Super User
Medical Form
MEDICAL CONDITION
Student Name: _____________________________________________
□ Yes, my child has Medical Condition □ No, my child does not have a Medical Condition
List Medical Condition in detail:
Please attach any relative information regarding the Medical Condition(s) If Medication is needed during school hours, you may pick up a Medical Permission form at the office.
ALLERGIES
□ Yes, my child has Allergies □ No, my child does not have Allergies
List Allergies in detail:
I Do Not Hold Tipton Academy responsible for forgetting to administer medication to my child.
Parent/Guardian’s Signature: ______________________________ Date: __________ If I want to ensure that my child receives the medication, I have the right to come into the school and administer this medication to my child.
Family Form
TIPTON ACADEMY
Mother/ Guardian Information
Last Name: _________________________ First Name: ______________________
Address: _____________________ _________________ _________________
City State Zip Cell Number: ________________________ Home Number: ___________________________
Work Number: _______________________ Relationship to Student: __________________________________
LIST OTHER CHILDREN IN THE FAMILY
Father/ Guardian Information
Last Name: _________________________ First Name: ______________________
Address: _____________________ _________________ _________ _________ City State Zip Cell Number: ________________________ Home Number: _________________________
Work Number: _______________________ Relationship to Student: __________________________________
NAME DATE OF BIRTH GRADE SCHOOL ATTENDING
WITH WHOM DOES THE CHILD RESIDE? Both Parents______ Mother_________ Father _______ Guardian_______
______ Stepmother ______ Stepfather
PRESENT LIVING SITUATION: ____Own Home ____Renting Home ____ Living with another family due to financial reasons
____ Car ______Motel/Hotel _____ Campsite/Trailer
Knowingly falsifying registration information is grounds for immediate removal of the child from Tipton Academy. I attest that the above information is accurate and complete to the best of my knowledge.
Signature of Parent or Guardian Enrolling Student:
___________________________________________________________________ Date: ________ Relationship: ____________________________
Tipton Academy will not tolerate unlawful discrimination by or against students because of their race, color, creed, religion, height, weight, age, marital status, veteran status, citizenship, national origin, sex, handicap or disability, or any other factor prohibited by law. This policy applies without exception. After investigation, persons who violate this policy are subject to appropriate sanctions for their conduct.
Enrollment Form
1615 Belton Garden City, Michigan 48135
734-261-0500 Fax: 734-956-6360
Principal Suzanne March
ENROLLMENT APPLICATION
Name (full) ____________________________________________________Age_____Sex_____
Address________________________City_____________Zip_______Date of Birth__________
Home Phone_________________________Cell Phone__________________________________
Email Adress____________________________________________________________________
Last School Attended and Address___________________________________________________
School District Where You Live and County Your Home Resides In_________________________
How did you hear about Tipton Academy (newspaper, friend, etc):__________________________
Grade which student is enrolling at Tipton Academy: _____________________________________
Has your child ever been suspended or expelled from another school district? Yes______ No______
Is your child currently eligible for Special Education Services? Yes_____ No______ Does your child have a current IEP? Yes_____ No_____
Is your child currently eligible for Section 504 services? Yes_____ No______
Ethnic: Caucasian_______ Asian______ African American______ Hispanic_______ American Indian________ Other _________________
♦ Is the primary language in your home OTHER than English? Yes______ No________ ♦ If YES, what language? _____________________ ♦ ENGLISH LANGUAGE LEANER: Has the student ever been enrolled in a Bilingual or English Language Learner (ELL) program? Yes______ No_______
Signature of Parent/Guardian Date
Annual Asbestos Notification
2017 - 2018 ANNUAL ASBESTOS OFFICIAL NOTIFICATION
September 11, 2017
Dear Tipton Academy Parents, Students and Staff:
Pursuant to the Environmental Protection Agency (EPA) Asbestos Hazard Emergency Response Act, AHERA, 40 CFR 763, Tipton Academy is complying with the annual asbestos notification with this publication. Certain construction material may contain asbestos, and are considered Asbestos Containing Building Materials (ACBM).
Tipton Academy continuously monitors the status of known and assumed ACBM throughout its facility. This is accomplished by conducting six-month periodic surveillances in conjunction with three year re-inspections of newly identified or remaining ACBM. Based upon these activities, required maintenance or renovation response actions, abatement of asbestos materials may be necessary.
Our asbestos management plan is available at the Main Office building and can be reviewed by interested individuals during normal business hours. Additionally, your school and/or facility Asbestos Management Plan is also available for review during normal business hours.
If you have any questions regarding this notice, please contact Suzanne March at (734) 261-0500.
Allergy Listing
Tipton Academy
1515 Belton St. Garden City, MI 48135
ALLERGY LIST
Student’s Name:_________________________________________________________
Teacher’s Name:_________________________________________________________
Yes, my child has allergies.
No, my child does not have allergies.
List allergies in detail:
Parent/Guardian’s Signature Date
