2022-2023 Episcopal School of Nashville Summer Packet

Family Contact Information

Family Last Name

Student 1

Legal Name of Student

Preferred Name of Student

Date of Birth

Grade

T-shirt Size

Student 2

Legal Name of Student

Preferred Name of Student

Date of Birth

Grade

T-shirt Size

Student 3

Legal Name of Student

Preferred Name of Student

Date of Birth

Grade

T-shirt Size

Student 4

Legal Name of Student

Preferred Name of Student

Date of Birth

Grade

T-shirt Size

If you are a returning family and all information is the same, you may click the box below and skip the family information.

Information has not changed from the 2021-2022 School year. New Information is needed for 2022-2023 school year

Parent/Guardian I

Relationship to Student

Phone

Address

Can this names and contact information be included in the school directory? Yes No

Parent/Guardian II

Relationship to Student

Phone

Address

Can this names and contact information be included in the school directory? Yes No

Parent/Guardian III

Relationship to Student

Phone

Address

Can this names and contact information be included in the school directory? Yes No

Parent/Guardian IV

Phone

Address

Can this names and contact information be included in the school directory? Yes No

Grandparent/Special Friend Contact Information

We would like to have contact information for Grandparents and Special Friends so we can invite them to special events and keep them informed on happenings at Episcopal School of Nashville.

Grandparent/Special Friend

Phone

Address

Include in Mailings and Emails Yes No

Grandparent/Special Friend

Phone

Address

Include in Mailings and Emails Yes No

Grandparent/Special Friend

Phone

Address

Include in Mailings and Emails Yes No

Grandparent/Special Friend

Phone

Address

Include in Mailings and Emails Yes No

Authorization for Pickup

The following individuals are allowed to pick up my student/students from school. I understand that only individuals listed on this form have my permission to accept responsibility for my child. I confirm that all persons listed are of legal age and assume the responsibility of my child. All persons will be required to show a photo ID. In legal custody or other court orders, the school must have a copy of the legal agreement on file. If there are changes to this list contact LaTerra Davis, laterra.davis@esnashville.org.

Name

Relationship to Student

Phone

Name

Relationship to Student

Phone

Name

Relationship to Student

Phone

Name

Relationship to Student

Phone

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Please list all persons to whom the student may NOT be released. Parent must provide legal documentation to support this request if the person listed is a parent of the student.

Emergency Contact Informatiom

Please list those individuals that may be contacted to assume temporary care of your student if you are unable to be reached.

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

Name

Phone

Relationship to Student

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Medical

Required Documentation:

A copy of the student's birth certificate and immunization forms are required. Students cannot begin school without these important documents. You may upload these files below, mail them to LaTerra Davis at 1310 Ordway Place, Nashville, TN 37206, or email her at laterra.davis@esnashville.org

New Families, please provide the following documents for your student's permanent file:
- Record of Immunization and/or Exemption
- Updated Health Record
- Copy of their birth certificate

Returning families, please provide the following documents for your student's permanent file:
- Updated Health Record
- Updated Record of Immunization (children with an exemption on file need not update)

Record of Immunization and/or Exemption

Upload (8MB)

Health Record

Upload (8MB)

Copy of student's birth certificate

Upload (8MB)

Prescription Medication

I authorize Episcopal School of Nashville staff members to administer the following prescription Medication to my child as directed by the pediatrician.

All medication to be administered must be in the original container from the pharmacy.

Doctor's Name

Email/Web Address

Phone

Student

Please describe any medical conditions including allergies for this student.

Medication

Student

Please describe any medical conditions including allergies for this student.

Medication

Non-prescription Medication: I authorize Episcopal School of Nashville staff members to administer first aid for minor illness and injuries, as need.

Yes No

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Permission to Photograph

I hereby grant permission for video recordings and digital photographs to be taken of my child and of my work as part of their participation in Episcopal School of Nashville. I understand that recordings and pictures will only be used for non-profit educational purposes.

I authorize Episcopal School of Nashville to use images of my student on its website and/or in printed promotional materials without further consideration. I acknowledge Episcopal School of Nashville has the right to treat the media at its discretion, such as cropping.

NO names of students will be identified.

I acknowledge that Episcopal School of Nashville may use the images at their discretion at a later date.

I understand that once Episcopal School of Nashville posts an image of my student on its website, the image could possibly be downloaded by a third party. I agree to not hold Episcopal School of Nashville responsible for any harm that may arise from such unauthorized reproduction.

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Permission to Leave Campus

Throughout the school year, opportunties for field trips and other activities are planned off campus. Students and staff will be transported using public and/or private transporation.

Please indicate your preference in regards to your student leaving campus.

Yes, I give permission for my child to leave campus on planned trips. No, I do not give permission for my child to leave campus. I understand that supervision will be given to my student on campus and assignments given.

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Before and After Care

Monday through Friday, Episcopal School of Nashville offers before care from 7:15 am to 7:45 am, and after care from 3:00 pm to 5:30 pm, to all enrolled students. All students attending before or after care are required to pay a $35 registration fee. Before and after care follows the school calendar year and is not available on holidays or half days. The cost is $5 per half hour. An invoice will be sent at the end of each week.

By signing below, I agree to all terms and fees if my student attends before and after care.

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Permission to Receive Holy Communion

An important part of the life of Episcopal School of Nashville is the Chapel program. The primary goal of Chapel is to build a stronger sense of community and to develop each child's unique spiritual awareness. On occasion, Holy Communion will be celebrated by an Episcopal priest. To receive Holy Communion is a personal and family decision.

My student may receive Holy Communion.

Yes No

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

Parents Association

Parent involvement is vital to the spirit of Episcopal School of Nashville. We need volunteers throughout the school year for different events.

I would like to be contacted about the PA and volunteering for events.

Yes No

Parent/Guardian I Digital Signature (By entering my name below, I am giving my legal digital signature to this agreement.)

This address will receive a confirmation email

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2022-2023 Episcopal School of Nashville Summer Packet

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