James Madison High School

Required Student Documents

PARENT CHECK LIST

1. Student Registration Form - This registration form begins following the Parent Check List and is to be completed and submitted online.
The items below must be completed and returned at Orientation.

The items below must be completed and returned at Orientation. Note: You will need to open each document below by clicking on it. Some of these forms can be filled in on the computer and printed and others will need to be printed and filled out. For your convenience you can access Google Translate located at the top left side of this page to create translated versions of these documents.
2. Parental/Student Military and Institutions of Higher Learning Opt Out Form ( FILL IN AND PRINT)
3. Condom Availability Opt Out Form Parent/Guardian ( FILL IN AND PRINT) and Student Letter ( READ ONLY)
4. Parent/Guardian Student Ethnic Identification Form ( FILL IN AND PRINT)
5. Parent/Guardian Home Language Identification Survey ( FILL IN AND PRINT)
6. McKinney-Vento Act Residency Parent/Guardian Letter ( READ ONLY), Parent Guide ( READ ONLY), and Questionnaire ( FILL IN AND PRINT)
7. Preferred Language Form ( FILL IN AND PRINT)
8. Child & Adolescent Health Examination Form - this form must be signed and stamped by physician ( PRINT AND COMPLETE)

NOTE: When filling out your forms please use the following information: The student ID Number and OSIS number are the same - for public school students this is the nine (9) digit number that is on your report card, private school students please leave blank.

Whenever a form requires the school name, please indicate James Madison High School.

Our school identification information is:
District 22
School # 425
Borough Brooklyn
Grade Code 009 (010 for 10th graders)
Class Code Leave Blank

Please complete the form below. Mandatory fields marked *

General Information Student

Last Name * First Name * MI
Home Address * Apt #
City * State * Zip *
OSIS # * Email *

Emergency Contact Information

Student »
Last Name * First Name * MI
Parent/Guardian (Student resides with) »
Full Name * Relationship *
Parent's Preferred Language of Communication: Written * Oral *
Home Phone # * Work Phone # * Cell Phone # *
xxx-xxx-xxxx
Email Home * Email Work
Address * Apt #
Borough * State * Zip *
Other Parent/Guardian »
Full Name Relationship
Parent's Preferred Language of Communication: Written Oral
Home Phone # Work Phone # Cell Phone #
xxx-xxx-xxxx
Email Home Email Work
Address Apt #
Borough State Zip
List below names of three (3) persons who may be called in case of emergency or if child is sick in school »Please note that your child will be released only to the persons listed below.
Full Name * Phone # * Relationship *
Full Name * Phone # * Relationship *
Full Name * Phone # * Relationship *
If there is a person who may NOT HAVE ACCESS to child, please indicate »
Full Name Relationship Order of Protection Exists? Yes
Health Information »
Name of Physician/Clinic * Phone # *
Health Alert »
1. Does child have any health conditions that may affect participation in physical activities? * Yes No
2. Limitations * 3. Allergies *
4. 504 services for the current year? * Yes No
5. Previous year? * Yes No
6. My Child Has: Private Health Insurance Medicaid No Health Insurance
7. If "no Health Insurance" are you willing to share contact info from this form to learn about insurance options? * Yes No
8. If none of the named contacts can be reached, what do you wish the school to do if your child is sick or injured? *
Siblings »
Last Name First Name
School of Attendance
Last Name First Name
School of Attendance
Last Name First Name
School of Attendance

General Information

Is the information listed here the same as that on your current school record? Yes No

Consent to be on the Internet

I hereby give permission for my child's photograph, artwork, poetry or other work produced in conjunction with a school project, class or extracurricular activity, to be on the Department of Education's World Wide Web (WWW) site and James Madison website, in accordance with the policies set forth in the DOE's Internet Acceptable Use Policy. I understand that the information to be posted does not include information from my child's academic, guidance, permanent or cumulative record (i.e. grades or attendance records). I also understand that the information to be posted does not include other personal identifiable information such as my child's address, phone number, or social security number. Yes No

Policies and information

1. I give permission for my child to use e-mail services provided by James Madison HS. Yes No
2. I give permission to allow my child to design and publish web pages on the Department of Education Facilities, World Wide Web and/or the James Madison High School website. Yes No
3. I want to receive attendance and grade information by e-mail. Yes No If yes, enter email:
4. I give permission for my child's photograph, video image or printed image and/or artwork, audio recording, film, photograph, poetry, or other work produced in conjunction with a school project, class or extracurricular activity, to put on the Board of Education's World Wide Web and/or the James Madison High School website, in accordance with the policies set forth in the Board of Education's Internet Acceptable Use Policy. Yes No
5. I give permission to James Madison High School to give my name, address, phone number and e-mail address to the Parents' Association of the James Madison High School (the PA) solely for the purpose of allowing me to receive communications from the PA. Yes No
6. My child has read,understands, and will abide by the rules and regulations regarding the use and care of computer facilities. My child understands that all rules apply when using computer facilities. My child understands that his/her privileges may be suspended or closed if they violate the provisions of this contract as set forth in the Board of Education's Internet Acceptable Use Policy.

As the parent or guardian of the student named above I state that I have read and accept the responsibility for my son/daughter's actions with regard to his/her use of computers and related facilities provided by the James Madison High School. Yes No
7. My child and I have read and understand the English departments Summer reading list. Yes No
8. My child and I have read and understand the James Madison High School Dress Code Yes No
9. My child and I have read and understand the Minimum Standards for Participation in Extracurricular Activities. Yes No

This is to confirm that all information is truthful and accurate to the best of your knowledge. *
I will notify the school in writing of any changes in contact information contained within this document.*
Electronic Signature: *

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