I Affirm That All Information on This Form Is Accurate to the Best of My Knowledge

I Affirm That All Information on This Form Is Accurate to the Best of My Knowledge

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FOR Crow Creek Tribal Schools

Name of Student: (Last) (First) (Middle)
Address: P.O. BoxStreet:
City:State:Zip Code
Date of Birth: MonthDayYear Sex: Male ( ) Female ( )
Social Security Number______
Tribal Affiliation:Degree of Indian:
Enrollment Number:Home Agency:
Dominant Language spoken in the home:
Occupation (Optional) Employer:
Telephone Home:
Cell Phone:
Other (Specify): / Mother/Guardian
Occupation (Optional) Employer:
Telephone Home:
Cell Phone:
Other (Specify):
Emergency Contact
Phone No.
Relationship to Student / If you are a court appointed custodial parent or guardian, you must attach the appropriate documentation

I affirm that all information on this form is accurate to the best of my knowledge


Parent/Guardian SignatureParent/Guardian Print Date

Student Name
  1. List school previously attended:
  2. Previous school contact number:
  3. Reason for leaving:
  4. Did student miss 15 or more days in the last school year? ( )Yes ( ) No
  5. Has student ever been suspended? ( ) Yes ( ) No Expelled? ( ) Yes ( ) No
If yes date and reason must be given:
  1. Has student participated in Special Education Program? ( ) Yes ( ) No
  2. Has student participated in Talented and Gifted Program? ( ) Yes ( ) No
  3. Will your student participate in sports? ( ) Yes ( ) No
If so complete ALL sports/physical information forms.
  1. Is student a ward of the court? ( ) Yes ( ) No
If yes a copy of the court order must be submitted.
  1. Has student ever been arrested? ( ) Yes ( ) No
If yes what was/were the violations?
  1. Has student ever been in jail or a detention center? ( ) Yes ( ) No
If yes how many times?
  1. Does student have a probation officer? ( ) Yes ( ) No
  1. Has student ever received counseling? ( ) Yes ( ) No

I affirm that all information on the above mentioned student is true and accurate to the best of my knowledge. Any false statement or misrepresentation or omission of required information in this application will result in denial of this application.


Student SignatureParent/Guardian Date

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Crow Creek Tribal Schools

Day Students Check out Form 2017-2018

(Dorm Students must use the Dorm Check-Out Form when checking out during school)

It is very important the Parent/Legal Guardian have this form complete and notarized for the safety of our students. Students will not be allowed to check out of the dormitory or school unless they are released to a person whose name appears on this permission form. Any other special circumstances will have to be referred to a Principal, Dormitory Supervisor or Superintendent.


Student NameHome Reservation


Parent/Legal GuardianPhone # you can be reached at immediately


PO Box/AddressCityStateZip

  • I hereby give the following adults permission to check out my son/daughter for week-ends or holidays.
  • I understand that these adults must personally pick up the student and sign him/her out from the school (if during school hours) and from the dormitory.
  • I understand that off reservation students may not check out to Ft. Thompson and surrounding communities for overnight unless with parents or legal guardian.

(Handwriting must correspond to notarized signatures at bottom of the page)





I also give the school permission to seek out adequate housing and transportation for my son/daughter during emergencies.


Signature of Parent/Legal GuardianVerified by Notary of the Public


My Commission Expires on

Crow Creek Tribal Schools
Campus Portal Acceptable Use Policy

Crow Creek Tribal Schools has developed a Campus Portal as a means to further promote educational excellence and to enhance communication with parents and students. The Campus Portal allows parents and students (Grades K-12) to view school records anywhere at any time. In response for the privilege of accessing the Crow Creek Tribal Schools Campus Portal, every parent and student is expected to act in a responsible, ethical and legal manner. The Campus Portal is available to every parent or guardian who has a student enrolled at Crow Creek Tribal Schools. Parents and students are required to adhere to the following guidelines.

