Parent-Student Handbook Signature Page

Parent-Student Handbook

Statement of Responsibility
Student's Name*
What is the student's grade for the 2024-25 school year? *
Arkansas Code Annotated 6-18-502 requires school districts to provide parents and students with the following: the rules and regulations by which the school is governed the behaviors that will call for disciplinary actions the types of corrective actions that may be imposed

Additionally, schools are required by state law to obtain documentation of student and parent receipt of student discipline policies. The statement must be signed and turned in to your child's school.

We have access to a copy of the North Little Rock Parent-Student Handbook. We understand the District's discipline policies and realize that the student must adhere to these and to the other policies, rules, and procedures contained in the Handbook. In the event that we are not entirely certain of some aspect of school policy, we will contact the principal for clarification.

I hereby release the district, its Board of Directors, staff, employees, and any institutions with which it is affiliated, from any and all claims and damages arising from my child's use of, or inability to use, the district's network. This includes but is not limited to claims that may arise from the unauthorized use of the system to purchase products or services. I understand that any user who violates this policy and accompanying regulations is subject to loss of network privilege as well as other district disciplinary actions.

We acknowledge that we have read and understand Act 1149 of 1999 listed in the Appendix of this handbook regarding our parental responsibility for allowing a child to possess a weapon on school property.

Act 574 of 1995 requires parents to inform school officials if their child has been expelled from school in any other school district or is a party to an expulsion proceeding. We hereby verify that the student we have enrolled in the North Little Rock School District has not been expelled from any other school district nor is a party to an expulsion proceeding at this time.
Please check the following acknowledgments below. By checking below and signing this sheet, you are signing for all forms indicated below.*

I understand and will follow all of the testing rules and procedures listed on the State Assessment signature page.I understand and will follow the District's student internet/email usage agreement.I acknowledge the Smart Core Informed Consent Form.
I understand the photo/video release and....*

I DO give permission for my child to be photographed by NLRSD or district- authorized media personnel.I DO NOT give permission for my child to be photographed by NLRSD or district- authorized media personnel.
Vision and Hearing Screening

I give permission for my child's personally identifiable information/student education records to be disclosed to a Third Party Billing Agent for the purpose of billing Medicaid and/ or private insurance for Vision and Hearing Screening.
NOTE: Parents, there are additional forms that you may want to complete depending on your interest. The following forms are:

* Emergency Procedure Information (This information should be given directly to the school office.

* Smart Core Waiver Form

* Volunteer Survey (This form is to be completed if you would like to volunteer in the schools).

* Objection to publication of directory information (This form is not to be filed if the parent has no objection) Only file if there are objections.
Email Address*
Phone Number*
Student's School*
Today's Date*

MonthDayYear
Date
Please select the school that your child will be attending. The form will be emailed to the school. Please keep a copy for your records.*

Amboy ElementaryBoone Park ElementaryCrestwood ElementaryGlenview ElementaryIndian Hills ElementaryLakewood ElementaryMeadow Park ElementaryRidge Road ElementarySeventh Street ElementaryPike View Early Childhood CenterNorth Little Rock Middle School (6th Grade)North Little Rock Middle School (7th/8th Grade)North Little Rock AcademyNorth Little Rock Center of ExcellenceNorth Little Rock High School
Do your child ride a bus to school? If YES, please answer the next three questions.*

YESNO
1) What is your bus number and/or route number?
2) What is your bus stop?
3) What is your address? *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Signature

Clear
Parent/Guardian Signature*

Clear
Should be Empty: