Consent Form

Consent Form for 2026-2027

This form must be completed for each child in the family. You should see an option in the upper left corner to change between your children.

Contact Details

On file with the school. To make updates go to the Demographics Change page.

Student name

Address

Mother (first, last)

Mother's mobile number

Mother's Email

Father (first, last)

Father's mobile number

Father Email

Emergency contact 1

Emergency Phone 1

Emergency 1 Relationship

Health and Well-Being Authorizations

During the school year, minor medical and student health-related care services to students will be administered by an external medical services provider, contracted by the school to provide care in the school’s health room.

The school health services assume that your child will be able to participate and function fully in their classes and activities when they are healthy and free of discomfort. However, there may be times when they will experience headaches, pain from minor injuries, and other general aches. In the case of mild discomfort, we are able to administer Paracetamol (Panadol), Acetaminophen (Tylenol, APAP), or Ibuprofen (Advil or Motrin), cough drops, and lozenges. Note: We will send a child home if there is a suspicion of infection, a temperature of 100 F (37.8 C) or greater, persistent coughing and shortness of breath, body aches and pain, extreme tiredness, conjunctivitis, persistent vomiting, diarrhea, or any symptom causing distress that requires further medical evaluation.

Parental Consent for Physical Examination

These examinations are limited to basic, non-invasive assessments necessary for initial evaluation and care.

Measurement of vital signs, including:

Blood pressure, Heart rate, Temperature (measured via ear or forehead)
Blood oxygen saturation (measured with a pulse oximeter on the fingernail)
Pain assessment using visual pain scales

Yes No

In case of trauma:

Examination of the injured area
In the event of head trauma – basic neurological examination (pupil assessment, meningeal signs, muscle strength)
Applying direct pressure to a bleeding wound to control hemorrhage
Cleaning the wound, removing foreign body (for example splinter removal, tick removal)

Yes No

In case of abdominal symptoms (abdominal pain, vomiting, diarrhea): Palpation of the abdomen

Yes No

In case of respiratory symptoms: Auscultation of the lungs in cases of severe cough

Yes No

In case of dermatologic symptoms: Examination of the skin in cases of rash or suspected insect bites

Yes No

Eye examination in cases of irritation, presence of a foreign body, or conjunctivitis

Yes No

ENT examination:

Examination of the throat and ears in cases of common cold or flu-like symptoms
Collection of nasal swab samples for COVID-19, Influenza, and RSV rapid COMBO antigen testing, if indicated

Yes No

Medication Permission Form

I hereby permit medical personnel to administer the following medications when deemed necessary:

For headaches, fever, and pain (including injury-related or menstrual cramps): Paracetamol (Acetaminophen) – syrup or tablet

Yes No

For headaches, fever, and pain: Ibuprofen – syrup or tablet

Yes No

For diarrhea: Oral electrolyte solutions

Yes No

For diarrhea: Recenum Junior solution

Yes No

For diarrhea: Loperamide / Activated Charcoal (Carbo medicinalis) – for temporary relief of diarrhea

Yes No

For vomiting: Oral rehydration with electrolytes

Yes No

For vomiting: Dimenhydrinate (Aviomarin) tablets, syrup

Yes No

For vomiting: Ondansetron tablets, oral solution

Yes No

For minor itchy rashes or insect bites: Fenistil topical ointment or gel

Yes No

For minor itchy rashes or insect bites: 1% Hydrocortisone cream

Yes No

For abdominal cramps: No-Spa (Drotaverine hydrochloride) tablet

Yes No

For sore throat or throat irritation: Chlorchinaldin throat spray or lozenges

Yes No

For sore throat or throat irritation: Strepsils 1 lozenge every 2–3 hours

Yes No

For allergic reactions or urticaria (hives): Oral antihistamines Desloratadine tablets or syrup / Loratadine

Yes No

For allergic conjunctivitis: Antihistamine eye drops for allergic conjunctivitis

Yes No

For eye irritation: 0.9% saline eye drops

Yes No

For relief of swelling, bruises, or minor soft tissue injuries: Arnica or Altacet gel / Topical diclofenac gel

Yes No

For anxiety, itching, allergies: Hydroxyzine Tablets or syrup

Yes No

For skin injuries: Alcohol wipes / Distilled water / Iodine solution / Octenisept spray

Yes No

Physical Activities

Can your child participate in school activities, including physical education courses and after-school sports?