1. Parents and students will not share their passwords with anyone, including their children or
2. Parents and students will not attempt to harm or destroy data of their own children, of
another user, school or district network, or the Internet.
3. Parents and student will not use the Campus Portal for any illegal activity, including
violation of Data Privacy laws. Anyone found to be violating laws will be subject to Civil
and/or Criminal Prosecution.
4. Parents and students will not access data or any account owned by another parent or student
5. Parents and students who identify a security problem with the Campus Portal must notify
the Schools Technology Coordinator immediately (852-2993) or ()
without demonstrating the problem to anyone else.
6. Parents and students who are identified as a security risk to the Campus Portal will be
denied access to the Campus Portal.
User guidelines and system requirements can be found at Please review them before signing and returning this document. You are required to sign and return this agreement before you receive access to the Campus Portal. Students must both sign and have a parent signature to gain access to the Campus Portal.
Please fill in all blanks (Print)
Parent(s) Name: ______

Email Address: ______

Children Information

Name: ______Grade: ______

Name: ______Grade: ______

Name: ______Grade: ______

I have read the Campus Portal Acceptable Use Policy and I agree to abide by and support these rules.

I understand that if I violate any terms of this Acceptable Use Policy that I may lose my privilege to use the Campus Portal, and may be liable for civil and/or criminal consequences.
Student Signature ______Date: ______
Parent Signature: ______Date: ______

Crow Creek Tribal Schools

  • Permission Form for Internet Usage in Classroom and Dormitory
  • Photo Release
  • Religion of Choice Consent

Students at CCTS have access to the internet in computer related classes, as well as in the dormitory

There are strict rules for Internet usage by students. As a school system we attempt to block out as many inappropriate sites as possible, but as you may have read or heard, this can be difficult at times.

In order for your child to be allowed any contact on the internet, we need to have your permission. Please understand that due to certain circumstances your student may access an inappropriate site. We will not be held liable for any such occurrences.

If it is proved that a student has misused the internet or e-mail services, their privileges may be revoked for the remainder of the school year.

Please check on of the following:

_____I Do Not Give Permission for my child to be on the internet. _____I Do Give Permission for my child to be on the internet.

I also give permission to use my child’s picture on your website. I understand that staff will monitor student use of the internet and agree not to hold the school liable for any unintentional incident of my child viewing an inappropriate site.



PHOTO Release Form

All photographers taking photographs or on Crow Creek Tribal Schools property or of Crow Creek Tribal School Events or student works must obtain a signed release form from any student, faculty member, staff person who is visibly recognizable in the photograph. crowd scenes where not single person is the dominate feature are exempt.

These rules govern photographs intended for use in any Crow Creek Tribal School publication of marketing or a public relations nature, such as newsletters, brochures, yearbooks, promotional items, or other such material. Releases also must be obtained for photographs used on the Web. These rules are not in effect when photographs are taken on news events, but photographs taken for news purposed required a release for reuse in marketing materials.


______I DO give my consent for Crow Creek Tribal School to interview me or my child (name listed below) to use in photograph(s) video in any and all of its publications and in any and all media for use but the Crow Creek Tribal School. I will make no monetary or other claim against Crow Creek Tribal School for the use of the interview and/or the photographs(s) video.

______I DO NOT give my consent for Crow Creek Tribal School to interview me or my child (name listed below, to use in photograph(s)/video in any and all of its publications.

Name of child (Please Print)______

Parent/Guardian (Please Print)______

Parent/Guardian Signature______

Relationship to child (if child is a minor)______


Religion of Choice Consent

I,_____ Give Consent_____ Do Not Give Consent - For my child to participate in sweat lodge ceremonies or attend the church of their choice for purposes of purification, prayers or personal spiritual guidance while attending CCTS. My child’s religion affiliation is:______


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Family Education Rights and Privacy Act (FERPA)

The Family Education Rights and Privacy Act of 1974, commonly known as FERPA, is a federal law that protects the privacy of student education records. Students have specific, protection rights regarding the release of such records and FERPA requires that institutions adhere strictly to these guidelines.

