Contact Information STUDENT INFORMATION – Please Print STUDENT’S LEGAL LAST NAME
LEGAL FIRST NAME
MIDDLE NAME
DATE OF BIRTH
GENDER
GRADE
PREFERRED NAME HOME ADDRESS (Street Address & Apt. No.)
CITY
STATE
MAILING ADDRESS (If Different From Home)
CITY
STATE
LAST SCHOOL ATTENDED
RACE/ETHNICITY: (Choose all that apply) ☐African American ☐American Indian/Alaskan Native ☐Hispanic ☐Other
☐Asian
ZIP CODE
√ IF APPLICABLE ____ Unlisted ____ Cell
HOME PHONE #
ZIP CODE
STUDENT’S EMAIL
CITY
STATE
ZIP CODE
☐Hawaiian/Pacific Islander
☐Caucasian
LEGAL DOCUMENTS: (Restraining order, Custody Agreements and any other court documents) ☐ YES – Please provide documents ☐ NO
PARENT / GUARDIAN INFORMATION PARENT/GUARDIAN NAME
LIVES WITH STUDENT?
☐ YES ☐NO
RELATIONSHIP TO STUDENT:
HOME ADDRESS (If different from above)
CITY
State
EMPLOYER
ZIP CODE
WORK PHONE
PARENT/GUARDIAN NAME
EMAIL ADDRESS
HOME PHONE
LIVES WITH STUDENT?
CELL
☐ YES ☐NO
RELATIONSHIP TO STUDENT:
HOME ADDRESS (If different from above)
CITY
State
EMPLOYER
ZIP CODE
WORK PHONE
EMAIL ADDRESS HOME PHONE
CELL
EMERGENCY CONTACT INFORMATION – Please list at least two persons not listed above.
Any person listed may be contacted in an emergency; parent/guardian contact will be attempted first. Any person listed may pick student up from school.
NAME (Please print)
RELATION TO STUDENT
HOME #
CELL #
WORK #
LIVES W/ STUDENT? ☐YES ☐NO
NAME (Please print)
RELATION TO STUDENT
HOME #
CELL #
WORK #
LIVES W/ STUDENT? ☐YES ☐NO
NAME (Please print)
RELATION TO STUDENT
HOME #
CELL #
WORK #
LIVES W/ STUDENT? ☐YES ☐NO
INSURANCE INFORMATION | 2014‐2015 STUDENT NAME: Do you have any reason to believe your child is not physically able to take part in all school‐sponsored ac vi es he/ she chooses? ☐YES ☐NO If yes, please explain: Is there anything unique related to your child’s physical condi on or medical history which the school should know? ☐YES ☐NO If yes, please explain: ANY KNOWN ALLERGIES: PARENT PERMISSION FOR SCHOOL TRIPS: I hereby give permission for my student to take part in field trips and oth‐ er school‐sponsored ac vi es included in the planned program of the school. Transporta on may be provided at the discre on of Western Mennonite School in such form as approved. ☐YES ☐ NO I authorize Western Mennonite School, its employees and my child’s weekend/hospitality home (if applicable) to administer first aid or secure the services of a physician or hospital, and to incur expenses for necessary services in the event of accident or illness. I will provide payment for these services. Every reasonable effort will be made to contact the parent(s) as soon as possible. Do you agree to the above statement? ☐YES ☐NO INSURANCE COVERAGE: COMPANY: GROUP #: POLICY #: NAME OF POLICY HOLDER: PARENT/GUARDIAN SIGNATURE My signature indicates that all informa on provided on this form is correct to the best of my knowledge. Signature: Rela onship: Date: ____________ Emergency contact number(s): ____________________________________________________________________ _______________________________________________________________________________________________ INSURANCE DISCLAIMER: Although I realize that Western Mennonite School requests that I provide health insur‐ ance for my child, I do not have any health insurance coverage at this me. I will be responsible for any medical bills accrued by my child while a ending Western Mennonite School and will not hold Western Mennonite School re‐ sponsible for those bills. PARENT/GUARDIAN SIGNATURE: DATE: ______________ FORM REQUIRED FOR EVERY STUDENT
Community Standards
Student Name:
Grade:
Philosophy Admi ed students must agree to help bring unity to the Western Mennonite community by suppor ng the Western Mennonite School Standard of Conduct and guidelines listed in the student handbook. Standard of Conduct The WMS Standard of Conduct is a guide for WMS students and families and is in effect while a student is enrolled at WMS. It is a code consistent with the teachings of Jesus Christ, and while not exhaus ve in nature, it is representa ve of behaviors WMS students and families are expected to follow. Any student or family who is unwilling to abide by the following Standard of Conduct will be asked to withdraw from WMS. As a student and family of Western Mennonite School I sincerely resolve to: 1. Be open to the influence of Jesus Christ and His followers, respec ully listening in chapels, small groups and classes. 2. Allow others to seek truth about Chris anity. 3. Treat others in a respec ul and courteous manner. 4. Be trustworthy in words and ac ons. 5. Believe the best about somebody or a situa on. If I have ques ons I will go directly to those involved. 6. Refrain from being involved in any ac vity that could nega vely represent my family, friends, school, or me. WMS administra on understands that members of its community may fall short in their fulfillment of the Standard of Conduct. This may result in disciplinary ac on from administra on. When these mes happen, WMS administra on expects its students and families to reaffirm their commitment to the WMS community by re‐establishing a lifestyle that supports the school’s Standard of Conduct. Student Rights and Responsibili es WMS expects each student to share in the responsibility for self‐discipline and for ensuring the health and safety of those around them by repor ng inappropriate behavior to the correct authori es. WMS students have the right: 1. To be heard as a responsible member of a community of faith and learning. 2. To be encouraged for behavior that shows responsibility and considera on of others. 3. To have conversa on kept in confidence when they come to a staff member for counseling (excep ons include items covered under mandatory repor ng rules) 4. To be treated with courtesy and respect when confronted by a staff member on a discipline issue. 5. To be dismissed from school only a er careful a empts at correc on by the school community (in the spirit of Ma hew 18:15‐20) fail to bring about sufficient evidence of changes in a tude and behavior. 6. To know the standards of behavior expected of them as well as the consequences of misbehavior. 7. To privacy which includes privacy in respect to the student’s school records. 8. To equal educa onal opportunity and freedom from discrimina on, including the responsibility not to discriminate against others. I have read the Community Standards listed above and the Student Handbook, and agree to abide by the stated guidelines: Parent/Guardian Signature: ____ Date: Student Signature: ____ Date:
