Parent Permissions Form

Required

Student Namerequired

First Name

Last Name

Graderequired

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 Name

First Name

Last Name

Guardian's Relationship to Student

Guardian's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Guardian's Cell Phone

Guardian's Email

To Be Completed for All Students

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.

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.

Parents assume all risks and agree to hold Dublin School harmless by selecting to allow this.

For juniors and seniors ONLY: 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.

DO NOT allow my student to ride with Day students.

Parents assume all risks and agree to hold Dublin School harmless by selecting to allow this.

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.

Parents assume all risks and agree to hold Dublin School harmless by selecting to allow this.

For juniors and seniors ONLY: 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.

DO NOT allow my student to ride with recent alumni.

Parents assume all risks and agree to hold Dublin School harmless by selecting to allow this.

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.

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.

required

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.

Swim Permission*

required

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

required

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

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

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

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$5 Issuance/replacement fee, $25 initial balance, and it will be billed to your student’s account.

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 fee.

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.

$5 Issuance/replacement fee, $25 initial balance, and it will be billed to your student’s account.

Reloading Laundry 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 2022-2023 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 2022-23 Dublin School Handbook:

Student and Parent Handbook Contract

I/we hereby enroll our child/guardian at Dublin School for the 2022-2023 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 24.

Parent Electronic Signaturerequired

Student Electronic Signaturerequired

Daterequired

Must contain a date in M/D/YYYY format