Change to Student Information Form

*This form is accessible via mobile devices. However, desktop devices are best for optimal functionality. An inoperative “submit” button indicates that some form fields are missing or typed incorrectly. Desktop devices will describe any necessary corrections that hinder submissions, but mobile forms do not have this function.

Parent Name (First and Last)

Student Name (First and Last)

Today's Date MM/DD/YYYY

I need to:

Update Items

Change my Address on File Change my Phone Number on File Change my Email Address on File Change Authorized Individuals for Pickup Add/Change a Medication or PRN given at School Update Custody Information Change Credit Card on File Inform the School of a Recent or Upcoming Hospitalization & Consequent Changes to Daily Care/Mobility/ Medication Regimen, and/or Hygiene Other

If "Other" selected, specify here:

1.) If you have a new ADDRESS, PHONE and/or EMAIL, ***enter the new information below:***

New information

2.) If you have a new PICKUP PERSON or MEDICATION/PRN UPDATE,***complete, save, and upload the forms below:***

Change Authorized Individual(s)for Pickup Form>
*Newly authorized individuals are required to show their ID's for pickup until staff is familiar. This form is for school records and not related to Dashpass. Please don't forget to log in to your Dashpass app and add them as well.

Update To Medication/PRN Form>
*Please remember although this form may be uploaded below, the actual prescriptions, PRN rescues, or over the counter medications must be physically handed from parent to med-certified staff at the front desk only. Mainspring Academy's formal medication intake/discontinuation procedures are strictly required, with no exceptions. Parents and staff will cross-check the med count and sign the intake form with a med staff and a 2nd staff witness. MEDS, OTC's, and RESCUES MAY NOT BE: sent in backpacks, handed in at carline, passed to extended day, left at the front desk, left on admin desks, passed to therapists, passed to teachers, etc.

New Information2

Notes2

3.) If you have a new CREDIT CARD, ***complete, save, and EMAIL the form. Do not upload.***.

Change in Credit Card Payment Form>
*Please do not upload. EMAIL the completed form to Sabrena at [email protected]. Card information will not be taken verbally over the phone. On the form, please indicate if the card is meant to replace a current card on file OR is to be processed for one-time use only.

4.) If your child has recent/upcoming PROCEDURES HOSPITALIZATIONS, INJURIES, etc. that create significant changes in daily care (health, hygiene, mood, routines, rest, feeding, medications, discomfort, etc.) that will effect their school day, ***EMAIL administration with details, care literature, and doctor's orders, and anything we may need to know to help them through the school day.
*Email necessary records and documentation to Admin at [email protected]

4a.)If you have CUSTODY CHANGES (that may create changes in pickup, mood, behavior, etc.) that will effect their school day, ***EMAIL administration.
Email necessary custody records to Admin at [email protected]

Notes

Parent E-Signature (First, MI, Last)

Change to Student Information Form

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