Parent Consent Form

    Parent Consent Form: Deviation from Student's Legal Name

    Parent Consent for Deviation from Student’s Legal Name

    Student ID#

    Student First Name

    MI

    Student Last Name

    Birth Date

    Parent/Guardian First Name

    Parent/Guardian Last Name

    Phone Number

    Relationship to Student

    Under Fla. Admin. Code R. 6A-10955:Education Records, each school district must develop a form to obtain parental consent whereby parents may specify the use of any deviation from their child’s legal name in school. Without this consent, school personnel are obligated to use your student’s legal name as it appears on their birth certificate.

    This consent authorizes school personnel to use the parent/guardian approved name/nickname, as indicated below, for my student. I understand that this name/nickname will be entered into the Student Information System (FOCUS).

    I, authorize my student, to be referred to by the following approved name/nickname: _____________________.

    Parent Signature:

    Printed Name: ________________________________________

    Date: ______________________________________________