Pecatonica Area School District Registration Part 2: Forms
After you have registered your child(ren) through Infinite Campus, you will continue to Part 2: Forms. There are numerous forms, which we've linked to you through this form. They are available on our website if you choose to print them out. Otherwise you are acknowledging that you've read the form and included any information. The forms are found here:

I understand that I may revoke any of the authorizations at any time by submitting written notice to the office. This authorization is valid for one year from the date digitally signed through submission of this form.
Email address *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Contact Phone Number *
Name of Child(ren) and Grade Level these forms are for: *
If you fill out this form just once, it will apply to all children in the household that you are guardian of. If you want one child, for example, to be exempt from the military recruitment, for example, but not another, you will need to fill out this survey form a second time if you have different answers for another child.
Asbestos Notification. *
Please read/review the Asbestos Notification (link is above) and then check the box next to the form indicating that you read it. You may retain a copy or bookmark for future use.
Concussion Information Form/Protocol. *
Please read/review the Concussion Protocol and then check the box next to the form indicating that you read the form. You may retain a copy or bookmark for future use. No person may participate in a youth athletic activity unless the person returns the information sheet signed by the person and, if he or she is under the age of 19, by his or her parent or guardian. ** This form will need to be printed and submitted prior to start of the first practice, and copies are available to each athlete to obtain parent signature. **
Military Recruitment/Access to Student Information *
Please read/review the Federal Education Rights & Privacy Act notification on US Military access to student directory information, which is used for recruitment to branches of the US Military. You must not only indicate that you read the form, but you must also indicate if you want to opt OUT of giving the military this information.
Field Trip Consent *
Throughout the year out students will be involved in in-district field trips and out-of district field trips. To help us maintain accurate records and assist us in our future planning, we would like to obtain parental permission which would cover all of our scheduled field trips. This will eliminate the need for us to obtain your written permission for each field trip. Do you agree to these terms? If you choose yes, you are stating that you give permission for your child to participate in field trips.If you choose no, you are stating that you do not agree to the terms and that your child is not able to participate in school sponsored field trips.
As a user of computer and Internet resources, I understand and will abide by the Acceptable Use Policy. I further understand that any violation of the regulations is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked, school disciplinary action may be taken, and/or appropriate legal action may be pursued. I grant permission for my son/daughter to access computer and Internet resources. I understand that students and parents/guardians are responsible for and will be held accountable for violations of the Acceptable Use Policy.While the Pecatonica Area Schools Internet connection is filtered to block access to inappropriate sites, I understand that some materials that can still be accessed on the Internet may be objectionable for some individuals, and there is no guarantee of information accuracy. I accept responsibility to provide guidance to my son/daughter for the use of the computer network and the Internet, for following school rules and staff directives regarding computer and Internet use, and complying with Pecatonica policies and procedures related to computer and Internet use. I understand that the Pecatonica Area School District and individual staff members cannot be responsible for the content of material accessed in violation of school district rules, policies and procedures.
Photo/Videotape Agreement *
In the course of a school year, groups of students are occasionally videotaped and or photographed in classroom situations, during fine arts performances and on field trips. The resulting photo and or videotape may be used in a variety of ways to promote the school district, individual school, or specific programs to the community; to instruct students or staff members; for publication in yearbooks, or, to orient new parents, staff, and students. The final product could also take a variety of forms: pamphlets or video programs. Pursuant to the Family Education Right and Privacy Act and State Statue 118.125 (1)(d), any parent, guardian or eligible students (18 years of age or older) may inform the district of their desire that their child not be photographed or videotaped by completing the PHOTOGRAPH AND OR VIDEOTAPED DISCLAIMER form, found on the school district website: . The form may also be obtained from the School District Office, 704 Cross St. Blanchardville, WI 53516. Parents wishing to photograph or video tape routine classroom activities should obtain permission from the classroom teacher 24 hours prior to the taping.
Handbook Agreement Grades 6-12 Code of Conduct and First Aid/Emergency Care *
Consent of reading the handbook is required by both the participant and a parent or legal guardian before participation will be allowed in activities or sports. STUDENTS 6TH-12TH GRADE I hereby agree to abide by the policies and regulations listed in the Handbook including the Athletic & Activities Code Pledge Sheet. PARENT/GUARDIANS: A parent or legal guardian of the above listed participant have read the policies and regulations set forth by the handbook including the athletic and activities participation at Pecatonica Middle/High School and give my permission for my son or daughter to participate under these conditions. I hereby agree with these policies and regulations and will see that my son or daughter abides by them to the best of my ability. If any of the rules are violated, I will go along with the disciplinary actions taken by the Athletic and Activities Board. I also give permission for the coach or advisor to secure first aid and emergency care for my son or daughter from qualified personnel should he or she require such assistance.In addition to attending the parent/athlete meeting, you can also review our activities code and policies by clicking the following link:
Parent in Military Questionnaire
"Parent in Military" is a student "characteristic" in our information database indicating the student has a parent or guardian who is a member of the armed forces on active duty, serves full-time National Guard duty, or is a traditional member of the National Guard or Reserve.
WIAA Eligibility, Rules, and Code of Conduct *
Your high school is a member of the Wisconsin Interscholastic Athletic Association. The following rules and regulations are developed by the member schools of the WIAA and govern the participation by boys and girls in school athletics and in some instances, impact upon sports activities outside the school.This information bulletin is a summary of the WIAA OFFICIAL HANDBOOK as it pertains to those rules and regulations. Both student-athletes and their parents should have an understanding of these requirements. Equally important is that student-athletes and/or parents talk to their principal or athletic director if they have any question about these regulations. For additional information on Rules of Eligibility see the WIAA Handbook, or visit the WIAA website at This bulletin does not discuss specific penalties for all violations. The reason is that penalties vary depending upon the nature of the violation. In addition, schools often have established penalties or periods of ineligibility, which are greater than the minimum prescribed by WIAA rules. Please review the entire document found on the school district website before signing off on the form below.
Elementary Early Release Student Information
Your child's safety is our number one concern. Please fill out the below information to ensure accuracy of your child's transportation record for early release days.
On scheduled early release Wednesdays your child(ren) will: *
If your child(ren) are attending daycare please provide the Daycare Providers Name, Address & Phone number
Elementary Unscheduled Weather Related Early Release Student Information
Your child's safety is our number one concern. Please fill out the below information to ensure accuracy of your child's transportation record for unscheduled weather related early releases. After school care is NOT available during weather related early releases.
On unscheduled weather related early release days your child(ren) will: *
If your child(ren) are attending daycare please provide the Daycare Providers Name, Address & Phone number
Elementary Fluoride Program
Pecatonica school district, in cooperation with the Lafayette County Health Department, is offering students in grades 1-5, a fluoride mouth rinsing program to prevent dental decay and to enhance overall oral health. This simple method of applying fluoride to the external surfaces of the teeth has been demonstrated to be safe and effective in controlling tooth decay. Participants will rinse their mouth in school with a pre-packaged unit dose of 0.2% neutral sodium fluoride solution for one minute once each week under trained school staff supervision. The solution is not swallowed.
This procedure is very important to the oral health of your child. It is especially important in our area because many children live in rural areas with no fluoride in the water supply. Participation is entirely voluntary and there is no cost to you. We encourage you to allow your child to participate in this valuable health project. This prevention program, however, should not take the place of regular dental care by your dentist or proper home oral care.
If you have any questions about this project, please call the school nurse in your child’s school.
Leah Walrack RN, BSN
Public Health Nurse/ School Nurse
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