Form Required for Every Student
Transportation Permissions | 2014‐2015 Student Name:
Grade:
The purpose of this form is to allow you, as the parent, the ability to give specific transporta on related permissions for your son/daughter for the school year. Please read each sec on carefully and make the appropriate selec ons that best fit you and your student’s needs. As a closed campus, all students, including those that are 18 or older, unless specifically approved by the student’s parent/ guardian and WMS administra on will not be allowed to leave campus during the school day, nor drive themselves to any athle c events. Parental permission for these things can be given below and kept on file by iniƟaling all sec ons that apply. Permission to leave campus during the school day without a school faculty/staff member for such things as lunch on Fridays, appointments, etc. _____ Yes, my student may leave campus
_____ No, my student may not leave campus
_____ I would like to give permission for each specific instance WMS only allows the siblings of the driver to ride in any student driven vehicle. Non‐siblings may ride in a student driven vehicle if the carpool is registered with Student Services Office. Please list any car pool you would like to give your child permission to ride in while travelling to or from school, and/or athle c events. Carpool driver/s: ____________________________________________________________________________ Student #1 ___________________________________ Student #2 ____________________________________ Student #3 ___________________________________ Student #4 ____________________________________ Student #5 ___________________________________ Student #6 ____________________________________ Please register any vehicle(s) that you will be driving to campus this school year. Vehicle #1 Color _________________ Make ___________________
Model _____________ License ___________
Vehicle #2 Color _________________ Make ___________________
Model _____________ License ___________
Form Required for Every Student
Internet and Technology Use Policy | 2014‐2015 Student Name:
Grade:
Western Mennonite School offers students the privilege of computer use through educa onal so ware and Internet access. Both the computer so ware and the Internet offer students a vast array of resources that have the poten al to enrich their educa onal experience. The Internet is intended as a supplement to library resources and is first and foremost a research tool. The primary use of the school’s network and the Internet is for ac vity that supports the educa onal objec ves of the school and the Standards of Conduct. Any student using a computer on campus, including personal laptops and other devices, agrees to the responsible use of these resources. 1. I will not do anything that interferes with the opera on of the school’s network or the Internet. 2. I will not a empt to gain access to unauthorized areas of the network. 3. I will respect the work of others, and I will not tamper with or in any way violate the property, folders, files, etc. of others. 4. I will not violate copyright laws or commit plagiarism by downloading any copyrighted materials found on the Internet. (This includes music, music videos, movies, etc.) 5. I will use the school’s limited resources responsibly by not using excessive hardware space and by limi ng the number of copies I print. 6. I will not use the school’s network to access or display objec onable, obscene, or violent images, messages, or materials. 7. I will not knowingly send, receive or display obscene or violent images, messages or pictures. 8. I will not download or play computer programs or games that are not school approved. 9. I will not access unauthorized social networking sites. 10. I will not give out personal informa on such as complete name, phone number, address or iden fiable photo without permission from teacher, parent or guardian. 11. I will not use the computers or Internet to insult, harass, or a ack others. I understand that any viola on of these guidelines will result in the loss of Internet and computer use and privileges as well as other possible disciplinary or legal ac on. The school will cooperate fully with civil and federal authori es in the event of criminal ac vity rela ng to our electronic communica ons system. I ________________________________, have read and understand the Acceptable Internet and Technology Use Policy and agree to adhere to all guidelines listed here. I understand the consequences that will occur upon viola on of this policy. As a student Internet and computer technology user, I accept full responsibility and liability for the results of my personal ac ons. Student Signature _____________________________________________________________ Date ________________ Consequences for any student viola ng the Acceptable Technology Use Policy st
1 offense = loss of computer privileges for one day – Dean of Students informed and parents no fied 2nd offense = loss of computer privileges for one week – Dean of Students informed and parents contacted by phone and a formal le er placed in student’s file 3rd offense = loss of computer privileges on campus for the semester – Dean of Students informed, and parents no fied. This policy is in place to protect the privacy of all members of the Western Mennonite School Community and to safeguard the integrity of the system. Any ac vity that interferes with the opera on of the school’s network or Internet will be considered vandalism. All costs for labor and materials incurred due to vandalism will be billed to those responsible for that vandalism.
Form Required for Every Student