Gaylord Community SChoolS An NCA Accredited School District North Ohio Elementary ● 912 North Ohio Avenue ● Gaylord Michigan 49735-1253 Phone: (989) 731-2648 ● Fax: (989) 731-3387 ● www.gaylordschools.com South Maple Elementary ● 650 East Fifth ● Gaylord Michigan 49735-1253 Phone: (989) 731-0648 ● Fax: (989) 731-0095 ● www.gaylordschools.com North Ohio Elementary Mandy Bolen, Principal South Maple Elementary Therese Hansen, Principal Dear Parent, Thank you for registering your child with Gaylord Community Schools. Please provide the following documents when registering your child: • Original Birth Certificate or Inability to Provide Birth Certificate with acceptable documentation • Updated Immunization Record or Immunization Waiver • Proof of Residency (Driver’s License, Lease/Rental Agreement, Utility Bill, etc) Parents fill out all appropriate forms • Student Information Record (Emergency Card) • Registration Proof of Residency • Transportation Registration Form (If Applicable) • Authorization To Release Confidential Information • Affirmation of Prior Discipline • Concussion Awareness Acknowledgement Form • Consent for Disclosure of Immunization Information • Information Sheet • Network and Internet Access Agreement • Network and Internet Acesss Agreement Signature Page • Directory Opt Out Form (If Applicable - Form Only Available After The First Week Of School ) Your child’s school assignment will be based on the following criteria: • Same elementary school building as sibling(s) • Residence zone • Enrollment
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G a y l o r d C om m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
South Maple Elementary ● 650 East Fifth ● Gaylord Michigan 49735-1253 Phone: (989) 731-0648 ● Fax: (989) 731-0095 ● www.gaylordschools.com
N o r t h O h i o E l e m e n t a r y M a n d y B o l e n , P r i n c i p a l S o u t h M a p l e E l e m e n t a r y T h e r e s e H a n s e n , P r i n c i p a l
Dear Parent, Thank you for registering your child with Gaylord Community Schools. Please provide the following documents when registering your child:
• Original Birth Certificate or Inability to Provide Birth Certificate with acceptable documentation • Updated Immunization Record or Immunization Waiver • Proof of Residency (Driver’s License, Lease/Rental Agreement, Utility Bill, etc)
Parents fill out all appropriate forms
• Student Information Record (Emergency Card) • Registration Proof of Residency • Transportation Registration Form (If Applicable) • Authorization To Release Confidential Information • Affirmation of Prior Discipline • Concussion Awareness Acknowledgement Form • Consent for Disclosure of Immunization Information • Information Sheet • Network and Internet Access Agreement • Network and Internet Acesss Agreement Signature Page • Directory Opt Out Form (If Applicable - Form Only Available After The First Week Of School )
Your child’s school assignment will be based on the following criteria:
• Same elementary school building as sibling(s) • Residence zone • Enrollment
All Kindergarteners and
4-6 year old transfer students
All 7th Graders and 7-18 year
old transfer students
Diphtheria, Tetanus, Pertussis
(DTP, DTaP, Tdap)
4 doses DTP or DTaP
1 dose must be at or after 4 years
of age
4 doses D and T or
3 doses Td if 1st dose given at or
after 1 year of age
1 dose Tdap at 11 years of age or older upon entry into 7th
grade or higher
Polio 4 doses
3 doses if dose 3 was given at or after 4 years of age
Measles, Mumps,
Rubella (MMR)* 2 doses at or after 12 months of age
Hepatitis B* 3 doses
Meningococcal Conjugate
(MenACWY) None
1 dose at 11 years of age or older upon entry into 7th grade
or higher
Varicella
(Chickenpox)*
2 doses at or after 12 months of age or
Current lab immunity or
History of varicella disease
Vaccines Required for School Entry in Michigan Schools
Whenever children are brought into group settings, there is a chance for diseases to spread. Students
must follow state vaccine laws in order to attend school. These laws are the minimum standard to help
prevent disease outbreaks in school settings. The best way to protect students in your care from other
serious diseases is to promote the recommended vaccination schedule at www.cdc.gov/vaccines.
