PRM e-form 2018-19
Please submit one form for each child you have attending PRM. This form must be submitted in addition to the emergency contact, media release, and medical information that is sent home with your child in hard copy form on the first day of school. Thank you.
student's last name *
Your answer
student's first name *
Your answer
student's ID # (can be found on schedule) *
Your answer
student's date of birth (mm-dd-yyyy) *
Your answer
student's gender *
student's grade *
name of parent/guardian completing form *
Your answer
preferred parent contact phone # *
Your answer
preferred parent contact email *
Your answer
Request for Supervision at Dismissal from School
By typing my name below, I understand that should a circumstance arise where my child should not be released from school for any reason, I will notify the school, in writing, and with sufficient notice, to request that my child not be released from school until either myself, as parent/guardian, or an authorized designee listed above, has arrived to dismiss my child from school. (Board Policy 8601 available at
By typing my name below as parent/guardian, I acknowledge that this will serve as my electronic signature to indicate that I understand the procedure regarding requests for supervision at dismissal from school. *
Your answer
The Kinnelon School District has developed a code of conduct to define and to maintain an atmosphere of stability and order so that the educational experience is maximized on all levels. Codes are present to bring clarity to the expectations that govern the smooth operation of our schools. They are intended to form a framework of expected conduct; and they are conceived within a context of professional seriousness for the well being of all students.

The Kinnelon schools are grounded in the concept of mutual respect for all members of the school community. It is expected that all interaction among the members of the school community springs from that vantage point. Anything less is unacceptable. We believe that any successful system, be it a business, a house of worship, an organization, a family, embraces a set of regulations to frame its design; so too, with school systems. The codes articulated here are in place not to inhibit, but rather to ensure a perspective of healthy structure, making clear the expectations of conduct within our schools.

What follows are the guidelines that drive those expectations. Because schools have the privilege of dealing with people rather than machines, situations are often accompanied by extenuating circumstances. Therefore, although we attempt to operate consistently in responding to conduct that may be deemed inappropriate, disciplinary procedures and consequences need to be determined by administration within a framework of individualization. A “one size fits all” determination is often not prudent. Wherever possible, however, we have, in fact, stated the definitive consequence, especially those dictated by Board of Education policy, such as school attendance. These policies are common to all and will be followed as approved and adopted. Our goal is always to respond to common infractions with consistency. However, reality sometimes calls for individual assessment for the ultimate determination.

Below is an alphabetical list of the behaviors that the Kinnelon Schools deem unacceptable and subject to disciplinary consequences. For any conduct that violates local, state or federal law, administrators will follow the appropriate procedures as required by law.

Academic dishonesty (cheating/plagiarism), Assault of another student/staff Causing a false alarm for fire, bomb or any other emergency condition Cutting class-unexcused absence from a class Disrespect to staff Disruption of class or school activities Driving violation (KHS only) Entering/leaving school without permission Failure to report to assigned detention/ICE Fighting Forgery/falsifying documents Gambling on school property Hazing of another student (Policy #5512) Insubordination, defiance of authority, failure to follow teacher directive, disregard of school policy Joining a secret society/organization/gang Lateness to class Lateness to school Littering Parking violation (KHS only) Physical harassment of another student (Policy #5512) Possession of any type of explosive device on school property Possession/use/sale of any controlled substance (Policy #5530) Possession/use of a weapon Possession of pager (NJ Statute 2C:33-19) Reckless behavior that endangers the safety of others Setting or causing a fire on school property Smoking on school property Stealing property belonging to another student, teacher or to the school Threat toward staff Threat toward another student Truancy-unexcused absence from school Use of intimidation Use of personal electronic equipment (cell phones, laptops, hand-held electronic devices, Walkman, Discman) Use of vulgar, offensive or derogatory language Vandalization of or disrespect for property of school or persons Verbal harassment of other students Violation of Acceptable Use Policy.

