Skip to main content
New Horizon School (BVIU #27)
Main Menu Toggle
About Us
About Us
Directions
Message from the Supervisor
Employment Opportunities
ESY Breakfast Menu
About Us
Staff Directory
Programs/Services
Classrooms
Special Subject Classes
Therapies
Transition
Behavior Services
School Wide Positive Behavior Support
Student Assistance Program (SAP)
PA Parents and Family Alliance Website
Programs/Services
Parent Resources
2022 Summer Camps
2022-2023 Annual Forms
3-7-2022: Masking Policy Update
COVID Quarantine and Isolation Guidelines- Updated 1/13/2022
Attendance Policy for the 2021-2022 School Year
Information About State Testing
Upcoming Events at New Horizon
Home Study Resources
Student/Parent Handbook
Volunteering
BVIU Polices
Links to Resources
School Calendar
Wellness Policy
Wellness Policy Assessment
Summer Food Sites
Parent Resources
Contact
Contact Us
Contact
Staff Only
Facebook
Twitter
Search
Loading...
Editing previous response:
Please fix the highlighted areas below before submitting.
2022-2023 Parent Form: Permission to Swim
Please complete the form below. Required fields marked with an asterisk *
Contact Information
Student First Name
*
Answer Required
Student Last Name
*
Answer Required
Phone
*
Answer Required
Address
*
Answer Required
Birthdate
*
Answer Required
1. ANY VISUAL OR HEARING IMPAIRMENTS SUCH AS TUBES IN THE EARS, OR CHRONIC EAR INFECTIONS? EXPLAIN.
*
Answer Required
2. ANY PHYSICAL OR MOTOR IMPAIRMENTS (e.g., Wheelchair, Cerebral Palsy)
*
Answer Required
3. ANY RESPIRATORY OR CIRCULATION PROBLEMS SUCH AS A HEART MURMUR OR ASTHMA? (STUDENTS WITH CURRENT TRACHEOTOMIES ARE EXCUSED FROM SWIM CLASS).
*
Answer Required
4. ANY ALLERGIES, ESPECIALLY TO CHLORINE?
*
Answer Required
5. A HISTORY OF SEIZURES?(WHAT TYPE, SEVERITY, FREQUENCY)
*
Answer Required
6. ANY OTHER LIMITATIONS OR IMPORTANT INFORMATION THAT THE SWIM STAFF SHOULD KNOW?
*
Answer Required
7. IF YOUR CHILD HAS DOWN’S SYNDROME, WERE THE RESULTS OF THEIR ATLANTOZXIAL DISLOCATION TEST, POSITIVE OR NEGATIVE?
*
Answer Required
Positive
Negative
My child does not have Down Syndrome
8. Permission to swim:
*
Answer Required
Yes, my child may participate in swim class for the 2022-2023 school year.
No, my child MAY NOT participate in swim class for the 2022-2023 school year.
By typing your name below, you are agreeing to an electronic signature of this document.
*
Answer Required
Calendar
Staff Directory
Homework
Directions