The following are statements that reflect what the Family Education Rights and Privacy Act (FERPA) covers concerning your rights as a parent and student:

  • Parents are allowed to review all files and material the school has about their child.
  • All schools are required to follow FERPA.
  • The schools cannot provide a student with his/her parent’s financial records.
  • A student can request that doctor of his/her choice review psychiatric or treatment records.
  • FERPA does not allow the students to see the same files and records that their parent can see.
  • A probation officer cannot see a student’s educational records without parental consent.
  • The school is required to keep a list of all people who access a student’s records.
  • Parents are allowed to bring someone with them to review their child’s school records.
  • Parents are allowed to review their child’s testing protocols.
  • Student Special Education records are the school’s responsibility to safeguard and no file should ever be left out of place where they can be seen by unauthorized people.
  • Staff members can be reprimanded for failure to safeguard student records.

If you have further questions on your rights under the FERPA law then please feel to contact the school or visit the www (world wide web) and do a search on FERPA. This will pull up the law, its interpretation and how it affects you as a parent/student.

By initialing this form I have read all the above information.



Crow Creek Tribal Schools

BIE McKinney-Vento Enrollment/Referral/Residency Form

The Purpose of this form is to address the requirements of the McKinney-Vento Act, Title X. This Document will be used to share with school staff and partnering agencies to ensure all providers have the necessary information to support the child and his/her family.

Student Name: ______( ) Male ( ) Female

Please check only ONE that best describes where the student is presently living (Please specify name of hotel, shelter, or organization providing the transitional housing)

In my own home or apartment

In the home of a friend or relative because I lost my housing. (fire, flood, lost job, divorce, domestic violence, kicked out by parents, parent in the military was deployed, parent(s) in jail). Name/Address and phone of person with whom you live (full name required)


In a shelter because I don’t have permanent housing. (living in a family shelter, domestic violence shelter or children/youth shelter) Name/Address of phone of shelter


In Transitional housing (housing that is available for a specific length of time only and is partly or completely paid by a church, a nonprofit organization or some other organization) Name/Address and phone of organization providing housing


In a hotel or motel (because of economic hardship, eviction, cannot get deposits for permanent housing) Name/Address and phone of hotel or motel where your staying


 In sheltered care (living in a car, park, campground). Provide where you are living such as where you car is parked.______

In housing that does not have plumbing, electricity or heat. (circle all that apply)

Awaiting foster care placement

None of the above (describe my current living situation. Briefly describe your situation. Address/Directions______

Name of parent/guardian or person who student resides with______

Address ______City______State______

Parent/Guardian Phone #:______Cell______Work______Shelter ______Family/Friends


Signature of Parent/Guardian or person who student residesDate

Crow Creek Tribal SchoolSchool Year: 2017/2018

New form must be completed yearly



Student Name______School______Grade______

Over- the-counter (OTC) medication are drugs that do not require a prescription and are purchased “over-the-

counter.” This form is required before over-the-counter medications can be administered at school. Exceptions to

this are homeopathic/herbal medications and aspirin, which require you to complete the form “Permission to Give

Prescription/Homeopathic Medication at School.”


______I approve all medications listed below

______I do not want any OTC meds given to my student


_____ Antibiotic Cream (i.e. bacitracin cream, triple_____ Ibuprofen (i.e. motrin, advil)

Antibiotic ointment)

_____ Hydrocortisone Cream (i.e. anti-itch relief)_____ Acetaminophen (i.e. Tylenol)

_____ Oral Products (i.e. oragel, chloraseptic)_____ Antacids (i.e. Mylanta, Maalox,


_____ Anti-septic Spray (i.e. bactine)_____ Burn Relief/Gel

_____ Cold Medication (i.e. guaifenesin, phenylephrine_____ Eye drops for dryness


_____ Antihistamine (i.e. Benadryl, chlorapheniramine,_____ Cough Syrup (dextromethorphan

Loratadinecough drops

All medications will be given at the manufacturer’s recommended dosages.

(Signature of Parent or Guardian) (Date)

Medication History:

Is the student allergic to any medications?______If yes, please list the medicine(s) and type of reaction:______

Does your student take any medications (either over-the-counter or prescription) on a regular basis?___

If yes, please list:______