Legal Custody Form

We are the parents/guardians who have legal custody over ______________________________.  No other person has such a right.  Only we are legally entitled to make decisions concerning the education of ______________________________. 

We agree that no other person is entitled to participate in the issues surrounding _____________________________ attendance at school, including participation at school meetings.  We agree that no other person is permitted to attend a school

 meeting, and the school will not conduct a meeting unless only both or one of us (if we so agree beforehand) is present.  We understand that separate meetings for each of us will not be held.

Recognizing that requiring the school to provide duplicate copies of school grades, notices, and other related educational materials and notices is administratively burdensome, we agree that the school is required to send only one set of such

 materials to the parent/guardian identified below, and that we retain the responsibility of communicating such information to each other.  We understand that the school is not required to send such materials to any other person.

We also notify the school that, as indicated below on the dates listed, ______________________ may be released to me(us) at dismissal.  In an emergency or when we cannot be reached, _______________________ may be released to those

persons whom we have identified on the emergency contact card.  We agree and represent that these dates below reflect when we have physical custody of ______________________________ as reflected in the custody order and/or custody

 agreement we have provided to the school.

We agree that we are responsible to pay tuition in accordance with the school’s tuition policies and that we are jointly and independently responsible to pay tuition, and that our failure to pay tuition constitutes grounds for dismissal of our student.

Signature:  _________________________________________________

List all school days and times when you may pick up listed child(ren):

            ______________________________________________________________________

Signature:  _________________________________________________

List all school days and times when you may pick up listed child(ren):

            ______________________________________________________________________

Name of parent/guardian to receive school materials:  __________________________________