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GVHS Emergency Card & Parent Agreement Forms (2018-2019)

All Garnet Valley School District emergency card and parent forms can now be completed online. This means that all of the information that was once mailed home and stored on paper is now digital, making the process for both our parents and staff more efficient.

We ask that you work to keep this information as up to date and current as possible so please contact your school's nurse if any changes that need to be made on your child's emergency card or main office if you need to change your contact information. 

Locations
Sections
Participant Information

Please provide the necessary information for your child.

Agreements

For each of the agreements below, please read the terms, check the box to mark your acknowledgement, and type your name to confirm.

Authorization to Administer Over the Counter Medication (Acetaminophen)

I give permission to the school nurse to administer Acetaminophen (Tylenol) to my child. Please note the school nurse is authorized to decline to administer any medication.

Please make a selection *
Authorization to Administer Over the Counter Medication (Ibuprofen)

I give permission to the school nurse to administer Ibuprofen (Advil, Motrin) to my child. Please note the school nurse is authorized to decline to administer any medication.

Please make a selection *
Authorization to Administer Over the Counter Medication (Benadryl)

I give permission to the school nurse to administer Benadryl (for insect/food medication allergic reaction only) to my child. Please note the school nurse is authorized to decline to administer any medication.

Please make a selection *
Asthma inhalers/Epinephrine inhaler, Insulin, or Epipen Agreement

Asthma inhalers/epinephrine inhaler, insulin, or epipen may be carried by the student, when the family physician and the parent/legal guardian gives written permission on file in the nurse's office.

Please make a selection *
Medication Administration Consent Agreement

By agreeing to the Medication Administration Consent Policy, we the parent/guardian(s) of the registered student, do hereby authorize the school nurse or other employee designated by the principal, an employee and authorized representative of the Garnet Valley School District, to administer the medication listed in the medications section in accordance with the dosage and time instructions listed.  If no medications are listed then medication will not be administered.

In consideration of the administration of prescription and non-prescription drugs by the nurses' and/or designated employees who are employed by said district, I hereby covenant and agree to hold harmless and indemnify all such employees against any and all claims, damages, expenses, attorneys' fees, suits, cause or causes of action in law and equity or any place however which may be brought against such employees because of a negligent act or omission committed by such employees in connection with such administration.  This agreement shall be effective until revoked by the parent/guardian in writing.

Note:  If possible, parents are advised to give medication at home and on a schedule other than during school hours.  If it is necessary that a medication be given during school hours, the following School District procedures must be followed:

  • Medication must be ordered/advised by physician/dentist and permission granted to the R.N at the school to contact physician/dentist if necessary.
  • Medication must be brought to school in original container with appropriate label intact.  If medication is not properly labeled, it will not be given.  The medication must be given to the R. N. at the beginning of the day and kept in the nurse's suite.  Oral medication may not be carried by the student during school hours.  Asthma inhalers/epinephrine inhaler, insulin, or epipen may be carried by the student, when the family physician and the parent/legal guardian gives written permission on file in the nurse's office.
  • Medication of more than 2 weeks duration must be accompanied by a physician's note.

I have discussed this procedure with our child and he/she understands that it is his/her responsibility to get the medication at the designated time.

Children’s Health Insurance Program (CHIP)

CHIP is pleased to partner with school districts in helping families find health insurance coverage for their children. Schools are a valuable partner in this effort. After all, healthy kids are better students.

CHIP covers uninsured kids and teens up to age 19. With more than 111,000 uninsured children in Pennsylvania, this is great news for families!

 CHIP provides quality, comprehensive health insurance for routine doctor visits, prescriptions, dental, eye care, eyeglasses, mental health, and much more. CHIP covers uninsured kids who are not eligible for Medical Assistance. For most families, CHIP is free – for others, it is low cost. 

For more information on the CHIP program and to read more about the eligibility requirements, please visit the CHIP website at www.CHIPcoversPAkids.com.

By clicking "agree" you acknowledge reading and are aware of the Children’s Health Insurance Program (CHIP).

Free & Reduced Lunch

By clicking "agree" you acknowledge the information concerning the free and reduced lunch program located here. Click here for the Free and Reduced Lunch letter from the district. Click here for the Free and Reduced Lunch application.

(FERPA) Family Educational Rights and Privacy Act

By clicking "agree" you acknowledge reading and are aware of the Family Educational Rights and Privacy Act (FERPA) that is listed above in the policy section. 

REVIEW OF ACCEPTABLE USE AND OTHER POLICIES

By clicking "agree" you acknowledge reading and are aware of the Family Educational Rights and Privacy Act (FERPA) that is listed above in the policy section. 

Garnet Valley School District Student Record Procedural/Discipline Manual

By clicking "agree" you acknowledge reading and are aware of the Garnet Valley Student Record Procedural Manual (SRPM) that is listed above in the policy section. 

Photo/Video Release

Throughout the school year, there may be times when Garnet Valley School District staff, the media, or other organizations, with the approval of the school principal, may take photographs of students, audiotape/video students, or interview students for school-related stories in a way that would individually identify a specific student. Those photographs and/or audio/video images or interviews may appear in district publications; in district video productions; on the district Web site/social media; in the news media; or in other nonprofit, education-related organizations’ publications.

By clicking "agree" you acknowledge reading this section and are aware that you can opt-out by completing the opt-out form Here.

Locker Consent

By clicking "agree" you acknowledge reading and are aware of the Locker Consent listed above in the policy section and that you can opt-out by completing the opt-out form Here.

Safe Homes Pledge

The Garnet Valley Communities That Care provides a Safe Homes Pledge that assures other parent/guardians that their children and teens will be safe in your home.

I pledge that...

  •  I will provide a secure, locked storage place for all firearms in my home if applicable.·      
  • I will require all young people riding in my vehicle to use age-appropriate safety restraints.
  • I will actively chaperone any parties in my home.
  • I will not serve nor will I allow anyone under the legal drinking age (21) to consume alcohol and/or other drugs at any age in my home or on my property.
  • I will safe guard all prescription medicine in my home to prevent its use by a young person.
  • I will actively chaperone phone and other technology usage.
  • I will not permit bullying behavior.
  • I will welcome communication with other parents in an effort to create a safer community for our children and teens.

Thank you for doing your part to keep our students safe!

The program is entirely voluntary. The Safe Homes Pledge is not a legal contract; rather, it is intended to demonstrate each participant’s good faith commitment to follow the principles set forth below.

Please make a selection *
Student Recruitment – Attachment to GVSD Policy 250

By clicking "agree" you acknowledge reading and are aware of the Student Recruitment – Attachment to GVSD Policy 250 listed above in the policy section and that you can opt-out by completing the opt-out form Here.