2022-2023 PARENTAL OPTIONS
(Applicable Only for the Current School Year)


PARENTS: PLEASE READ AND COMPLETE THE INFORMATION BELOW AND RETURN IT TO YOUR SCHOOL


Student Name:                                                         Date of Birth:                                
Address:                                                                                                
City:                                                                        Zip Code:                        
Telephone No.:                                                        Grade:                                
School:                                                                                                
Physical Examination
JCS, Inc. may require physical examinations of students enrolled in JCS, Inc. programs or activities. Any physical examination required by JCS, Inc. shall be kept confidential.  A parent or guardian having control or charge of any child enrolled in public schools may file annually with the principal of the school in which s/he is enrolled a statement in writing, signed by the parent or guardian, stating that s/he will not consent to a physical examination of the child.


* I do not want my child to undergo a physical exam for JCS, Inc. programs or activities.

* I grant consent for my child to undergo a physical exam for JCS, Inc. programs or activities.