Encourage parents to follow CDC’s recommended schedule; by doing so, school requirements will be met.
During disease outbreaks, incompletely vaccinated students may be excluded from school. Parents and guardians choosing to decline vaccines must obtain a certified non-medical waiver from a local health department. Read more about waivers at www.michigan.gov/immunize. *If the student has not received these vaccines, documented immunity is required. All doses of vaccines must be valid (correct spacing and ages) for school entry purposes.
Updated March 1, 2017
GAYLORD COMMUNITY SCHOOLS2021-2022 STUDENT INFORMATION RECORD
Please print clearly in ink and provide all information requested. Sign, date, and return to your student's school.
STUDENT INFORMATION 2021-2022 GRADE: ___________
Student's Legal Last Name First Name Middle Name Preferred First Name
.Student's Residence Address City Zip Code School District of Residence
.Mailing Address for Student Mailings City Zip Code County of Residence
.Student's Home Phone Number Gender(M/F) Date of Birth Birthplace (City/State/Country)
.
Please note that if ethnicity and race information is not provided, the US Department of Education requires the school district to provide an answer on our behalf.
Ethnicity(check one) Race (number all that apply)
Non-Hispanic: African American American Indian/Alaska Native Asian
Hispanic: Native Hawaiian/Pacific Islander White Hispanic/Latino
Language spoken at home: English_________ Other___________________________________________________________________
Student Lives With: (check one)
__Natural Parents __Mother/Other __Host Family __Adult Student
__Father/Step-Mother __Father Only __Relative __Other
__Mother/Step-Father __Mother Only __Court Placed
__Father/Other __Legal Guardian __Joint Custody
List the names and relationships of all adults residing with the student:__________________________________________________________________________________
Student's Residence is: (check one)
__Single Family Dwelling __More than 1 family in house __Motel/Car/Campsite
__With Friends/Family(other than parent/guardian) __Shelter __Other
Mother Name: Father Name:.
Lives with Student: Lives with Student:.
Work Place: Work Place:.
Work Phone: Work Phone:.
Cell Phone: Cell Phone:.
Email: Email:.
Parent Living Elsewhere: Address:
Please complete stepmother/stepfather information if applicable:
Stepmother Name: Stepfather Name:.
Home/Cell Phone: Home/Cell Phone:.
Work Place: Work Place:.
Work Phone: Work Phone:.
Is any parent a member of the Armed Forces and on active duty: (Circle one) Yes No
If there are adults who are restricted from seeing your child by order of a court, please list them here. We cannot restrict a parent without legal documentation on file at the school.
.
OFFICE USE ONLYSTUDENT ID: STUDENT UIC: AM BUS ROUTE:
RESIDENT STATUS: DISTRICT OF RESIDENCE: PM BUS ROUTE:
K-8 HOMEROOM TEACHER: DISTRICT ENTRY DATE: Secondary Route Info - AM: PM:
Date Printed 04/26/2021
Other Children Residing in the Home
Name (Last, First) Birthdate Grade School Attending
MEDICAL INFORMATION
Allergies: _____Asthma - Parent providing inhaler to office? (circle one) Yes No_____Food(List below)(Contact cafe for special diets) _____Diabetes_____Animals _____Convulsions/seizures (Explain below)_____Medications Other Medical Information (Explain below)_____Other
Parent providing Epipen? (circle one) Yes No
Medical Authorizations and Authorization to Transport in Case of EmergencyIn case of an accident or serious illness, I request the school to contact me. If the school cannot reach me, I hereby authorize the school to callthe physician indicated and follow his/her instructions. If the physician cannot be reached, the school may make necessary arrangements forthe wellbeing of my child.