Yes No

Welcoming Statement

Please be informed that under Board Policy:
At ASW, we are committed to fostering an affirming, safe, and welcoming community of students, families, staff, alumni, and charitable partners. We aspire to live by our core values, joining together so that everyone belongs. We believe every person has unique contributions to make to each other and to the world. This includes and is not limited to prohibiting discrimination according to race, cultural identity, physical appearance, age, ability, socio-economic status, family make-up, gender identity expression, sexual orientation, or religion.

We believe that feeling safe, seen, heard and valued is essential to learning. When we belong, we feel connected to others and gain a better understanding of the world around us. As an organization we will actively seek to include and celebrate diversity as a strength of our community and to enact these beliefs in our policies and school operations.

We expect our community of staff, parents, students, alumni, and charitable partners to uphold the mission and core values.

We will continue to review our work to identify the key challenges and areas requiring development.

We will measure and share the progress we make with our community through annual action plans and regular updates.

Required I acknowledge that I have been informed of the Diversity and Action Policy and that I accept this policy as a condition of enrollment.

I accept

Academic Integrity Policy

Parents play an essential role in academic integrity. At ASW, we recognize this role and encourage parents to work with their children to maintain their Academic Integrity both inside and outside of school.

Academic integrity means:

citing appropriately those whose work is used in the preparation of schoolwork
completing school work without the input of others, whose knowledge of the task might advantage the student unfairly
submitting work for assessment that is representative of the student’s learning and not that of others, individually or collectively
maintaining a level of confidentiality and personal ownership of one’s work, both assessed and non-assessed
adhering to ethical and honest practice during examinations and assessments

Required I support the Academic Integrity Policy, as well as the requirements of the programmes at the school, and I accept this policy as a condition of enrollment.

I accept

Drug, Alcohol, and Tobacco Policy

Under the stipulations of Board Policy: Drug, Alcohol, and Tobacco Use, we are presenting this policy to you for your review. As stated in the policy, as a condition of enrolment or continued enrolment, at least one parent or guardian must acknowledge via this consent form that they have received, read, and understood a copy of this policy.” We kindly ask that you and your child read the policy summary (the full policy can be found in both Elementary School and Upper School handbooks). If you have any questions or concerns, please feel free to reach out to the divisional office, principals, vice principals, or the school director.

Required I acknowledge that I have been informed of the Drug, Alcohol, and Tobacco Use Policy and that I accept this policy as a condition of enrollment.

I accept

Child Protection and Safeguarding

Please be informed that under Board Policy ASW is committed to child protection and safeguarding and promoting the welfare, both physical and emotional, of every student. We are committed to prevention, protection, and action. ASW staff are mandatory reporters of suspected abuse or neglect. Any allegation or risk to child welfare will be handled in line with the ASW Child Protection and Safeguarding Policy.

Required I acknowledge that I have been informed of the ASW Child Protection and Safeguarding Policy and Procedures and accept the school's procedures and commitment to student welfare as a condition of enrollment.

I accept

Image Use & Photo Consent

Information Regarding the Use of Photos in Internal Materials
As written in the American School of Warsaw Photo and Video Guidelines, ASW may use student photographs without prior parental consent when it serves a legitimate school interest. This includes, but is not limited to: Identification & Administration (ID cards, PowerSchool), Educational & Informational Purposes (yearbook, Parent Portal, eNotes, projects), and On-Campus Displays.

Consent for the Use of Photos in External Promotional Materials
I consent to the American School of Warsaw processing and sharing my child's image for school promotional and marketing activities, as well as in external publications. This applies to public-facing digital and print materials (official website, social media, brochures, promo videos).

Please select your preference regarding promotional and marketing activities:
Please Note: Lack of consent means your child may be asked to step aside during group photos. You may withdraw this consent at any time by contacting communications@aswarsaw.org.

Yes, I consent No, I do not consent

ASW Student Responsible Use Agreements

School devices are the property of ASW and are provided for educational use only. Device and account activity may be monitored by the school. Students are expected to care for school devices and may be responsible for repair or replacement costs resulting from damage or loss. Report any damage or technical issues to a teacher or the Technology Office immediately.

