A separate application is required for each student.

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* 1. Student Information

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* 2. If new to the school, how did you hear about SMG Preschool & Kindergarten?

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* 3. Parent/Guardian 1 Information (Person Completing Application)

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* 4. Parent/Guardian 2 Information

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* 6. School Requirements (Please place your initials in the box for each requirement).

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* 7. St. Maria Goretti Picture Release
We often have the opportunity to photograph the children during classroom activities. The majority of these informal pictures will be displayed within the classroom for the families to enjoy. Occasionally, certain pictures may be submitted to local news publications or used for advertising the program offered here at Saint Maria Goretti. Please choose from the following:

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* 8. Roman Catholic Diocese Of Phoenix Photographic and Interview Release
On behalf of and as the parent or legal guardian of the above named student, who is under eighteen (18) years of
age, (hereinafter “the Minor”), I hereby authorize the Roman Catholic Diocese of Phoenix (hereinafter “the Diocese”),
all of its parishes, affiliated organizations and entities, and St. Maria Goretti Preschool and Kindergarten (hereinafter, the “School”) to record the Minor’s picture, voice and likeness in photographs, films, videotapes or other media during and in connection with the Minor’s education or participation in School or Diocesan activities or events, and to use the
Minor’s picture, voice or likeness on the Diocese website, in the Catholic Sun newspaper, or in any other media or publication without further compensation or permission. 
I further authorize the Diocese, its parishes, affiliated organizations, entities and agents, and/or the School to edit any recordings of the Minor’s likeness and/or voice and incorporate any such recordings into print publications, electronic publications, software, movie and sound films or tapes, broadcasts (radio and television), programs or otherwise, and to use and license others to use such publications, recordings, software, movie and sound films and tapes and broadcast programs in any manner of media whatsoever, including unrestricted use for purposes of publicity, information, advertising and sale promotion. I understand that the Diocese exclusively owns all rights to these recordings irrespective of the form in which they are produced or used.
I further agree to indemnify and hold the Diocese, its parishes, affiliated organizations, entities, licensees, employees and agents, and the School harmless from and against any claims and liability for damages, losses or expenses of any kind arising from the making or use of any recordings, including, without limitation, claims with respect to the Minor’s privacy or publicity. I have read and understand the contents hereof, and have the right and authority to execute this release and to give this indemnification. I understand that this Release is to be interpreted under the laws of the state of Arizona without resort to its conflict of laws rules, and I hereby submit to the jurisdiction of the courts of the state of Arizona with respect to any action arising under this Release.
Parent/Guardian Consent
Per my initials in the box below, I certify I am the parent or legal guardian of the minor named above. I have the legal right to consent to and do consent to the terms and conditions of this Release.

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* 9. I would like the following information to be shared in a school directory that will be shared with school families for the purposes of contact from room parents, birthdays, play dates, etc.

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* 10. SMG School Confidentiality Agreement
Our volunteers and parents always work under the supervision of the professional staff and only with those teachers who have requested the services of a volunteer or parent. At any time the teacher or administrator may dismiss any volunteer whose actions are not in the best interest of the school or students. Like teachers, volunteers and parents are bound by a code of ethics to keep confidential matters within the school. The staff and students need to know they can trust you. Please do not discuss a student’s school progress or difficulties with anyone except the teacher…including the parents. That is the teacher’s responsibility.  Confidentiality is vital to the partnership.

I understand that to volunteer in the classroom or at any events/functions I must have a volunteer card on file and am current with my Called to Protect/Safe Environment certification. I further understand that in my course of volunteering or participating at SMG, I may become aware of confidential information about specific students or the school. This may include such information as students’ academic performance, behavior, disabilities and related matters. By placing my initials in the box below, I understand and agree that I will not disclose such confidential information except to school employees who have a need to know. A breach in confidentiality may result in withdrawal from the school without refund.

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* 11. AZ State Department of Health Services Code Word
The State Department of Health Services requires verification via telephone in order to have someone not listed on the original blue card pick up your child from school. For your child’s safety, a mandatory code word system will be used when a parent calls to authorize another individual (who is not listed on the original blue card) to pick up their child. A staff member may ask for the word if the parent's voice is not recognized. If this word is not given, the child will not be released to said individual. It is the parent’s responsibility to take note of this word and provide it to the office when asked. (We recommend placing it - with the schools contact number of 480-948-3606 - in your cell phone contacts).
If a child is to go home with someone not listed on the blue card, and this information is known in advance, written permission needs to be given to the office.
I understand the telephone procedure listed above, and the code word for the student listed above is:

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