Unacceptable behavior may result in any of the following consequences. This list does not imply any sequential order or progression. The severity of the incident being considered will determine the consequence applied.

Conference with student/teacher Conference with student/teacher/administrator Teacher detention Student’s temporary removal from class Administrative detention Conference with student/parent/administrator ICE – Isolated Classroom Environment (KHS) Deprivation of privileges such as: participation in any/all co-curricular activities attendance at any/all school related/sponsored events participation in graduation ceremony moving freely around the school building transportation by school bus Restitution/restoration for any damages In-school suspension (Policy #5610) Out of school suspension (Policy #5610) Expulsion (Policy #5620).

Each school publishes specific codes in their school handbooks. Those codes carry the district position on such areas as: Affirmative Action Non-Discrimination Sexual Harassment Student Harassment and Hazing Substance Abuse.

These are always available for review.


Pupils must obey the driver promptly, and be courteous to him/her and to fellow pupils. The driver is in full charge of the bus and pupils.

It is recommended that pupils be at the bus stop about ten minutes before the bus is scheduled to arrive.

Pupils must wait until the bus is completely motionless before boarding and must enter the bus without crowding or disturbing others. They should occupy their seats immediately and fasten seat belts.

Pupils should never stand or play on the road while waiting for the bus. They should exhibit good behavior while waiting for the bus and not trespass on neighboring properties.

While the bus is in motion, pupils must remain seated and must not speak with the driver. Classroom conduct is to be maintained on the bus at all times.

Pupils may not call out, nor extend head or limbs outside of the windows.

Pupils should not bring pets, baseball bats, knives or other dangerous articles on the bus.

Pupils who do not behave will receive a School Bus Incident Report. If a pupil receives three “incident reports” they will be removed from the bus for a minimum of 1 week.

The number of students scheduled for our buses for this school year brings our buses close to or at capacity. Therefore, we regret that it will be impossible to honor requests for a child to ride a bus other than that to which he/she was assigned.

In addition to the Kinnelon Public Schools Code of Conduct, each teacher will share guidelines for acceptable behavior that is appropriate for our youngest learners.

By typing my name below as parent/guardian, I acknowledge that this will serve as my electronic signature and attest that I fully understand the terms of the Code of Conduct. *
Your answer
The following agreement must be read and signed by the pupil and his/her parent(s) or legal guardian(s) in order for students to be able to use district computer, network, and/or technology infrastructure, as well as to participate in Bring Your Own Device (BYOD) activities.

By signing this Consent and Waiver Agreement, my parent(s) or legal guardian(s) and I, as a student of the Kinnelon Public School District, state that we have discussed the rights and responsibilities. I agree to abide by the restrictions contained in this agreement.

Computer Networks/Computers includes, but is not limited to, the school district’s computer networks, computer servers, computers, other computer hardware and software, Internet equipment and access, and any other computer related equipment. The Board and its employees do not have control over the information on the Internet, although the Board shall attempt to provide prudent and available barriers to objectionable material. Sites accessible by way of the Internet may contain material that is illegal, defamatory, inaccurate or potentially offensive to certain individuals. The intention of the Board is to make the Internet available for the purpose of furthering educational goals and objectives. The Board does not guarantee that students will not find some means to access materials not linked with those goals and objectives.

Students are responsible for acceptable and appropriate behavior on school district computer networks/computers. The school district’s networks, Internet access, and computers are provided for students to conduct research, complete school assignments, and communicate with others. Access to computer networks/computers is given to students who agree to act in a considerate, appropriate, and responsible manner.

