* 1. USE OF TYLENOL:

* 2. USE OF MEDICATIONS OTHER THAN TYLENOL:

Roberts School Administrative Staff is authorized to dispense the following medicines other than Tylenol, to my child for current school year.  Dosage will be given in accordance with the directions on the bottle.  In the case of a prescription medication the bottle with the directions should be given to the school.

* 3. PARTICIPATION IN ATHLETICS – ACTIVITIES - FIELD TRIP  - INJURY AWARENESS:

In consideration of permission granted my child or ward to participate in activities during the school year in progress, I hereby authorize school personnel of Roberts School District, in case of injury to said child, to consent to any x-ray examination, anesthetic, medical or surgical diagnoses or treatment, and hospital care, to be rendered to the minor under the general or special supervision and advise of any physician or surgeon licensed to practice in the United States of America.

It is understood I will be notified of the injury at the earliest possible opportunity but this authorization will allow treatment until I arrive.  I further understand that the expenses incurred from any such treatment will be my responsibility.

I am aware there is a risk of being injured as a result of participation in any school sport or activity.  I am aware that the injury may be severe including, but not limited to: death, fractures, brain injuries, paralysis, neck or spinal injuries, damage to virtually all internal organs, serious injury to ligaments, muscles, tendons, and other aspects of the muscular system.

Nevertheless, I want my child to participate in school athletics and activities.  I also understand that the school district is not responsible for payment of any kind of injuries received while participating in such activities unless found negligent.

I also understand that to compete in interscholastic activities my son or daughter must complete a Montana High School Association Physical.  The Form can be found by clicking here.

PERSONAL INSURANCE STATEMENT: Select all that Apply

* 4. PARENT CONSENT FORM TO CONDUCT HEARING AND VISION SCREENING:

Hearing and Vision screenings are conducted annually at Roberts School.  Vision screening will be conducted for students in Kindergarten, first, third, fifth, seventh, ninth, and eleventh grades.  Hearing screening will be completed as part of the Office of Public Instruction’s Hearing Conservation Program.  All Kindergarten, first grade, tenth grade and any new students will automatically be tested.  Children with a history of hearing loss or middle ear dysfunction are also automatically screened.  The following types of screenings may be performed: Pure Tone, Otoacoustic Emissions (OAE’s), and Immittance Screening.  If a child is not a new student, on the Annual re-check list or in one of the test grades but they have been referred for hearing screening, written consent is needed.  Results and recommendations will be mailed home.  Your signature gives consent for your child to have their vision and hearing screened during the current school year.  (For a complete description of each test please contact the school office.)

* 5. F.E.R.P.A. (Family Educational Rights and Privacy Act) and consent to release student records

In regard to student records, federal law requires that “directory information” on my child be released by the District to anyone who requests it unless I object in writing to the release of any or all of this information.  Directory Information ordinarily includes the student’s name, address, telephone number, date and place of birth, honor roll, college and military acceptances, scholarships, participation in officially recognized activities and sports, weight and height of members of athletic teams, photographs, dates of attendance, awards received in school, most recent previous school attended.  Examples of places your child’s information may be released are the school newsletter, honor roll lists, school newspaper, yearbook, athletic rosters, music programs, graduation activities, military personnel. This is not an all inclusive listing, just some examples.  Pursuant to federal law, the District is required to release the names, addresses and telephone numbers of all high school students to military recruiters and institutions of higher education upon request.  This notification to parents and students concerning school records will inform them of their right to object to the release of this information.  In exercising my right to limit release of this information I have:

Select all that apply

* 6. STUDENT HANDBOOK 

As an informed parent, your signature below indicates that you have read the rules and regulations of the Roberts Public School Student Handbook and understand the rules and regulations as approved by the Trustees of School District #5.

Click Here to View The Handbook

* 7. Families of Four Making Under $45,000 will qualify for Free and Reduced Lunches.

Click Here for Free and Reduced Cut Offs

Click Here for Free and Reduced Forms to Fill Out and Print Off

* 8. School Vaccination Laws 

State of Montana Required Vaccinations 

Religious Exemption Form

* 9. I Certify that the above information is correct to the best of my abilities.  I agree that the information above is correct and by typing my name with a date it will act as my official signature.

If you are an out of district family, please click here and fill out the attached form. It must be submitted to the school office.

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