Roxbury School District Forms

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District High School Eisenhower Lincoln/Roosevelt
Franklin Jefferson Kennedy Nixon

District (Applies to all schools)

Form Name

Description
Anaphylaxis Action Plan District wide form for students suffering from allergies
Asthma Treatment Plan District wide form for students suffering from asthma
Babysitting/Daycare*  Request for babysitting/daycare transportation
Free/Reduced Lunch Application Form for free or reduced lunch.
Genesis Parent Access Registration Form to sign up for account for Genesis parent access
Health History  * Kindergarten/new student health history
Home Language Survey  * Home language survey
Medical Condition Update Form Medical condition update form
Medication Permission Form Permission slip for administering medication
Seizure Action Plan District wide form for students suffereing from seizures
Self Administered Medication Form Permission slip for self administering medication
(not to be confused with the general permission slip for administering medication)
Strep Permission Form * Strep testing permission form
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10
Transportation Student transportation assignment
Website Consent NJDOE website posting parental/guardian consent form

* Forms required for Kindergarten registration.

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High School

Form Name Description
Athletic Sign up Forms Athletic Participation Checklist, Physical Exams Forms, etc.
Class Restriction for Medical Reasons Form for students who may have restrictions for certain classes due to health issues.
Code of Conduct Form RHS Code of Conduct
Concussion Information/Waiver Waiver and Information sheets for athletes and parents regarding concussions
Field Trip Permission Blank permission slip for school field trips
Grades 5-12 Studnts AUP Agreement
(Revised 07/31/2007 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Physical Education Restrictions Form for students who may have restrictions for physical education
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10
Student Handbook RHS Student Handbook
Media Consent Form (01/25/2007) Parent Consent Form for Release of Student's Personal Information and/or Student's Written Work/Artwork for Press Release or on the School District's Websites

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Eisenhower

Form Name Description
Grades 5-12 Students AUP Agreement
(Revised 07/31/2007 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10
Athletic Sign Up Forms Athletic Participation Checklist, Physical Exams Forms, etc.

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Lincoln/Roosevelt

Form Name Description
Cell Phone Form Parent form for cell phone usage.
E-mail Sign up Form to sign up for email notifications
Field Trip Permission Permission slip for Lincoln/Roosevelt field trips
Grades 5-12 Students AUP Agreement
(Revised 07/31/2007 version))
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Health Record Form Universal child health physical form
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10
Grade 5 Supply List List of materials and supplies for 5th grade students.
Grade 6 Supply List List of materials and supplies for 6th grade students.
Media Usage Consent and authorization for student pictures in the media

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Franklin

Form Name Description
E-mail Sign up (08/24/07) Form for signing up for email notification
Grades K-4 Code of Conduct (08/13/07 version) Code of Conduct-Student's Responsibilities
Grades K-4 Students AUP Agreement
(Revised 08/24/07 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Media Usage Consent and authorization for student pictures in the media
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10

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Jefferson

Form Name Description
E-mail sign up Form for signing up for email notification
Grades K-4 Code of Conduct (08/13/07 version) Code of Conduct-Student's Responsibilities
Grades K-4 Students AUP Agreement
(Revised 08/24/07 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Media Usage Consent and authorization for student pictures in the media
School Supply Lists (Aug. 2010) List of school supplies needed for grades K - 4
Allowable Foods for Distribution and Request for Addition Information on Permittable Foods
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10

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Kennedy

Form Name Description
E-mail sign up (08/24/07) Form for signing up for email notification
Grades K-4 Code of Conduct (08/13/07 version) Code of Conduct-Student's Responsibilities
Grades K-4 Students AUP Agreement
(Revised 08/24/07 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Media Usage Consent and authorization for student pictures in the media
School Supply List List of School supplies need for grades K-4
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10

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Nixon

Form Name Description
E-mail Sign up (New 08/10/07) Form to sign up for email notifications
Grades K-4 Code of Conduct (08/13/07 version) Code of Conduct-Student's Responsibilities
Grades K-4 Students AUP Agreement
(Revised 08/24/07 version)
Acceptable Use Policy Agreement to use the Internet and District Network Resources
Student Supply List Grades K-4 supply requirements
Media Usage Consent and authorization for student pictures in the media
Student Registration Form
(Revised 02/22/10 version)
Version date 02/22/10

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