Parent Permissions Form

Required

Student Namerequired

First Name

Last Name

Graderequired

9th

10th

11th

12th

Are you an international student?required

Yes

*Section for International Students Only*

Please provide contact information of a US Guardian, if one exists. We recognize that not all international students have an official guardian in the US, but many have a relative or family friend who could be contacted in the need of an emergency if the student needs to be off-campus. This information is for the Dean's Office only, and we will work with the family if there is no one available.

Guardian Namerequired

First Name

Last Name

Guardian's Relationship to Studentrequired

Guardian's Address required

Guardian's Cell Phone #required

Guardian's Emailrequired

Travel with Current Parents:

On occasion a parent may come to visit his/her child and want to take their son's/daughter's roommate(s) or friend(s) out to a meal with them. Students will also need permission from an Administrator. This is available to ALL students.

Current Parent Travel Permissionrequired

My student may ride with an enrolled student's parent, at the discretion of any Administrator. Dublin School cannot assure the insurance status or driving skills of any individual. Parents assume all risks and agree to hold Dublin School harmless.

DO NOT allow my student to ride with an enrolled student's parent.

Travel with Day Students

Many of our Day Students drive themselves to school. With permission from an Administrator, they can take other students off-campus to local eateries and shops. This is only available to 11th and 12th graders.

Travel with Day Student Permission (Juniors and Seniors ONLY)If your student is not in 11th or 12th grade please choose 'DO NOT'

Allowed to ride locally (30 minute radius) with Day Students, at the discretion of any Administrator. Dublin School cannot assure the insurance status or driving skills of Day students. Parents assume all risks and agree to hold Dublin School harmless.

DO NOT allow my student to ride with day students

If your student is not in 11th or 12th grade please choose 'DO NOT'

Travel with Recent Alumni

Similarly we often have recent graduates return to campus to visit with friends. With permission from an Administrator, they can take current students off campus to grab a bite to eat or visit a local shop. This is only available to 11th and 12th graders.

Travel with Recent Alumni Permission (Juniors and Seniors ONLY)If your student is not in 11th or 12th grade please choose 'DO NOT'

Allowed to ride locally (30 minute radius) with recent alumni, at the discretion of any Administrator. Dublin School cannot assure the insurance status or driving skills of recent alumni. Parents assume all risks and agree to hold Dublin School harmless.

DO NOT allow my student to ride with recent alumni.

If your student is not in 11th or 12th grade please choose 'DO NOT'

Day Student Driving

This is granting permission for your licensed day student to drive to and from school. Only Seniors may use their cars during the academic day, with permission from an administrator. Seniors may park in the lower half of the William North lot, if space allows. All other cars must be parked in the lower Day student lot and must remain in the parking lot for the duration of the academic day.

Day Student Driving Permission

Permitted

Not Permitted

Day Student Carpooling

This permission allows 9th and 10th grade Day Students to ride with other licensed Day Students to and from school. It does not give 9th and 10th-grade students permission to go off campus with other Day Students during the academic day. This is only available to 9th and 10th-grade day students.

Day Student Carpooling Permission

Permitted

Not Permitted

Automobile Information

All vehicles driven to campus must be registered with the Dean of Students Office.

News and Photo Release

This allows Dublin School to use photos of students online, through the School's social media accounts and in print publications. Our general policy for social media usage is to use first names only, never first and last when in direct reference to a photo.

News and Photo Release Permissionsrequired

I authorize Dublin School to release my student's name and/or photo.

I authorize Dublin School to release my student's photo, but NOT their name.

I DO NOT authorize Dublin School to release my student's name and/or photo.

Swimming

This allows students to swim during Camping Trips, off campus trips, and at both the Whitney and Steele Family Boathouses. In addition, students participating in Sailing or Crew will be given a swimming test to ensure their safety while participating in a water sport.

Swimming Permissionsrequired

Allow my student to swim under the supervision of a Dublin faculty member.

DO NOT allow my student to swim.

Dublin School Store

This allows student to charge any purchases at the School Store to their student account. It is the preference of the school store that cash and cards be used primarily for purchases, but understands that this is not always an option.

The Store carries school supplies, various sundries, DS apparel, snacks and drinks. Please note: These permissions may be changed at any time by contacting Laurie LeClair - lleclair@dublinschool.org

Dublin School Store Permissionsrequired

Allow my student to charge home all items from the store.

Allow my student to charge home ONLY for school supplies and toiletries from the store.

DO NOT allow my student to charge home any items from the store.

Sleepover Permissions for Boarding Students ONLY - Please check all that apply:Please select up to 2 choices

I give blanket permission for my boarding student to have a sleepover (to host or to be a guest) with another boarding student at any time during the school year. Following the school's rules

I give blanket permission for sleepovers in my students dorm room whether they or their roommate(s) are hosting.

I prefer to give permission for each sleepover occurrence.

Please select up to 2 choices

Laundry and Laundry Facilities

Boarding students have the option of signing up with E&R Laundry Service (they will be available during Registration on Opening Day) or using the laundry facilities on campus. The laundry machines use a prepaid card and do not accept cash. This part of the form allows you to purchase and fill the laundry card.

Laundry Card - New Students

Please issue my student a laundry card at a cost of $5, with an initial balance of $25, and bill it to my student's account.

DO NOT issue my student a laundry card.

Laundry Card - Returning Students

My student was issued a laundry card last year, it may or may not be in their possession. If my student requires a new laundry card, I understand that they will be charged a $5.00 replacement fee as well as a $25 initial balance to their student account.

My student did not have a laundry card last year. Please issue my student a laundry card at a cost of $5, with an initial balance of $25, and bill it to my student's account.

DO NOT issue my student a laundry card.

Reloading Landry Card - All Students

Automatically reload laundry card from student account when necessary ($25).

DO NOT automatically reload laundry card.

Signatures

Travel

I acknowledge that my student will go off-campus via school transportation, at the discretion of any school administrator.

Handbook

Below you will find a link to the 2023-2024 Dublin School Student Handbook, as well as an electronic signature form. The form must be signed by each student and at least one parent/guardian acknowledging that you have thoroughly read the handbook and agree to abide by the rules and procedures of the School. It is important that you read through the handbook carefully to familiarize yourself with the current school policies. Please complete the electronic form by August 24.

Click Here to Read the Dublin School Handbook

Student and Parent Handbook Contract

I/we hereby enroll our child/guardian at Dublin School for the 2023-2024 school year and agree that such enrollment is subject to fundamental rules of the school and by other disciplinary rules and policies as appear in the handbook for students and parents. By signing this contract I agree to provide the School support in maintaining a safe environment by enforcing the fundamental rules of the School. I also agree that this contract is valid for any subsequent changes that may be made to the Handbook throughout the duration of my enrollment at Dublin School.

I/we understand that breach of said rules may be grounds for dismissal at any time prior to graduation.

The undersigned student hereby authorizes the School to send students grades and other evaluative reports directly to the student's parents and to such colleges as may be deemed necessary by the director of college counseling as long as he or she remains a student at the School.

I/we understand that continued enrollment at Dublin School is subject to annual review.

Please sign this document electronically by August 23.

Parent Electronic Signature -1required

Parent Electronic Signature -2

Student Electronic Signaturerequired

Date

Must contain a date in M/D/YYYY format

Namerequired

First Name

Last Name