Forms

Requirements for Current & Returning Families

The following are required for current families re-enrolling for the following year:

  • Registration Form (one for each child every year)
  • TB Screening Certificate (required for each co-oping parent every two years)
  • Fingerprint for background check (each co-oping parent every 5 years, you will be notified when/if renewal is needed)
  • Central Registry (each co-oping parent every 5 years; you will be notified when/if renewal is needed)

Forms must be returned to Diann Vaughan by mid-May.

Requirements for New Families

All new and alumni families enrolling for the upcoming school year must complete each of the forms below as well as the Fingerprinting for Background Checks, unless otherwise noted. Forms/fingerprinting for new families must be returned to Diann Vaughan by the date indicated in the enrollment packet.

Use the Forms Checklist in the box below to help you navigate the requirements.  You do not need to submit the checklist.

Fingerprinting for Background Checks:

Each cooping parent is required to have their fingerprints taken as part of their background check. To have this completed, please schedule an appointment with Fieldprint Live Scan by vising the following website https://fieldprintvirginia.com. The following documents can provide you with instructions to successfully complete this process:

Here is important information that you will need when filling out the online form:
Facility ID:  104758 (This should auto-populate AUCP on the application
Field print code:   FPVADSSChDayCntrVol
Fingerprint results will be sent directly to AUCP.

Forms

Form Notes
Forms Checklist
AUCP Registration Form
  • One form for each child
  • Both parents must sign & date the bottom of page 3
  • Emergency Contacts MUST have addresses filled in
  • Fill in all spaces (or reflect N/A, where applicable)
Emergency Release Form
  • Must be notarized – Diann can do this
Commonwealth of Virginia School Entrance Health Form
  • The most recent physical examination must be within the past 12 months for children over two-years old; within the past six months for children under two-years old
  • The bottom of page 1 must be signed and dated by parent
  • The bottom of both page 2 and page 4 must be signed and dated by physician
  • TB assessment on page 4 is required for all students over one year old and must be done after May 1st
Proof of Child’s Identity
  • Original documentation must be submitted in person for review by the Membership Chair, President, or Director (the form and documentation may be presented at the New Family Orientation or Parent Welcome Night in September)
Authorization to Administer Medication
Food Allergy Action Plan
  • Only required for allergies and/or medication needs. Must have separate form for EACH medication.
  • Physician’s signature required on Authorization to Administer Medication form.
Parent Reference Form
  • Two references must be completed for each co-oping parent.
Sworn Statement of Affirmation
  • Please contact Diann to get additional forms if you have lived out of state w/in the past 5 years
   
   
Central Reg Form (Revised 2016)
  • Enclose no money
  • Parts II and III must be fully completed with full names (do not use initials)
  • Part IV must be notarized (Diann can do this)
  • Please print pages 2 and 3 on one sheet (front and back); No need to print page 1 (instruction sheet)
Tuberculosis Screening Certificate (Revised 2016)
  • Required for each co-oping parent
  • New Families: Test must be done between August 14th and first day of school (if it is done earlier than this, it will have to be redone)
  • TB Screening Locations:
  • Arlington Co. Public Health Dept., 2100 Washington Blvd, 703-228-1300 (walk-in, Tues 3-6:30pm, Wed 9-12:30pm, Fri 7:30-11am)
  • Alexandria Health Dept., 4480 King Street, 703-746-4960 (walk-in Monday 8-11am and 2-6pm; appointment only Tues & Wed 8-11am and 1-3:30pm, Fri 8-11am
  • Fairfax Co. Health Dept., 7611 Little River Turnpike, Annandale, 703-534-8343 (walk-in, Mon & Wed 8am- 12:30pm/Tues 10am-2pm, or by appointment daily 8am-4:30pm)
  • Fairfax Co. Health Dept., 3750 Old Lee Highway, Fairfax City, 703-246-7100 (walk-in, Mon & Tues 8-12:30pm/Wed 10-2pm, or by appointment daily 8am-4:30pm)
  • Target Minute clinic and CVS pharmacy locations may do assessments as well for a fee; clinic hours vary
Media Release Form  
AUCP Committee Selection Form