аЯрЁБс>ўџ @Bўџџџ?џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС5@ №ПbjbjЯ2Я2 "4­X­X џџџџџџˆЂЂЂЂЂЂЂЖZ Z Z 8’ Ў DЖž ў ў ў ў ў н н н $ЈRњlCЂ;й н ;;CЂЂў ў лXћћћ;ŽЂў Ђў ћ;ћ&ћ!ЂЂ!ў ђ pФ”gЮZ ЩІ!QЬn0ž!fovf!ЖЖЂЂЂЂfЂ!0н Ў‹ |ћ dk ан н н CCЖЖЄZ хЖЖZ  Maria Hastings School Permissions Form 2013-14 All Parents/Guardians must complete and return this form. One form may be filled out for all children. The information on this form is confidential and will only be used by school personnel, except as you give permission on this form. Child(ren): Circle: Name: Grade/Teacher: Birthdate: Male/Female Last First Middle Name: Grade/Teacher: Birthdate: Male/Female Last First Middle Name: Grade/Teacher: Birthdate: Male/Female Last First Middle Name: Grade/Teacher: Birthdate: Male/Female Last First Middle Name: Grade/Teacher: Birthdate: Male/Female Last First Middle Parent Permission Form Please indicate whether or not you give your permission for each item by circling yes or not and signing below. Yes NoI give my permission for the following information to be published in the School Directory as long as my child(ren) attends Hastings: Address, Home Phone Number, Home email address, Work email address, Parent Names. (Please cross out any information you do Not want in the directory.)Yes NoI give my permission for my work and/or home email address to be added to school and or classroom listserv and/or email list for the purpose of sending school related information. This information will NOT be given or sold to anyone else.Yes NoI give my permission for the school to give our family name, address and phone number to other members of the school community to be used for school functions, school business and to allow contact between parents ONLY. I give this permission for the duration of the time that my child (ren) attends Hastings. (Please cross out any reasons for which you do NOT want this information released.)Yes NoI give my permission for my child(ren) to be photographed/videotaped and/or quoted for school purposes to inform the community about school activities via: School Display, PTA Newsletter, School/Community Newspaper, or for parents. NOTE: The law provides that Students may be photographed during any event open to the publicYes NoI give my permission for my child(ren) to be photographed/videotaped and/or quoted for school purposes to inform the community about school activities via: School Website (Photos or student work only. Names will NOT be used.).Yes NoI give my permission for my child(ren) (grade 4 & 5 only) to Ride his/her bike/scooter to and from school unaccompanied. I understand that it is my responsibility to help my child find a safe route, to teach my child bicycle/scooter safety rules, ensure that my child is wearing a helmet, and is responsible for locking his/her bike/scooter on school premises. Bikes/scooters must be walked on Crosby Road. (NOTE: skates, roller blades and skateboards are not permitted on school property.) Please have 4th & 5th graders sign here to verify they have read the rules. Signature:________________________________________________________________ Yes No I give permission to the school nurse to share information relevant to my child(ren)’s health condition with appropriate school personnel when needed to meet my child(ren)’s health and safety needs, or to emergency medical personnel and the receiving hospital, including persons to contact information, in the event my child(ren) requires emergency medical treatment. I give permission to exchange information with my child’s primary care physician for the purpose of referral, diagnosis and treatment. 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