Parent/Guardian Consent Form

*Please note that you must complete this form for each of your students enrolled with GRPS*



I consent that my student may: *
Be photographed/videoed/interviewed for school-related material
Be photographed/videoed/interviewed for District-related material
Be photographed/videoed/interviewed for non-GRPS media (ex: publications of our partners or agencies we work with)
Be sent emails
Be transported to home or to a caregiver
Be transported to a health evaluation or screening
Utilize the internet
As the parent/guardian, I consent that I may: *
Receive automated calls
Receive emails
Receive text messages
Armed Services
My student's information may be released to Military Recruiters

Health Services

I consent that my student may: *
Receive health and human services provided by Kent School Services Network: KSSN brings health and human services into the building to support student achievement by serving students and families.In addition to KSSN staff, staff from the following KSSN partner agencies may work with your child: Arbor Circle, DA Blodgett/St. John's, Kent County Dept. of Health and Human Services, Cherry Health
Receive free vision screening provided by Vision to Learn: VTL provides free vision screening
Receive eye exam(s) and eyeglasses provided by Vision to Learn. This may be billed to my Medicaid benefits
Receive free hearing screenings provided by the Kent County Health Department
Receive free vision screenings provided by the Kent County Health Department
Provide immunization records to Kent County Health Department
Receive free dental services provided by Cherry Health Dental Services. This may include dental exams, x-rays, cleaning, fluoride and sealants at school, at no charge to you. However, if your child has dental insurance or Medicaid these carriers will be billed as payment in full. If your child plans to be seen by a non-Cherry Health dental office in the next year your insurance may not cover duplicated services
Receive medical services provided by Cherry Health School-based Health Centers
Receive counseling services provided by Cherry Health School-based Health Centers

Data and Technology

As a Parent/Guardian of the above student: *
I understand that the District plans to share information with program evaluators from Grand Valley State University's Community Research Institute (CRI) for use in an evaluation of out of school time programs
I understand that my student will be utilizing technology and devices and must adhere to the District's Acceptable Use policy contained in the Student Policy Handbook. I agree to indemnify the District of any monetary liability incurred by the student while utilizing the District's technology or the Districts network

Facilities and Transportation

As the Parent/Guardian of the above student, I understand and consent to: *
My student may participate in a number of chaperoned field trips that may include but are not limited to: various attractions, college campuses, professional environments/buildings, other GRPS schools, and other special events
My student may be transported to and from school for field trips, and school related activities, in automobiles that may be owned by the school, or by an employee or volunteer. I understand that these vehicles are not school buses, and as such, are not in compliance with all current regulations for school buses. I feel that the additional risk of transporting my child in a car, as opposed to a bus, is acceptable as it allows my child educational enrichment beyond the classroom environment
As the parent/guardian of the above student, I have read and understand all of the prompts to which I have provided answers. *
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