Request to Change from Remote to In-Person Instruction
If you would like for your student to switch from remote to in-person learning at ten weeks, please fill out the following survey. You must fill out this survey for each student you would like to return. If you decide to have your student(s) remain on remote you do not need to do anything at this time.

Completing this form is not a guarantee that your student will be able to return to in-person instruction. We are continuing to follow all NYSED and DOH guidelines. This includes six foot distancing, which limits our class sizes and only 22 students on a bus. This survey will give us the data to determine the availability and possibility of allowing more students in our building.

You will receive a phone call if your student is able to come back for in-person instruction. Please leave a valid phone number below that has voicemail. This survey will be closed on October 26, 2020 at 3pm. No late responses will be accepted. ***All families wanting their student to come back in-person need to complete the survey, even if you contacted the school previously.
Email address *
Name of Parent/Guardian Completing Form: *
Your Primary Phone Number: *
Grade in School *
Student Last Name *
Student First Name *
Transportation *
Will your student need a mask provided by the District? *
Any other thoughts you would like for the school to know?
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Brushton-Moira Central School. Report Abuse