Application for Attendance for Utah Resident Students Not Living with a Parent or Guardian

Policy Code: 
JECB-E2
Adoption Date: 
Tuesday, October 24th, 2006
Review Date: 
Tuesday, September 28th, 2010

APPLICATION FOR ATTENDANCE FOR UTAH RESIDENT STUDENTS NOT LIVING WITH A PARENT OR GUARDIAN 

Iron County School District requires a responsible adult to be accountable and responsible for each student attending district schools.  There are occasions where students live away from home and away from legal parents or guardians.  In those cases, the adults they live with must act as that responsible adult and assume the accountability, liability, and responsibility in the event that situations arise where accountability, responsibility and liability for the student is necessary.  Such cases may be, but are not limited to:

  1. Accidents, where a responsible person is required to sign for the student to receive medical treatment.
  2. Permission  to participate in field trips, sports, and activities.
  3. Violations of the law by the students, such as assaults, thefts, or vandalism, where restitution an/or court appearances are required.

___________________________________________________________________________________________________________________

 

I certify that I will assume any responsibility, liability, and accountability for

 

 _______________________________________________

 (Student's Name Living Away From Parent or Guardian)

 

that may occur at school or school activities.  I will also be the responsible adult to receive all communications and grades from the school in the student's behalf.

 

_________________________________________            ________________

Signature of Person Assuming Responsibility                        Date

 

Address:________________________________________

 

            ________________________________________

 

Phone # ________________________________________

 

 

_________________________________________            ________________

Principal's Signature as Witness                                             Date

 

Contents

Non-Discrimination Statement

Iron County School District is committed to a policy of equal employment opportunity and does not discriminate in the terms, conditions, or privileges of employment on account of race, age, color, sex, national origin, physical or mental disability, or religion or otherwise as may be prohibited by federal and state law.

School District Office

Hours 8 a.m. - 5 p.m. Mon.- Fri.
Address:
2077 W. Royal Hunte Dr.
Cedar City, Utah 84720
PH 435.586.2804  FAX 435.586.2815