This is to certify that I have received and read a copy of the "STUDENT RIGHTS AND RESPONSIBILITIES HANDBOOK AND DISCIPLINE POLICY." Also, I confirm that I have read and understand the "Notification of rights Under FERPA and Student Privacy and Education Records under LA. R.S. 17:3914" beginning on page 89 of the HANDBOOK.

If you have any questions, please contact your child's school.

It is imperative that all students, parents, and EBRPSS employees read the Guidelines for Network and Internet Access Policy (Section 23). Students and staff will be granted rights to use the network on their signing an Acceptable Use Policy (AUP), AUP receipt sheet, or this waiver. If any parent/guardian does not agree to the use of the district technology instructional resources by the student, please express any objections, in writing in a separate letter to the principal.

If a parent does not want their child to participate in this program, the parent shall notify the school in writing.

Throughout the school year, students may be highlighted in efforts to promote EBRPSS activities and achievements. For example, students may be featured in materials to train teachers and/or increase public awareness of our schools through newspapers, radio, TV, the web, DVDs, displays, brochures, and other types of media.

I, as the parent or guardian of , hereby give EBRPSS and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media.

1. This is with the understanding that neither EBRPSS nor its representatives will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that will not receive monetary compensation for my child's participation.
2. I further release and relieve EBRPSS, its Board Members, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material.

Some of your child's information may be shared with the Louisiana Office of Student Financial Assistance (LOSFA), Louisiana High School Athletic Association (LHSAA), various clubs and organizations that your child will join (BETA, FCA, FHA, etc.), local news media (Athletics, honor roll, events, and awards), event programs (football and other sporting events, music and theatrical performances, graduation and award ceremonies, etc.), yearbooks, online resources and educational tools (digital library resources, homework help, etc.), any postsecondary education institution(s) to which your child applies, school photography providers, and some others as detailed in this Handbook.

To allow your child to appear in event programs, be recognized for awards and achievements, take pictures for ID badges, take advantage of online resources, and to insure eligibility for TOPS, you must sign to provide your consent.

I CONSENT to my child's school collecting my child's personal information and disclosing the personal information collected to:

• LOSFA and postsecondary education institution(s) (Cumulative records required)
• University Transcript Requests for Scholarship and Admissions
• LHSAA, NCAA and Sports Programs
• Programs for Graduations, Performances, and Award Programs
• Clubs and Organizations
• Online Resources and Educational Tools
• Louisiana Department of Education

I understand and acknowledge that the consent provided herein shall be valid for my child's cumulative transcript records as of the date of signature and shall remain valid and in effect for the 2025-2026 school year.

By signing this form, I give permission for (student's name):

to receive health services from the school nurse or school-based clinic at my child's school. I understand that nursing personnel cannot take care of all the health needs my child may have. However, if my child is not already under the regular care of a doctor or clinic, will work with the school nurse to choose one.

I give consent for my child to receive on-site nurse services or clinic-based services. By signing the handbook, agree with the following:

• I have read the information about the school nurse clinic and understand what services may be provided, which include, but are not limited to: health education, first aid/emergency care, disease specific care, referral to health care providers in the community, health screenings, including hearing and vision screening, and immunization information.
• I understand that it is my responsibility to notify the nursing staff about changes in my child's healthcare, guardianship, the child's living or custody arrangements, and emergency contact phone numbers.
• I understand that SERVICES WILL NOT BE PROVIDED WITHOUT CONSENT. (Limited exceptions may be made for emergency medical care.)
• I give permission for information to be shared with appropriate school personnel and health care providers by the school nurse providing healthcare services and developing an individualized care plan.
• I acknowledge that have reviewed the Our Lady of the Lake, Inc. Notice of Privacy Practices located at https://ololchildrens.org/our-network/patients-and-parents/your-privacy..

This Notice of Privacy Practices (the "Notice") describes the legal obligations of Our Lady of the Lake Hospital, Inc., Our Lady of the Lake Physician Group, LLC (the "Organization") and your legal rights regarding protected health information held by the Organization under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). HIPAA protects only certain health information known as "protected health information."

To support accurate data collection as part of our beginning-of-year processes, please click the following link to open the survey in a new tab. Choose "East Baton Rouge Parish" as your district, complete the survey, and return here to continue.

I have already completed the survey.