Doctor Name:_________________________ Doctor Phone: ____________________
PERSONS AUTHORIZED TO PICK UP CHILD PRIOR TO END OF SCHOOL DAYIf your child is injured, ill, or needs to leave school early, we will contact the parents listed on the front of this card first. If parents areunavailable, we will contact the following individuals authorized to pick up your child from school. Your child should know the person. ID maybe requested.
Authorized Person Relationship Address Phone Number
.
.
.
.
Your child will not be released to any unauthorized person
EARLY DISMISSALOn early dismissal days or days when school is closed early due to weather or other unexpected circumstances, please provide instructions asto where your child is to go. PLEASE NOTE: LATCHKEY IS NOT AVAILABLE ON EARLY DISMISSAL DAYS. School will follow weekly busschedule unless notified otherwise.
(Please remember zone rules are to be followed.)
__Bus Home (Must be currently registered)
__Walk Home __Other (Explain below)
__Parent Pickup
I affirm that as the parent/legal guardian, all information provided is true and accurate, and that my child and I reside at the listedaddress. I understand that any false information provided by me may subject me to legal penalties for perjury.
_____________________________________________________________________________________________ _____________Signature of Parent/Guardian Date
G a y l o r d C o m m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
I declare that I physically reside at: I declare under the penalty of perjury that the student listed below resides at the above address. I also agree to notify the school within two (2) weeks when residency has been changed. I understand that a new affidavit and a new proof of residency must be submitted. If I move outside the district, appropriate forms will also be required. Falsification of any information or document required for residency verification or the use of the address of another person without actually residing there may result in; withdrawal of student from Gaylord Community Schools and/or being held liable to reimburse the district for expenses incurred to educate this student.
Student Name Grade
Sibling Names Grade / School
____________________________________ ____________________________________ Parent/Guardian Name Parent/Guardian Signature ____________________________________ ____________________________________ Relationship to Student Date
Proof of Residency Shown:
Ο Driver’s license Ο Proof of residency from the County Registrar of Voters Ο Lease/rental agreement Ο Current vehicle registration showing residency address Ο Utility bill for the current month Ο Letter from parent’s employer on company letterhead Ο Property tax bill or mortgage statement Ο Copy of money order for rent payment
Registration form must be submited at your student(s) school office. Families with multiple students need to submit only one form. Student Name School Grade Gender
Home Address ________________________________________City__________________Zip______________ Mother Name________________________________________ Phone_________________________________ Father Name_________________________________________ Phone_________________________________
Does student above have siblings currently riding? ___yes, ___no Pick Up and/or Drop Off -- Bus Stop will be at or closest to the students address We can accommodate ONLY one Pick Up and ONLY one Drop Off location
___AM Pick Up or ___ AM Daycare/Other: _________________________________________________
___PM Drop Off or ___ PM Daycare/Other: _________________________________________________
*Signature of Parent/Guardian*Print_____________________________Sign_________________________________
Joint Custody/Shared Parenting Only If student will be transported to/from a destination other than listed above, please indicate below. A copy of court papers must be provided to the transportation department. Parent Name _______________________________________ Relationship to Student ___________________ Home Address___________________________________ City_____________________ Zip______________
___ AM Pick Up or ___ AM Daycare/Other: _________________________________________________
___ PM Drop Off or ___ PM Daycare/Other: _________________________________________________
If your transportation needs change, a new registration form must be completed. It may take up to 5 school days to arrange for busing, once the transportation department receives this form. More time may be necessary during the new school year registration period. Rec._____________
G a y l o r d C om m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
Today’s Date: ________________________ Date request faxed: _______________________
Student Name Birth Date Current Grade Level _________________________________ __________________________ __________________________ Has your child ever attended Gaylord Community Schools? ____Yes ____No If Yes, school year(s) attended __________________ School building(s)_______________________________________________
I authorize release of the following records for the child listed above: Complete Cumulative Transcript Current MET, IEP, 504 Confidential Files (IEPC) Birth Certificate Withdrawal Grades Medical File Psychological & Diagnostic Reports Immunization Record Current Schedule Social Worker Reports
Has/have the above child received special education services? Yes No Has/have the above child received section 504 services? _____ Yes ______ No If marked yes, please indicate in which area(s) services were provided. _ I request that the information be kept confidential; used for professional reasons only and not be released to another individual or organization unless authorized by me. I understand that I have the right to inspect or receive a copy of the school records that are released. _____________________________________
