Back to School Forms

2020-21 SPS Back to School Forms Packet 

From the Desk of Dr. Stephen Zrike

Dear Parents and Guardians, 


Welcome to the 2020-21 School Year! 


It is essential for your child’s well being and education that we have accurate and complete information about them in our schools. We appreciate your time and attention so that we can keep your child safe, healthy and thriving in school, meet any of their unique needs, ensure timely communication with you at home, and keep you informed and updated about all that is happening in our schools. 


This year, in an effort to adjust to our new circumstances, we have designed the forms so that they can be completed electronically (if you are unable to complete the forms electronically, please contact the school to have them mailed to you). There are two separate forms to complete: 

  1. Student Contacts and Acknowledgement Form
  2. Student Health Form


Please complete ONE OF EACH FORM PER ENROLLED CHILD using the appropriate links for the school where he/she attends, below. We ask that all families complete these forms as soon as possible so that our schools will have the most updated information on file for your child(ren). It is important that schools have all of this information on file so that we can best serve your child and family. 

Finally, remember to update the school when any information contained in these forms changes (phone numbers, address, emergency contacts, language preference, health issues) throughout the year.

Thank you for partnering with us to ensure that we have the correct and updated information for your child!


Best, 

Dr. Stephen Zrike

Superintendent

Links to All School Forms

ENGLISH
ESPAÑOL
PORTUGUESE

Parents and/or guardians must complete each of the two forms for the school where your child is enrolled. Please click on the links below to complete the form. Enter one of each form per enrolled child. Should you have any questions or experience any technical difficulties, please contact your school nurse or school front office. 

School

Student Contacts and Acknowledgement Forms

Student 

Health Forms

Bates Elementary School

BATES - Contact and Acknowledgement Form

BATES - Student Health Form

Bentley Academy Innovation School

BENTLEY - Contact and Acknowledgement Form

BENTLEY - Student Health Form

Carlton Innovation School

CARLTON - Contact and Acknowledgement Form

CARLTON - Student Health Form

Horace Mann Laboratory School

HORACE MANN - Contact and Acknowledgement Form

HORACE MANN - Student Health Form

Saltonstall K-8 School

SALTONSTALL - Contact and Acknowledgement Form

SALTONSTALL - Student Health Form

Witchcraft Heights Elementary School

WITCHCRAFT - Contact and Acknowledgement Form

WITCHCRAFT - Student Health Form

Collins Middle School

COLLINS MS - Contact and Acknowledgement Form

COLLINS MS - Student Health Form

Salem High School

SALEM HS - Contact and Acknowledgement Form

SALEM HS - Student Health Form

Salem Prep High School

SALEM PREP HS - Contact and Acknowledgement Form

SALEM PREP HS - Student Health Form

New Liberty Innovation School

NEW LIBERTY -  Contact and Acknowledgement Form

NEW LIBERTY - Student Health Form

Salem Early Childhood Center

SALEM EARLY CHILDHOOD CENTER - Contact and Acknowledgement Form

SALEM EARLY CHILDHOOD CENTER - Student Health Form

About the Forms

SPS Contact and Acknowledgement Forms

The SPS Contact and Acknowledgement Form contains three key pieces of information that every school needs to obtain from parents and guardians on an annual basis. This information includes: 

1. Emergency Contact Information. Completing this information provides the school with updated contact information for parents/guardians and other emergency contacts. Identification of the primary contact’s preferred language for school notifications is also included.
2. Annual Acknowledgement and Consent. Completing this information provides the school with an acknowledgement for the SPS Family and Student Handbook, Media Release, Military Family Status, and Directory Information.
The SPS Family and Student Handbook (2020-21) can be found at www.salemk12.org/families/family_handbook. It is the responsibility of each parent/guardian to carefully read and understand the SPS Family and Student Handbook and to explain its contents to his/her child(ren).
3. Conditions for Academic Success. Completing this information provides the school with annual acknowledgement of each parent/guardian’s commitment to supporting the conditions he/she will need to achieve academic success including strong attendance and responsibilities for the use of technology.
4. Electronic Signature. The form contains a method of obtaining an electronic signature known as an S-Signature. A March 26, 2020 court order stated that an S-Signature had the same validity as a handwritten signature. Parents/guardians may submit their S-Signature by typing /s/ your name in the space provided (example: /s/ John Smith). 

SPS Student Health Forms

The SPS Student Health Form contains three key pieces of information that every school needs to obtain from parents and guardians on an annual basis. This information goes directly to your child’s School Nurse and includes: 

1. The Parent Personal Responsibilities Pledge. All parents and guardians are asked to carefully read, understand, and adhere to the Parent Pledge. The protocols and agreements outlined in the Parent Pledge are critical to ensure the health and safety of all students and staff during the COVID-19 pandemic.

2. The Student Personal Responsibilities Pledge. All students are asked to carefully read, understand, and adhere to the Student Pledge. The agreements outlined in the student pledge are critical to ensure the health and safety of all students and staff during the COVID-19 pandemic.

3. Medical/Emergency Information. Completing this form provides your child’s school with updated and accurate information regarding your he/she medical, dental, and health insurance providers. In addition, any allergies or medical concerns your child may be facing as well as daily medications he/she takes should be identified in this form.  4. Permission for North Shore Medical Center (NSMC) to Treat in Cases of Severe Emergency. Completing this form authorizes the North Shore Medical Center (NSMC) Salem Hospital Emergency Department to render treatment to your child in the event of an emergency situation. 5. Permission to Treat. This form authorizes the school nurse to administer commonly used medications (e.g. Tylenol, ointments, Benadryl, etc.) as needed within the school.

6. Hand Sanitizer Opt-Out Form. This form provides an opportunity for parents/guardians who do not want their children using hand sanitizer to opt out.
7. Other Medical Forms. The forms in this section should only be completed when needed:
8. Electronic Signatures. The form contains a method of obtaining an electronic signature known as an S-Signature. A March 26, 2020 court order stated that an S-Signature had the same validity as a handwritten signature. Parents/guardians may submit their S-Signature by typing /s/ your name in the space provided (example: /s/ John Smith). 
Thank you!

Thank you for taking the time to read all of this important information and complete the required forms. Please contact your school front office with any questions.




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