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212 West Lake Street ~ Elmhurst, Illinois 60126 ~ 630-279-2494 ~ www.elmhurstacademy.com
Elmhurst Academy
PARENT CONSENT INFORMATION
*Please initial next to each statement and sign at the bottom.
____ 1. I hereby give my consent to have my child receive first aid treatment at the school
and/or be treated by a physician for medical or surgical care should an emergency arise.
I understand that every effort will be made to contact me before such action is taken.
____ 2. I hereby give my consent for my child to be taken to the nearest hospital in the event
of an emergency to receive necessary medical attention if unable to contact either parent.
____ 3. I hereby grant permission for my child to leave the school or school area for the
purpose of walks, park visits or excursions under teacher supervision.
____ 4. I hereby give my consent to have my child’s photo taken during daily activities at
school for use in research and reflection, as well as portfolio documentation and assessment.
____ 5. I hereby give my consent for my child to be video recorded during daily activities at
school for use in research and reflection, as well as documentation and assessment.
____ 6. I hereby give my consent for my child’s photo used for school promotional purposes
including the website and social media.
____ 7. I am aware of Elmhurst Academy’s policy regarding my child’s release to only
authorized persons listed on the Application for Admission.
____ 8. Although the children are closely supervised at all times, accidents still occur.
I agree to release Elmhurst Academy from all liability for accidents.
____ 9. I have read the Elmhurst Academy Parent Handbook and understand all school
policies, including the Behavioral Management Policy and Closing/Late Pick-up Policy.
(Elmhurst Academy Parent Handbook can be accessed on our website,
www.elmhurstacademy.com, under the “enrollment” page.)
____10. I have read and understand the Elmhurst Academy tuition policies.
Child’s Name: ________________________________________________________________
Parent Signature:_______________________________________ Date: ________________