Signature of parent or guardian NOTE” *Parental permission is no longer required when records are requested by authorized school personnel in compliance with “Federal Education Rights and Privacy Act, Final Rule on Educational Records, Federal Register, June 17, 1976, Vol41, No. II, Page 2465.” *The Michigan Attorney General ruled on April 23, 1982 that a school district may not withhold records of a student who transfer to another district if the student has an outstanding obligation to the school district. ______________________________________
Signature of GCS Administrator
INFORMATION TO BE RELEASED FROM: SCHOOL DISTRICT ________________________________________________________________________ NAME OF SCHOOL_________________________________________________________________________ ADDRESS OF SCHOOL CITY_________________________________STATE ZIP PHONE ( ) FAX ( )__________________________
FOWARD STUDENT RECORDS TO SCHOOL INDICATED BELOW:
North Ohio Elementary 912 North Ohio Avenue Gaylord, MI 49735 Phone: (989) 731-2648 Fax: (989) 731-3387
South Maple Elementary 650 East Fifth Avenue Gaylord, MI 49735 Phone: (989) 731-0648 Fax: (989) 731-0095
Gaylord Intermediate School 240 East Fourth Avenue Gaylord, MI 49735 Phone: (989) 731-0856 Fax: (989) 732-6475
Gaylord Middle School 600 East Fifth Avenue Gaylord, MI 49735 Phone: (989) 731-0848 Fax: (989) 732-2632
Gaylord High School 90 Livingston Blvd. Gaylord, MI 49735 Phone: (989) 731-0969 Fax: (989) 731-2585
Form 8330 F4/Page 1 of 1
Please accept this as notification that Gaylord Community Schools will be requesting an FTE adjustment per Section 25 for the following student:
UIC# First Date of Attendance: _____________________
G a y l o r d C o m m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
DIRECTIONS: Check the applicable paragraph, provide all appropriate information and sign this document. Paragraph 1: The undersigned affirms that ________________________ has not been suspended or expelled from any public or private school in Michigan or any other state for an offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence against persons and/or property committed on school premises, at any school sponsored activity, or on a public or private conveyance providing transportation to and from a school or school sponsored activity. Paragraph 2: The undersigned affirms that _________________________ has been suspended or expelled from a public or private school in Michigan or another state for an offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence against persons and/or property committed on school premises, at any school sponsored activity, or on a public or private conveyance providing transportation to and from a school or school sponsored activity. If you checked paragraph 2, explain the circumstances in detail. Include the school name, dates of suspension or expulsion and a description of the incident, giving rise to the suspension or expulsion. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Student Signature Date Parent/Guardian Signature Date
Name of sending (former) School District: _____________________________________________________________________ Sending School – Please check one and return with student records: According to our records, we can verify that the information provided above by the parent/student is correct. According to our records, the information provided above by the parent/student is not correct. If the student has been involved in offenses involving weapons, alcohol, or drugs, or willful infliction of injury to persons or act of violence against persons and/or property committed on school premises, at a school sponsored activity, or on a public or private conveyance providing transportation to or from school or a school sponsored activity, please forward appropriate disciplinary documentation. ____________________________________________ ____________________ ______________ Signature of Sending District Administrator or Designee Title Date
UNDERSTANDING CONCUSSIONS Educational Material for Parents and Students
(Content Meets MDCH Requirements) Sources: Michigan Department of Community Health, CDC and the National Operating Committee on Standards for Athletic Equipment (NOCSAE), National Athletic Trainers Association
Some Common Symptoms Headache Balance Problems Sensitivity to Noise Poor Concentration Not “Feeling Right” Pressure in the Head Double Vision Sluggishness Memory Problems Feeling Irritable Nausea/Vomiting Blurry Vision Haziness Confusion Slow Reaction Time Dizziness Sensitivity to Light Fogginess “Feeling Down” Sleep Problems
Grogginess
WHAT IS A CONCUSSION? A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a fall, bump, blow, or jolt to the head or body that causes the head and brain to move quickly back and forth. A concussion can be caused by a shaking, spinning for a sudden stopping and starting of the head. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. A concussion can happen even if you haven’t been knocked out. You can’t see a concussion. Signs and symptoms of concussions can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If the student reports any symptoms of a concussion, or if you notice symptoms yourself, seek medical attention right away. A student who may have had a concussion should not return to activity on the day of the injury and not until a health care professional says they are okay to return to activity.
