Overton, Carter James Cielo Vista Elementary School

2021-2022 Student Emergency Card 8/3/2021

Student Information Page 1
Student ID Last Name First Name Middle Name Gender Grade Birthdate
907966 Overton Carter (CJ) James Male TK 11/29/2016

Resid Address 5 ANDALUSIA Student's Mobile

Rancho Santa Margarita, CA 92688 Student's overtonc966@mysaddleback.org
Email
Mailing Address 5 ANDALUSIA Counselor Unassigned
Rancho Santa Margarita, CA 92688
Birth Place Newport Beach , California - United States Of America

Parent/Guardian Information
Kylie & Corey Overton Primary Phone (619) 395-7611
kylie_rae3@yahoo.com Primary Contact 1:
Language: English Primary Contact 2:
Emergency Contacts
Kylie Overton (lives with) Mobile
Mother Phone (619) 395-7611 Employer AIG, One MacArthur place ate 600 Santa Ana ca
92688
kylie_rae3@yahoo.com
Corey Overton (lives with) Mobile
Father Phone (949) 416-6130 Employer Santa Margarita high school
Overtoncoreya@gmail.com
Melinda Overton Mobile
Grandmother Phone (563) 343-3575
Donna Provencher Mobile
Grandfather Phone (619) 316-4755
Craig Randall Mobile
Grandfather Phone (949) 439-2276
Melinda Overton Mobile
Grandmother Phone (563) 343-3575

Authorizations
Authorization Type Authorization Code Date Status Dt Status
1 Prog Participation Authorization or IMD Student Media Release 08/03/2021 08/03/2021 Granted
1 Prog Participation Authorization or INT Allow my child to access the Internet / SVUSD08/03/2021
Network 08/03/2021 Granted
1 Prog Participation Authorization or IPT Allow release of student information to PTA, PTSA,
08/03/2021
PTO 08/03/2021 Granted
1 Prog Participation Authorization or IVT Allow release of student information to Orange
08/03/2021
County Registrar
08/03/2021
of Voters
Denied
1 Prog Participation Authorization or IGV Allow release of student information for Recruitment
08/03/2021
Opportunities
08/03/2021 Denied
1 Prog Participation Authorization or IRC Allow release of student information to Military
08/03/2021
forces of the08/03/2021
United StatesDenied
1 Prog Participation Authorization or IGP Allow release of student information to Colleges
08/03/2021
and Scholarship
08/03/2021
Organizations
Granted
1 Prog Participation Authorization or INP Allow release of student information to Non-profit
08/03/2021
Organizations
08/03/2021 Granted
1 Prog Participation Authorization or MC Allow release of student information to Medi-Cal
08/03/2021
for Reimbursement
08/03/2021 Granted
1 Prog Participation Authorization or EG I acknowledge and understand that I must request
08/03/2021
paper report
08/03/2021
cards andGranted
progress reports from t
1 Prog Participation Authorization or SM I elect to receive messages distributed, on behalf
08/03/2021
of SVUSD,08/03/2021
through the School
GrantedMessenger Syste
1 Prog Participation Authorization or ITA Does your child have internet access at home?
08/03/2021 08/03/2021 Granted
1 Prog Participation Authorization or ITS Is your primary home internet access provided
08/03/2021
through a cell
08/03/2021
phone or cellular
Grantedhotspot?
1 Prog Participation Authorization or NTP I verify that my child and I have read and understand
08/03/2021
the information
08/03/2021
in the
Granted
Annual Notification to

Parent/Guardian Signature Date Parent/Guardian Signature Date