SEPARATED AND DIVORCED PARENT CUSTODY PROFILE

Additional information is needed to clarify custody issues, emergency contacts, and access to school information.

Student's Name: *

Grade *

Date: * +

Father's Name *

Mother's Name *

Step Father's Name

Step Mother's Name

Status of Marriage: *

Is there a restraining order or non-contact order we should be aware of: *

Yes

No

Do you have a separation agreement? *

Yes

No

Do you have divorce decree? *

Yes

No

Do you have a court order and custody agreement? *

Yes

No

Do you have sole legal custody? *

Yes

No

Do you have joint custody? *

Yes

No

Does the student live with you? *

Yes

No

Full time or part time? *

Full time

Part time

Does the non custodial parent have visitation rights if the student does not live with them? *

Yes

No

Please describe *

PLEASE NOTE: Non-Custodial Parent Rights

Per Oregon Revised Statue 107.154, non-custodial parents still maintain their right to school records unless a court order explicitly denies these records. Unless otherwise specified in a court order provided to Horizon Christian School, we will provide access to student records at the request of the non-custodial parent.

Does the non-custodial parent have the right to pick up the student from school and school-related activities? *

Yes

No

Does the non-custodial parent have rights to access the student's Family Portal, the school's web-based portal for student data, which includes attendance and current grade information? *

Yes

No

PLEASE NOTE- REQUIRED DOCUMENTS: To effectively provide the best care for your student, we require that the custodial parent provide the school with copies of all pertinent court documents to support your selections above. Please email a copy of the relevant court documents to the contact below or bring a copy to the school campus.

ESMS- Debbie Roberts: DRoberts@horizonchristian.school

HCHS- Anna Platt: aplatt@horizonchristian.school

Completed by: *

Date * +