IF YOU SUSPECT A CONCUSSION: 1. SEEK MEDICAL ATTENTION RIGHT AWAY-A health care professional will be able to decide how serious the concussion is and
when it is safe for the student to return to regular activities, including sports. Don’t hide it, report it. Ignoring symptoms and trying to “tough it out” often makes it worse.
2. KEEP YOUR STUDENT OUT OF ACTIVITY-Concussions take time to heal. Don’t let the student return to activity the day of the injury and not until a health professional says it is okay. A student who returns to activity too soon, while the brain is still healing, risks a greater chance of having a second concussion. Young children and teens are more likely to get a concussion and take longer to recover than adults. Repeat or second concussions increase the time it takes to recover and can be very serious. They can cause permanent brain damage, affecting the student for a lifetime. They can be fatal.
3. TELL THE SCHOOL ABOUT ANY PREVIOUS CONCUSSION(S)-Schools should know if a student had a previous concussion. A student’s school may not know about a concussion received in another sport or activity unless you notify them.
SIGNS OBSERVED BY PARENTS:
CONCUSSION DANGER SIGNS: In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. If a student sustains a bump, blow or jolt to the head or body and the following danger signs are present, immediate medical attention should be sought at the closest emergency department. One pupil larger than the other Repeated vomiting or nausea Becomes increasingly confused
or agitated Is drowsy and cannot be
awakened
Slurred speech Has unusual behavior A headache that gets worse Convulsions or seizures
Weakness, numbness or decreased coordination
Cannot recognize people or places
Loses consciousness (even briefly)
WHAT SHOULD YOU DO? If a student reports one or more symptoms of a concussion after receiving a bump, blow or jolt to the head or body, h/she should be immediately removed from activity (this includes but is not limited to, athletics, PE classes, band, dance, aerobics, theatre and choir.) The student should only return to activity with the permission of a health care professional experienced in evaluating concussions. Rest is key during recovery. Exercising or activities that require a lot of concentration (such as studying, working on the computer or playing video games) may cause concussion symptoms to reappear or get worse. Students who return to school after a concussion may need to spend fewer hours at school, take rest breaks, be given extra help and time, and spend less time reading, writing or on a computer or iPad. After a concussion, returning to sports and school is a gradual process and should be monitored by a health care professional. Concussions affect each individual differently. Some may recover quickly and fully while others may have symptoms that last for days, weeks or even months. To learn more, go to www.cdc.gov/concussion
PARENTS AND STUDENTS MUST SIGN AND RETURN THE EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM
Appears dazed or stunned Can’t recall events prior to or after a hit or fall Answers questions slowly
Is confused or has trouble with homework or school assignments
By my name and signature below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the “Understanding Concussions: Education for Parents and Athletes” provided by Gaylord Community Schools.
