Lake Marion Creek School

	Lake Marion Creek School
	6th Grade Parent Request for Electronic Access To Grades/Attendance

Student Name		Student ID# 5300
Home Address		Home Phone
Father’s Name		Work Phone
Mother’s Name		Work Phone
Student’s E-mail Address
Father’s E-mail Address
Mother’s E-mail Address

I request a password to access my child’s grades and attendance via the Internet.

Father’s Signature

Date

Mother’s Signature

Date

You, as the custodial parent, may return this form in person with a picture ID or have the form notarized and returned to the main office by the above named student. Signatures on this form must match those found on the Emergency Card at the school.

Your password will not be given to your student. It will be e-mailed to you at the e-mail address listed above.

If you desire to have automated e-mail messaging for grades and attendance, you may request this service while logged into the Parent Internet Viewer.

The Parent Internet Viewer may be accessed from the Polk County School Board website at: http://www.polk-fl.net. Once there, move your mouse over “For Our Parents,” and choose “Parent Internet Viewer.”

To be completed by a Notary Public

_______ Personally Known OR

________ Produced ID (type: ______________________________)

_______________________________________________________ ____________________________

^{Parent/Guardian
Signature
Date}

STATE OF FLORIDA, COUNTY OF ______________________________________________________

I hereby certify that the foregoing was executed before me on this _________ day of ______________________

My commission expires _________________________

_____________________________________________

^{Notary Public, State of Florida}

^{Office Use Only}

^{Verification Date}

^{Verification Signature}

Office Use Only

Date Entered

Date E-Mail Reply

Password Assigned