John Champe High School

41535 Sacred Mountain Street

Aldie, VA, 20105
Phone (703) 722-2680
School website http://lcps.org/jch
2014-2015 School Year

CLARITY Parent Portal Login Request

Important Note:

Each parent (who has legal access to a childs records) can have their own
unique log-in and password per child. Please use a separate form for each
parent or guardian who would like Parent Portal access.

Parent / Guardian Name (Please Print):

Please Circle one:
Mother
Farther
(Relationship)

Parent address:

(Please Print):

Student ID: ________

_________________________________________________

Guardian

________________________________________________________

Student DOB: ___________

Student Name: ___________________________________________________________________

Student Address: _________________________________________________________________

Student ID: ________

Student DOB: ___________

Student Name: ___________________________________________________________________

Student Address: _________________________________________________________________

Account access information will be mailed home in early October.

Data contained within the CLARITY Parent Portal is confidential and user accounts and passwords
should not be shared. Upon verification that a CLARITY Parent Portal user ID or password has been
compromised access through that account will be immediately disabled by designated school
personnel.
Parent/Guardian Signature: ______________________________________ Date: ___________
Print Name:__________________________________________________________________________________
By signing this form, I acknowledge that I have read and understand this information.

Please sign, date and return this page to the school at your earliest convenience.
For School use only
Legal Guardianship Verified: [ ]
Staff Person Verifying Parent/Guardian Authorization:____________________________ Date: _________________