___________________________________ Student Name Printed
___________________________________ Student Name Signature
___________________________________ Date
___________________________________ Parent or Guardian Name Printed
___________________________________ Parent or Guardian Name Signature
___________________________________ Date
Return this signed form to your school’s athletic office or to your coach. The school must keep this on file until the student is age 18. We realize this may not be the first nor the last time you sign and submit this form, as each organization needs to have a copy. Thank you for your cooperation and understanding.
Students and parents please review and keep the educational materials available for future reference.
Gaylord Community Schools
Consent for Disclosure of Immunization Information to Local and State Health Departments
Immunizations are an important part of keeping our children healthy. Schools and State and Local health departments must monitor immunization levels to ensure that all communities are protected from potentially life-threatening diseases and, if necessary, respond promptly to an emerging public health threat. It is important that disease threats be minimized through the monitoring of students being immunized.
Sharing immunization and personally identifiable information including the students name, Date of Birth, gender, and address with local and state health departments will help to keep your child safe from vaccine preventable diseases. The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, requires written parental consent before personally identifiable information from your child’s education records is disclosed to the health department. If your child is 18 or over, he or she is an “eligible student” and must provide consent for disclosures of information from his or her education records.
You may withdraw your consent to share this information in writing at any time.
I authorize Gaylord Community Schools to release my child’s immunization record to the Michigan Department of Health and Human Services and Local Health Department. I understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally identifiable information from the school.
Student’s Name: Date of Birth: / / Student Building: _______________________________ Grade Level: ____________________
Signature of Parent/Guardian or Eligible Student:
Date: / /
Printed Parent/Guardian Name:
Rev.8/2/18
Gaylord Community Schools First Through Third Grade Information
Today’s Date ____________ Child’s Name _______________________________ Birthdate ___________ Gender____________ Name you wish your child to be called in school __________________________________________ Mother’s First Name ________________________ Last Name ______________________________ Father’s First Name _________________________ Last Name ______________________________ Home Address _____________________________ City, State, Zip ___________________________ Mailing Address (if different) __________________ City, State, Zip __________________________ Home Phone _______________________________ Work Phone ____________________________ With whom does your child reside?_________________________________________________ Is your child right or left handed?_______________ Does your child wear glasses? __ Yes __ No Any known allergies? ___Yes ___No If yes, please explain: _________________________________________________________________________________
Any known health concerns? _________________________________________________________
___Heart Trouble ___Diabetes ___Seizures ___Asthma ___Frequent Colds ___Eczema ___Earaches ___Sore Throats ___Fears ___Hemophiliac ___Bee Stings ___Epilepsy ___Nose Bleed ___Hearing Problems ___Trouble passing urine or bowel movement ___Shortness of Breath ___Other:_________________________________________________________________________ 1. Are there any special things about your child that we should know, such as, illness, divorce,
recent move, special fears, etc. that could affect learning? ______________________________________________________________________________ ______________________________________________________________________________
2. Please list any group experiences your child has participated in (STARS, Head Start, Nursery School, Daycare, Story Hour, etc). Give names and dates. ____________________________________________________________________________________________________________________________________________________________
3. Has your child been identified for any special services such as health, speech/language, or ECDD? ____Yes ____No If yes, please explain. ______________________________________________________________________________
4. Does your child take medication on a regular basis? ____Yes ____No If yes, what medication?
5. How you’re your child spend his/her leisure time? ____________________________________________________________________________________________________________________________________________________________
6. Explain any responsibilities your child has at home. ____________________________________________________________________________________________________________________________________________________________
7. What are some favorite things your child likes to do? ____________________________________________________________________________________________________________________________________________________________
8. Do you celebrate holidays and birthdays in your home? ___Yes ___No If no, please explain ______________________________________________________________________________
9. Is your child able to sit in a group setting and listen to a story for ten minutes? ___Yes ___No 10. Does your child listen without interrupting while someone else talks? ___Yes ___No 11. Does your child know his/her: Phone number? ___Yes ___No Address? ___Yes ___No 12. Do you have books/magazines/newspapers at home that your child reads? ___Yes ___No 13. What do you expect your child to acquire through his/her educational experience?
