Remote Learning Agreement
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Agreement to the provision of group and/or related services through alternative means

During remote learning due to the COVID-19 pandemic, to the extent that any student’s education and/or related services are provided outside of the school building through alternative means (i.e., by phone or electronically through online/virtual platforms such as, See Saw, Skype, Facetime, Zoom, etc.), the delivery of group services poses unique confidentiality issues for children and their families. Therefore, with respect to any group education or related services provided to my child through alternative means:

1. I hereby agree that my child will be provided with the education and/or related services identified in the remote learning, through alternative means during the school closure period due to the COVID-19 pandemic:

2. I hereby agree that neither I nor anyone else in our home will record or screenshot the delivery of any individual or group education and/or related services to my child. I agree not to observe group education or related services provided to my child unless it is necessary to assist my child in his or her participation in the services.

3. I hereby acknowledge that the district cannot guarantee that the parents/guardians of the other children in my child’s group, or anyone else in the home of such other children, will refrain from listening to, observing, or recording any group education and/or related services provided to my child.

4. I agree the district will not be held responsible if other parents/guardians or individuals in their homes violate these acknowledgments/agreements when my child is provided with group education and/or related services.

5. I understand that my refusal to sign this Agreement will result in my child not receiving group education and/or related services outside of school through alternative means.

6. I understand that I may revoke this Agreement in writing at any time, after which my child will no longer receive group education and/or related services outside of school through alternative means.

Parent/Guardian Digital Signature (for provision date of group education and/or related remote learning student records or information in such records may be disclosed) *
Date *
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Student Digital Signature (for provision of group remote learning and/or related services in which student records or information in such records may be disclosed) *
Date *
MM
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DD
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YYYY
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