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Office Forms

PrearrangedAbsenceForm_CHS

Use this form

  1. every time your student will be out of school for more than one full day,
  2. when you know your student will have multiple, recurring absences such as repeat doctor’s appointments,
  3. when your student will have a long-term absence and you are unsure when he/she will be able to return to school.

Bullying and Harassment | (Spanish)

Use this form (last 2 pages) if you observe or experience an incident of bullying or harassment (including intimidation, cyberbullying, hazing and teen dating violence) or of discrimination. Please contact the school principal or another staff member to report the incident.

Private Auto Insurance Form

Use this form if you will be driving students to or from a school event, such as an athletic or club event. We also recommend completing the volunteer registration and background check.

Records Request

Use this form to request that your student’s records be transferred from another school to Churchill

Medication Authorization Form

Students at CHS may carry a one-day supply of a prescription medication with written permission from parent. The Medication Authorization Form must be turned in to the school. The medication must be stored in a clearly labeled original prescription bottle that includes the name of the student, the name and dosage of the medication, when and how the medication is to be taken, and the name of the prescribing physician. If the medication container does not have a prescription label, the parent must provide a separate written doctor’s order.

  • Students who bring prescription medication that does not meet the above criteria will face school and legal consequences.
  • Larger supplies of both non-prescription and prescription medication can be kept in the nurse’s office with written permission from parent.
  • If you have any questions about this policy, please call or email Kim Roellig (school nurse) at 541-790-5237, or roellig_k@4j.lane.edu.

Parking Contract

All parking on campus is by permit only except in designated visitor spaces. A Parking Contract must be completed and turned in to the front office before a student may receive a parking pass.

Community Service log

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