14. What else would you like your child’s teacher to know about your child? ____________________________________________________________________________________________________________________________________________________________
15. Would you be interested in occasionally sending snack items or a food ingredient for an occasional cooking project? ___Yes ___No
16. Would you be willing to volunteer in your child’s classroom? ___Yes ___No PLEASE REMEMBER: This is your child’s school. You may visit or call anytime. Please sign in at the
office and pick up a visitor pass before leaving the front hall every time you visit. You are encouraged to contact your child’s teacher regarding anything you feel might affect your child’s education.
Thank you for taking the time to fill out this questionnaire.
G a y l o r d C om m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
NETWORK/INTERNET ACCESS AGREEMENT FOR STUDENTS PLEASE READ BOTH SIDES OF DOCUMENT
Please read this document carefully before signing. The signature(s) at the end of this document are legally binding and indicate(s) that the signing party(ies) has (have) read all of the terms and conditions of this policy carefully and understand(s) their significance. The purpose of this agreement is to establish guidelines for access by Students to the Internet, electronic mail and electronic bulletin boards (hereinafter referred to as the "Guest Network"). Access to the Guest Network is provided to the Student for educational purposes. In exchange for the privilege of using the Guest Network, the undersigned agree(s) as follows:
A. The use of the Guest Network is a privilege, which may be revoked by the District at any time and for any reason or for no reason. Improper use of the Guest Network may also give rise to further disciplinary action consistent with this agreement and/or the student handbook code of conduct.
B. The Student and his or her parents and/or guardians acknowledge that it is not possible for the District to restrict access to all controversial material on the Guest Network.
C. The Student and his or her parents acknowledge that the Student does not have a reasonable expectation of privacy in his or her use of the Guest Network. The District reserves the right to monitor the Guest Network, including but not limited to Internet use and electronic mail.
D. Guest Network access is provided only for educational use by the Student. Use of the Guest Network for commercial purposes or other unauthorized purposes is expressly forbidden.
E. Guest Network resources are intended for use exclusively by registered users. The Student is responsible for the use of his/her account password and access privileges. Any problems that arise from the use of his/her account are the responsibility of the Student. Use of an account by someone other than the account holder is forbidden and may result in loss of access privileges. Any loss of security in an account password or in access privileges must be reported immediately to an appropriate Guest Network administrator.
F. Any misuse of Guest Network access privileges may result in suspension or revocation of access privileges and/or disciplinary action as determined by the District. Misuse includes but is not limited to the following:
1. Intentionally accessing or attempting to access files, data, or information without authorization 2. Impersonating another user on the Guest Network. 3. Activity which is detrimental to the stability and security of the Guest Network, including but not limited
to the intentional or negligent introduction of computer viruses and vandalism or abuse of hardware or software
4. The transmission or voluntary receipt of material which would constitute a violation of federal or state law, including, but not limited to, copyrighted material; harassing, abusive, threatening, or obscene material; material protected as a trade secret; defamatory statements; material which would constitute an invasion of personal privacy, or any material which would reasonably be considered to be discriminatory on the basis of sex, race, national origin or religion
5. Use of recreational programs or communications during the school day.
Form 7540.03 F1/Page 1 of 2
G a y l o r d C om m u n i t y S C h o o l S A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
6. Illegally installing, downloading, copying or using copyrighted software. 7. Intentionally interfering with the use of the Guest Network by others. 8. Intentionally wasting District information technology resources such as disk space, printer ink or paper. 9. Using the Guest Network and District information technology resources for non-educational uses. 10. Using the Guest Network and District information technology resources for cyberbullying, harassing,
sexting of other students, staff or members of the school community, or other prohibited purpose(s). G. The District does not warrant that the Guest Network will meet any specific requirements that the Student may
have, that service will not be interrupted or that information obtained on the Guest Network will be accurate or complete. The District will not be liable for any direct or indirect, incidental or consequential damages (including but not limited to lost data, information or time) sustained or incurred in connection with use of inability to use the Guest Network by the Student. Use of the Guest Network and any information or data obtained through use of the Guest Network is at your own risk.
