SPECIAL PROGRAMS:  This information assists in making educational placement decisions for the student.

Schools are permitted to disclose information on students if it has been properly designated as directory information. By law, directory information includes things that would generally not be considered harmful or an invasion of privacy if disclosed, such as name, address, photograph, and date of birth. Directory Information may not include things such as a student's social security number or grades. If a school has a policy of disclosing directory information, it is required to give public notice to parents of the types of information designated as directory information, and the right to opt out of having your child's information so designated and disclosed. Also secondary school students' names, addresses, and telephone numbers may be released to military recruiters and/or institutions of higher education. Parents have the right to deny release of directory information.

We are required by law to release your student(s) directory information to the following unless specified by checking "no" below.

The Student Health Information Form should be completed ANNUALLY for ALL students attending Baltic School District. The information you provide on this form will be used to alert us to any health conditions your child may have. Please make sure to keep our records current by sending in writing if your child develops any new medical conditions/issues or if medications change during the school year.  Our records can only be as accurate as the information we receive, keeping up to date information will help us to better serve you and your child.

Only fully completed forms are accepted.

I am the mother/father/legal guardian of the above child(ren), who attends Baltic School District 49-1. I hereby consent to any medical services & hospital care that may be required while said student is under the supervision of an employee of the Baltic School District 49-1. I hereby appoint said employee to act on my behalf in securing necessary medical services & hospital care from any duly licensed health care provider. I authorize officials of the District to contact persons I have designated as emergency contacts (above) for medical emergencies and in the event that I or my designated emergency contacts cannot be reached, school officials are authorized to take whatever action is deemed necessary for the health and safety of my child/children. Expenses incurred, including ambulance user or treatment by a physician, will not be borne by the District.

1) I authorize the use of disclosure of the above individual’s health information. Also if the student is involved in athletics/activities at Baltic School the Pre-Participation History and Physical Exam information pertaining to a student’s ability to participate in South Dakota High School Activites Association sponsored activities. Such disclosure may be made by any Heath Care Provider generating or maintaining such information.

2) The information identified above may be used by or disclosed to the school nurse, athletic trainer, coaches, medical providers and other school personnel involved in the care of this student.

3) This information for which I am authorizing disclosure will be used for the purpose of determining the student’s eligibility to participate in extracurricular activities, any limitations on such participation and any treatment needs of the student.

4) I understand that I have a right to revoke this authorization at any time. I understand that if I revoke this authorization, I must do so in writing and present my written revocation to the school administration. I understand that the revocation will not apply to the information that has already been released in response to this authorization. I understand that the revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy.

5) I understand that once the above information is disclosed, it may be re-disclosed by the recipient and the information may not be protected by federal privacy laws or regulations. I understand authorizing the use or disclosure of the information identified above is voluntary.

6) However, a student’s eligibility to participate in extracurricular activities depends on such authorization. I need not sign this form to ensure healthcare treatment.

I understand authorizing the use or disclosure of the information identified above is voluntary. However, a student’s eligibility to participate in extracurricular activities depends on such authorization. I need not sign this form to ensure healthcare treatment.

As a Parent/Guardian, I understand by signing my digital signature below that we need to complete the Medication & Treatment Authorization form, which is available on our school website, under "Forms & Doc's" if your student must take medication during school hours and it cannot be given at home.  Baltic School District requires this form be completed by the parent for over-the-counter medications and both parent and physician for prescription drugs before administering any medication. Medication must be delivered directly to the school Administrative office personnel by the parent/Guardian or responsible adult in the original pharmacy or manufacturer's container.  For your child's safety and the safety of other children, students are not allowed to carry medication to/at school unless prior authorization has been given by the school.  Renewal is required at the beginning of each school year.  

Written parental permission is required before a student (must be in 11th & 12th Grade).  A signature indicates that you are aware that your child will be leaving school grounds during the open block(s) in their schedule.  You need to also be aware that busses will be running at their normal times, and your child(ren) must provide their own transportation home if they decide to leave school before the busses.  I understand by signing below I'm giving my student(s) leave at the end of the day.

The Baltic School District is asking families who desire school bus transportation for the  school year to complete the applicable information below.  For out-of-town families in most situations, the bus will make individual stops.  For out-of-town housing developments or grouped housing, pick-up and drop-off points may be established.

For in-town families, pick-up and drop-off points will be established depending upon the location of families requesting transportation.  There will be no pick-up or drop-off points within 3 blocks of school.  It will most likely be necessary for in-town students to walk 1-2 blocks to the pick-up and/or drop-off point. 

Because of overcrowding on in-town busses, it has become necessary to restrict the age of students who may access in-town bussing.  Please be advised that in-town bussing is limited to PK-6th grades with students in grades 7-12 not eligible to ride in-town busses.  It is very important that in-town families requesting bus service complete this form so that pick-up and drop-off points can be established.

There will be fees associated with in-town bussing.  Students in JK - 3rd grades, bussing will be provided free of charge. Students in grades 4 - 6 may ride the bus, but will be charged $50 per student, per semester. This fee will be waived for students who submit an application for free or reduced school lunches and qualify.

Pre-School students may ride the bus in the morning or at the end of the school day free of charge.  In the middle of the day, pre-school students may be transported to and from in-town daycares for a fee of $20 per month

For all students residing withing 5 miles of the school, but outside the city limits, bussing will be provided free of charge.

Transportation fees may be paid in the parent portal or in the elementary office.

Please complete the form below by August 1st.  Approximately one week prior to the first day of school, out-of-town families will be informed of approximate pick-up and drop-off times, and in-town families will be notified of the location of pick-up and drop-off points with approximate pick-up and drop-off times.