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2021-2022 Permissions (PDF)

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2021-2022 Permissions (PDF) EVERY STUDENT, EVERY YEAR | FORM 22 2021-2022 PERMISSIONS THIS FORM IS ONLY FOR STUDENTS WHO DO NOT REGISTER ONLINE IN INFINITE CAMPUS. If you registered in Infinite Campus, you have already completed this information. STUDENT INFORMATION STUDENT NAME: DATE OF BIRTH (MM/DD/YYYY): SCHOOL ATTENDING: GRADE: PARENT / GUARDIAN NAME(S): TODAY'S DATE: PERMISSIONS FIELD TRIPS: I give permission for my student to participate in all field trips (with additional notification of the details). [ ] YES [ ] NO RIDE APPROVAL: I give permission for my student to ride with approved school personnel. [ ] YES [ ] NO FUNDRAISERS: I give permission for my student to participate in approved school related fundraisers. [ ] YES [ ] NO HOME INTERNET ACCESS: Does your household have reliable broadband internet access to allow for multiple devices [ ] YES [ ] NO connected at a time for your student to stay connected to learning and school, and for you to stay connected to their school? (Please do not consider any school-provided hotspots in your response.) If yes, please select your internet provider from the list: [ ] Verizon [ ] US Cellular [ ] Mediacom [ ] Maquoketa Valley Link [ ] Century Link [ ] Comelec [ ] Windstream [ ] Earthlink [ ] ImOn [ ] HughesNet [ ] Rise Broadband [ ] Viasat Internet (formerly Exede) HOME COMPUTING DEVICE: Does your household have access to a device (e.g., desktop, tablet, or laptop) so your student [ ] YES [ ] NO can participate in remote learning and/or completing homework? (Please do not consider any school-provided devices in your response.) WEB 2.0 TOOLS: Technology serves a major function in our classroom, and online tools can be used for communication, [ ] YES [ ] NO collaboration, time-management, document storage, and increased student engagement. Throughout the school year we will be using different websites for educational purposes. These websites are commonly referred to as Web 2.0 tools. Some of these Web 2.0 tools require the teacher to provide your student with a username/password to access the site and its content. The information can include a student’s first and last name, his/her ID number, and the school name. This information is kept confidential by the site and not used for any purpose other than account creation. Because of your student’s age, the Children’s Online Privacy Protection Act (COPPA), federal legislation which aims to protect children when using the Internet, requires that Dubuque Community Schools notify you to obtain permission for your student to use these web sites. I acknowledge that I have been informed about the possible use of Web 2.0 tools by my student at Dubuque Community Schools for education purposes during the school year. I consent to my student using Web 2.0 tools in school. PARENT-STUDENT HANDBOOK: The Dubuque Community School District Parent-Student Handbook contains federal, [ ] YES [ ] NO state and district policy information which is required to be distributed annually by the district, including instructions on how to withhold a student's directory information. The handbook can be accessed online at www.dbqschools.org/parents/ documents/parent-student-handbook or you can request a printed copy from any district school. I acknowledge that the handbook was provided to me in email, is available on the district website, and that it is my responsibility to read the information in the handbook. MEAL PROGRAM INFORMATION LETTER: Dubuque Community School District students may be eligible to receive free [ ] YES [ ] NO or reduced-price meals (breakfast and lunch) in accordance with guidelines set forth by the National School Lunch and School Breakfast Programs. Details about the Free and Reduced-Price Meals program and application can be found in the information letter available at www.dbqschools.org/meals-information-letter. The application can be completed online at www.dbqschools.org/meal-programs or you can request a printed copy from any district school. I acknowledge that the Meal Program Information Letter was provided to me by email and is available on the district website. (GRADES 6-12 ONLY) SCIENCE STUDENT SAFETY CONTRACT: To ensure a safe science classroom, a list of rules has been [ ] YES [ ] NO developed in the form of a student safety contract. All students will receive this contract at the beginning of each science course and must agree to follow the rules set forth in the contract prior to participating in the laboratory. The Science Student Safety Contract can be found online at www.dbqschools.org/science-safety-contract or you can request a printed copy from any district middle or high school. I acknowledge that the science student safety contract is available on the district website and it is my responsibility to read the contract, review it with my student, and know the measures taken to ensure the safety of my son/daughter in the science classroom. Does your student wear contact lenses? [ ] Yes [ ] No Is your student color blind? [ ] Yes [ ] No Does your student have allergies? [ ] Yes [ ] No If yes, list allergies: (GRADES 11-12 ONLY) MILITARY INFORMATION: Federal law requires schools that receive financial aid to give military [ ] YES [ ] NO recruiters the names, addresses, and phone numbers of high school juniors and seniors, and to provide military recruiters with the same access to students as employers and college recruiters. Any parent or guardian wanting this information withheld from the military must select No. This request must be made on a yearly basis. My student's name, address and phone number can be released to military recruiters. PLEASE SIGN BELOW __________________________________________ ________________ PARENT / GUARDIAN SIGNATURE DATE NOTE: If you wish to save data typed into this form, first save the file on your computer and re-open from your computer prior to typing. 07/2021.
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