Kazoo School
Child Information Record
Child Information Record BCAL-3731 (Rev. 7-18)
Student Information
FIRST NAME OF CHILD
*
LAST NAME OF CHILD
*
Date of Birth
*
mm-dd-yyyy
Address (Number and Street, Building/Apartment Number)
*
City, State
*
Zip Code
*
1. PARENT/GUARDIAN NAME
*
1. Phone
*
1. E-mail
*
Home Address (if different)
*
1. Employer Name
*
1. Work Phone
*
If different
2. PARENT/GUARDIAN NAME
*
2. Phone
*
2. Email
*
Address (if different)
*
2. Employer Name
*
2. Work Phone
*
Home School District
*
Select
Kalamazoo
Portage
Other
Please select the school district your child resides in
By checking this box, I agree to receive notification and alerts - text messages from Kazoo School for unplanned closures or emergencies (5 messages per month). Reply help for information or stop to opt-out. Message and data rates may apply.
*
Privacy Policy can be found on the website: https://www.kazooschool.org/s/KAZOO-SCHOOL-Text-Messaging-Service-Privacy-Policy-2024.pdf
Next
Health
Name of Child's Physician or Health Clinc
*
Physician's or Health Clinic's Phone Number
*
Hospital Preferred for Emergency Treatment
*
Insurance Company
*
Allergies, Special Needs, and Special Instructions
*
Permission Given for Emergency Treatment
*
Previous
Next
Emergency Contact and Release of Child: List all individuals, including parents/legal guardians, in order of preference, to be contacted in an emergency and to whom the child can be released.
1. Name
*
Emergency Contact and Release
1. Phone
*
2. Name
*
Emergency Contact and Release
2. Phone
*
3. Name
*
Emergency Contact and Release
3. Phone
*
1. Name
*
Release of Child Only
1. Phone
*
2. Name
*
Release of Child Only
2. Phone
*
3. Name
*
Release of Child Only
3. Phone
*
4. Name
*
Release of Child Only
4. Phone
*
Previous
Next
Kazoo School Policies and Agreements
I have read the Kazoo Family Handbook found on the website https://www.kazooschool.org/forms
*
Yes
No
Concussion Form Acknowledgement
*
Check this box to verify that you have received a copy of the concussion information form. This form must be signed annually by both parent/guardian and student and provided to the office.
Kazoo School has my permission to publish the following in the school directory
*
Home address
Home phone number
Cell phone number
Email address
Home address, Home phone number, Cell phone number, Email address
Appropriate Use Policy - Student Agreement
*
Check this box to acknowledge that you have read and fully understand the conditions and terms of this policy and agree to be a responsible user of the Kazoo School computer system:
Appropriate Use Policy - Parent Agreement
*
I have read and fully understand the conditions and terms of the AUP and give my child permission to have a Kazoo School account and agree to be responsible for my child's computer use while using the Kazoo School computer system.
Use of Personal Devices (Middle School Only)
*
Check this box to verify you have received and fully read the Consent for Utilization of Personal Electronic Devices and agree to all terms and conditions.
Pesticide Use Advance Notification
*
Select
YES - I would like to be notified prior to any scheduled pesticide treatment inside the buildings or on school grounds
NO - I do not wish to be notified prior to a scheduled pesticide treatment
Previous
Next
Authorizations and Releases
Auxillary Programs (extended day, late day and/or vacation programs)
*
YES - I give Kazoo School permission for my child to use the Kazoo School's auxiliary programs on an emergency basis
NO - I do not give permission for my child to use the Kazoo School's auxiliary programs
Photo Release - Kazoo School has my permission to use photographs of my child in the following
*
ALL - Advertising & Promotional Materials & Social Media
SOME - Advertising & Promotional Materials Only (No Social Media)
HOMEROOM ONLY
NONE (includes Homeroom)
Field Trip Participation
*
YES - I give Kazoo School permission for my child to participate in all Kazoo School field trips (including auxiliary and vacation program trips)
NO- My child is not permitted to participate in field trips (including auxiliary or vacation programs)
I give Kazoo School my permission to apply sun block and/or bug spray on my child/children
*
Yes
No
Previous
Submit
×
Upload Image
Upload
Webcam
Edit
Delete
To crop this image, drag a region below and then click "Save Image"
Uploading
by