Principled

Be Responsible: Handle devices carefully. Carry them securely, use them on stable surfaces, and keep food and drinks away.
Be Private: Use your school account only for school-related websites and services. Never put your name, address, or personal information into non-school related websites or AI tools.
Be Honest: Submit your own work. Cite all sources, including AI tools when permitted, and give credit to creators of ideas, images, music, and other content.
Be Conscientious: Check the AI Assessment Scale before every task to understand the level of AI allowed. Consult your teacher if you are unsure.

Communicators

Be Collaborative: Use technology tools productively and responsibly when working collaboratively with others.
Be Kind: Always use helpful and respectful language when communicating with others.

Inquirers

Be Curious: Use school-approved tools and resources to research, learn, and explore.
Be Creative: Use technology tools to spark new ideas, following your teacher's specific instructions.

Knowledgeable

Be Smart: AI and online content can contain errors or bias. Verify information from multiple reliable sources.
Be Aware: Recognize that digital spaces contain risks. Stay informed and protect yourself. If an online experience is inappropriate or uncomfortable, tell an adult right away.

Balanced

Be Focused: Use devices for learning and minimize distractions. Use devices in appropriate areas and times.
Be Organized: Store devices safely in their case, locker, or charging cart when not in use.
Be Mindful: Be mindful of your screen use. Take breaks from technology and consider whether your device is the best tool for the task you are working on.

Required I have reviewed with my child the ASW Responsible Use Agreements and the expectations for use articulated in the divisional Student Handbook and agree to be financially responsible for loss or negligent damage to the device issued to my child.

I accept

Google third-party apps and additional services

At the American School of Warsaw, we use Google Workspace for Education, and we are seeking your permission to provide and manage a Google Workspace for Education account for your child. Google Workspace for Education is a set of education productivity tools from Google, including Gmail, Calendar, Docs, Classroom, and more. At ASW, students will use their Google Workspace for Education accounts to complete assignments, communicate with their teachers, and learn 21st-century digital citizenship skills.

I understand that my child may have access to additional Google services, e.g. YouTube, Google Maps and Google Gemini. A list of additional services is available at https://google.com.

Further, we allow students to access appropriate and vetted additional third-party services with their Google Workspace for Education accounts. Our school administrator enables access to these third-party services with your student’s Google Workspace for Education account and authorizes the disclosure of data, as requested by the third-party services.

Required I permit ASW to create/maintain a Google Workspace for Education account for my child and for Google to collect, use, and disclose information about my child only for the purposes described.

I permit

ClickSend SMS Notifications (Urgent)

I agree to receive SMS notifications from ASW via ClickSend for event updates and important notifications. I understand that I can unsubscribe at any time by contacting the school directly at help@my.aswarsaw.org

Yes, I consent No, I do not consent

Personal Data (GDPR)

Please read and accept all the following personal data protection clauses:

Required I accept that the controller of the personal data concerning you and your child collected in connection with enrolment and attendance at the American School of Warsaw is the American School of Warsaw with its registered address in Bielawa, ul. Warszawska 202, 05-520 Konstancin-Jeziorna. I accept that personal data will be processed for the purposes and on the legal grounds described in ASW Personal Data Protection for Parents/Students. For more information, please contact the Data Protection Officer at dpo@aswarsaw.org.

I accept

Required I confirm I have read the information clause concerning the processing of my and my child’s personal data by the American School of Warsaw.

I confirm

Required I accept that the controller of the personal data concerning my child collected in connection with providing health services to my child located at the school will be an external medical services provider, American Medical Centers sp. z o.o. with its registered office in Kraków, 00-014, Kalwaryjska 69 / 9, 30-504. I accept that personal data will be processed for the purposes and on the legal grounds described in the information clause.

I accept

Required I confirm I have read the information clause concerning the processing of health-related personal data by American Medical Centers sp. z o.o.

I confirm

Required I acknowledge that American Medical Centers sp. z o.o. will provide to the American School of Warsaw health data regarding my child in order to enable the American School of Warsaw to perform its services specified in the Enrollment Agreement, in particular, data on my child’s well-being at school and information about the need to send the student home due to illness.

I acknowledge

I certify that all the information I have provided is correct and current. I give my express permission to all of the above stipulations and sections as determined by my individual responses, where allowed, and confirmation of my understanding where required.