Access to the computer networks and/or the Internet is a privilege, not a right. All students are responsible for appropriate behavior on school computer networks, just as they are in the classroom or on the playing field. Access to network and Internet services will be provided to students who agree to the established guidelines and rules:

Expectations for using the school district’s networks/computers, includes but is not limited to, the following:

1. Will not send or display offensive content;

2. Will not use or access pictures, images, graphic image files or other material or visual depictions that are obscene as defined in District Policy 2361;

3. Will not engage in any form of Cyberbullying; which includes but is not limited to, harassing, insulting, or attacking others;

4. Will not engage in inappropriate online behavior, including inappropriate interaction with other individuals through the use of on line media;

5. Will assume any cost for intentionally damaging computers, computer systems, or computer networks/computers;

6. Will not violate copyright laws and will discuss, with an appropriate member of the staff, ANY question involving internet resources as it applies to copyright infringement;

7. Will not access and/or use another students school based electronic accounts (i.e. password);

8. Will not trespass in another students digital property (i.e. folders or files);

9. Will not use the computer networks/computers for commercial purposes;

10. Will not intentionally engage in other activities that do not advance the educational purposes for which computer networks/computers are provided.

Individuals found engaging in prohibited behavior shall be subject to consequences and other appropriate discipline, which includes but are not limited to:

1. Use of the network only under direct supervision;

2. Suspension of network and/or computer privileges;

3. Revocation of network and/or computer privileges;

4. Suspension from school;

5. Expulsion from school; and/or

6. Legal action and prosecution by the authorities.

Rules and Responsibilities

As indicated in District Policy 2363, if a teaching staff member approves the use of privately-owned technology to access the Internet;

-The access of data during instructional periods or lesson extensions for any privately-owned technology, must be attained through the district‘s wireless network;

-A teaching staff member that has received direct administrative approval for student use of privately-owned technology and permits a student to use their device in class to access the Internet during instructional time, will provide the student with a list of approved Internet sites to access;

-A student granted such permission must comply with school district policies and regulations regarding acceptable use of computers and technology;

-Any use of privately-owned technology by a student shall be in strict accordance with administrative directives, the teaching staff member’s specific approval(s) and Board policies and regulations;

-Any violation of district policy will subject the student to appropriate discipline and/or grading consequences;

-The user accepts full liability for costs associated with his or her device and full liability for risks including but not limited to, loss of personal data due to an operating system crash, error, bugs, viruses, malware and/or software or hardware failure or programming errors that render the device unusable;

-The school district shall assume no responsibility for the security of privately-owned electronic devices brought to school by a student;

-The school district will not provide maintenance services for privately owned electronic devices brought to school by a student;

-Students may wish to independently purchase private insurance to protect against loss, damage, or theft of any privately-owned electronic devices taken to school;

-The user assumes all security risks for privately-owned electronic devices that are taken to school;

-Lost or stolen electronic devices must be reported to an appropriate staff member (principal, assistant-principal, teacher or support staff member) immediately in order to receive assistance in attempting recovery.

It is understood that the system administrators may monitor pupil activity on any electronic device accessing the district network and/or Internet. System administrators may access any files stored by students on district computers or at a remote site accessed by district computers. It is further understood that the system administrator, the principal or the superintendent may discontinue the computer network and Internet access privileges and may discipline any pupil who violates the terms of this agreement.

By typing my name below as student/network user, I acknowledge that this will serve as my electronic signature and attest that I fully understand the terms of the Kinnelon Public Schools Acceptable Use Policy. Please note that your electronic signature here is required in order to use the computers and/or network in our school district. *
Your answer
By typing my name below as parent/guardian, I acknowledge that this will serve as my electronic signature and attest that I fully understand the terms of the Kinnelon Public Schools Acceptable Use Policy. Please note that your signature here is required in order to have your child access and use the computers and/or network in our school district. *
Your answer
Before answering this question, please review the A-Z Student Manual with your child. By typing my name below as parent/guardian, I acknowledge that this will serve as my electronic signature and attest that I fully understand the contents of the A-Z Student Manual (, and have reviewed the information it contains with my child(ren). *
Your answer
MEDIA RELEASE: We are proud of our students and enjoy sharing photos on social media, the school websites, local news, etc. If names are used, it is usually the student first name only unless previously released. *
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