Lucia Mar | Annual Notification to Parents | 2019-2020

ACKNOWLEDGEMENT OF PARENT OR GUARDIAN OF ANNUAL RIGHTS NOTIFICATION You may detach, sign, and return this page to your child’s school indicating you have received the Parent Notice of Rights and Responsibilities. Also, where specified on this page, an option is available to indicate whether you have a child on continuing medication and if you do not wish directory information to be released. Electronic acknowledgement may also be noted during online registration/enrollment. Student’s Name: __________________________________________________________ School:​ _________________________________________ Grade: _______________ Student is on a continuing medication program: (Please check one) YES ___ NO___ If YES, you have my permission to contact student’s physician: Physician’s Name: ____________________ Telephone: __________________ Medication: ____________________________ Dosage: ____________________ Medication: ____________________________ Dosage: ____________________ If you do not wish directory information released, please sign where indicated below and return to the school office within 14 days of new enrollment; no later than September 4, 2019, for the 2019-2020 School Year. Note that your request will request the District not provide the student’s name and other information to outside organizations including the news media, interested schools, higher-education, parent-teacher associations, interested employers, and similar parties. (Excepting student information/photos in the yearbook). Please Do NOT release directory information regarding __________________________/__________________________ (Please print - Pupil’s Name) / Student Number I hereby acknowledge receipt of information regarding my rights, responsibilities, and protections. Signature of Parent or Guardian: ________________________ Date: __________ 41