the Map Academy Student Handbook with my student. I understand the contents of the document and that my student is expected to abide by them.

If I am a parent/guardian completing this form on behalf of a minor student, I acknowledge that I have reviewed the Student Technology Acceptable Use Policy with my student. I expect my student to follow technology and internet policies when using the school’s computers. I hereby release Map Academy Charter School, its staff members, and its officers from any liability associated with access to the internet and the use of school technology.

Community-based, experiential opportunities and field trips are an important part of our school’s program. Staff also support students with a range of wraparound opportunities which may involve use of Map Academy van transportation. By signing below, you grant your student permission to participate in school-sponsored experiential learning, field trips and out-of-school events/community building sponsored by Map Academy Charter School. You agree that you understand that students may travel to field trips on public transportation, by chartered bus, in Map Academy passenger vans or in chaperones’ private vehicles. You hereby release Map Academy Charter School, its staff members, and its officers from any liability for any injuries, damages, or losses associated with field trips or out-of-school events. You will communicate with staff regarding any questions or concerns about planned field trips or events.

In order to communicate about our school with potential parents and teachers, contributors to the school, other educators, and the general public, Map Academy produces public relations materials such as brochures, annual reports, a website, videos, newsletters, etc. These public relations materials allow us to celebrate student and school accomplishments. Please complete the following authorizing us to use photos, quotes, video, and/or student work in public relations materials. By choosing yes, you give permission for Map Academy Charter School to use photos, quotations, and/or student work in public relations materials. You will communicate any questions or concerns regarding public relations materials to school staff.

You can provide the name and address of my student to a third party mail house if requested by the sending district from which a student is enrolled, in conformance with M.G.L. c. 71, s. 89g

You can share my student’s name, address, and phone numbers with military recruiters, as required for public schools in the No Child Left Behind Act of 2001 as well as the National Defense Authorization Act for Fiscal Year 2002

Administer according to the manufacturer’s label. For relief of minor aches and pain. Student with temperature over 100.4 must be sent home.

Administer according to the manufacturer’s label. For stomach ache or heartburn. May cause constipation.

Administer according to the manufacturer’s label. For relief of body aches & menstrual cramps. Contains no aspirin but should not be given if student has asthma or allergy to aspirin. Student with temperature over 100.4 must be sent home.

(to be completed if not in violation of confidentiality)

By electronically signing this document you attest to all aforementioned responses and information provided in this form.

This field is for validation purposes and should be left unchanged.

Adult Supporter #1

Adult Supporter #2

Emergency Contact #1

Emergency Contact #2

Pickup Restrictions

Policy Agreements

Directory Information and Third-Party Mailing

Primary Care Physician

Over-the-counter Medication Authorization

Allergies

Prescription Medication Authorization

Signatures