Forms

Requirements for Current & Returning Families

The following are required for current families reenrolling for the following year:

  • Registration Form (one for each child every year)
  • TB Screening Certificate (required for each cooping parent every year)
  • Fingerprint for background check (every 5 years, you will be notified when/if renewal is needed)
  • Central Registry (every 2 years; you will be notified when/if renewal is needed)

Forms/fingerprinting for returning families must be returned to Diann Vaughan by May 11, 2018

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 May 18, 2018

Forms:

  • Forms Checklist – use this to help navigate the forms requirement; does not need to be returned
  • Registration Form
  • Emergency Release
  • Health Form
  • Proof of Identity
  • Media Release
  • Sworn Statement of Affirmation
  • MD or DC background check (if applicable)
  • Fingerprint for background check
  • Central Registry background check
  • Parent Reference
  • Committee Selection
  • TB Screening Certificate
  • Authorization to Administer Medication
  • Food Allergy Action Plan
  • Medication Administration Record

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 (2018-19)
AUCP Registration Form (2018-19)
  • One form for each child
  • Both parents must sign & date the bottom of page 3
  • Fill in all spaces (or reflect N/A, where applicable)
Emergency Release Form
  • Must be notarized
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 1, 2018
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
Medication Administration Record
  • Only required for allergies and/or medication needs
  • 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
Maryland Background Form
  • Please fill out if you have lived in MD within the past 5 years
DC Background Form
  • Please fill out if you have lived in DC within 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
  • 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 annually 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