H. The Student agrees to delete messages from his or her personal mailbox on a regular basis in order to avoid unnecessary use of disk space.
I. The Student may not transfer files, shareware or other software from the Internet or electronic bulletin board services. The Student will be liable to pay any costs or fees incurred as a result of any transfers without express permission from a Guest Network administrator regardless of whether the transfer was intentional or accidental.
J. The Student must have prior approval from an appropriate Guest Network administrator for any subscriptions with any electronic mail lists or news groups.
K. Users violating any provisions of this Network Access Agreement face disciplinary action. The District reserves to itself discretion to determine appropriate discipline and will consider the nature and severity of the violation. Possible disciplinary actions include:
1. Suspension or revocation of Guest Network access. 2. Requiring additional training as a precondition to continued use of the Guest Network. 3. Financial restitution for any unauthorized expenses or damages. 4. Confiscation of inappropriate materials. 5. Additional disciplinary action consistent with the student handbook or code of conduct.
In addition, the District may refer violations to appropriate law enforcement authorities. Nothing herein shall be construed as providing that the District must find a violation of the agreement in order to suspend or revoke the access privileges of a Student. Use of the Guest Network is a privilege and not a right, and the District reserves discretion to suspend or revoke access privileges for any reason or for no reason.
L. This Network Access Agreement is subject to change without notice. Any changes to the Network Access Agreement will be posted in an appropriate location on the Guest Network by a Guest Network administrator.
Form 7540.03 F1/Page 2 of 2
G a y l o r d C om m u n i t y S c ho o l s
A n N C A A c c r e d i t e d S c h o o l D i s t r i c t
NETWORK/INTERNET ACCESS AGREEMENT FOR STUDENTS SIGNATURE PAGE
Network/Internet Access Agreement for Students
➢ ___________________________________________
Printed name of student user
In consideration of the privilege of using the Network, I hereby release the District, its employees, agents and individual members of the Board of Education from any and all claims or causes of action arising out of my use or misuse of the Network or Network equipment. I agree to use the Network responsibly and to abide by the rules and regulations set forth herein and as may be added from time to time by the District. I have reviewed this Network Use Agreement with my parent or legal guardian (or I have reached the age of 18). ➢ ____________________________________________ _______________________
Signature of Student Date The following section must be completed for all students who have not reached the age of 18. As the Student’s parents or legal guardian, I have read and agree to this Network Access Agreement and have discussed it with my son or daughter. I understand that Network access is a privilege provided for educational purposes. I understand that it is impossible for the District to restrict access to all controversial material. I hereby release the District, its employees and agents and individual members of the Board of Education from any and all claims or causes of action arising out of my use or misuse of the Network or Network equipment. In addition, I agree to indemnify the District for any fees, expenses or damages incurred as a result of my child’s use or misuse of the Network or Network equipment.
➢ ___________________________________________ _______________________ Signature of Parent or Guardian Date
Field Trip Permission My child’s class may be taking field trips during the school year. When field trips require transportation, children will be transported by bus. Please circle appropriate response: ➢ YES or NO I give permission for my child to participate in class field trips.
Name of Parent or Guardian (Please print) Signature of Parent or Guardian Date
Parent/Student Acknowledgment of Student Handbook We have received and read the Parent/Student Handbook. We understand the rights and responsibilities pertaining to students and agree to support and abide by the rules, guidelines, procedures, and policies of the School District. We also understand that this handbook supersedes all prior handbooks and other written material on the same subjects. ________________________________________ ______________ ________________________________________ ___________ Parent/Guardian Signature Date Student Signature Date
Form 7540.03 F1a/Page 1 of 1
➢ ___________________________________________ Printed name of student’s parent/guardian
