2021-2022 Troy School District Universal Permission Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

All students and their parents/guardians are required to complete the Universal Permission form.

The Troy School District Student Handbook is available on-line at https://tinyurl.com/yx8mju2f

Student(s) Name: *

Grade: *

Parent/Guardian Name(s): *

Mailing Address: *

Physical Address: *

Phone Number: *

E-mail: *

Emergency Contact Information: *

Name and phone number of person to be contacted in case of emergency.

Student Handbook *

The Troy School District Student Handbook is available on-line at https://tinyurl.com/yx8mju2f. At the beginning of each year students review the Student Handbook. There are changes in the Handbook from year to year and students and parents should have a copy and review it regularly. The Handbook will answer many questions that you may have. Please read and discuss the information with your child so that you and your child understand the expectations of Troy School District. Please type your name below indicating that you have read and understand the contents of the Troy School District Student Handbook. Further, I understand that the expectations laid out in the Troy School District Student Handbook are in effect during school hours, at all school-sponsored activities, on all school properties, and on school buses. TYPE YOUR NAME BELOW:

Network and Internet Access Verification *

Access to school technology and internet services is a privilege. Anyone who does not adhere to the Troy School District’s Acceptable Use Policy for Network and Internet Access will have this privilege revoked and may be subject to further disciplinary action. This policy is found in the Troy School District Student Handbook in the Facilities & Programs section under the heading Computer Resources. PLEASE SELECT ONE OF THE FOLLOWING OPTIONS FOR YOUR CHILD:

[INTERNET ACCESS] I hereby give my permission to Troy School District to establish an account for my child on the local school network including internet access.

[NO INTERNET ACCESS]I hereby give my permission to Troy School District to establish an account for my child on the local school network only.

Required

Acceptable Use Policy for Network and Internet Access *

As the parent/guardian, I have read the terms and conditions of Troy School District‘s Acceptable Use Policy for Network and Internet Access. I understand that this access is designated for educational purposes and that Troy Public Schools have taken available precautions to eliminate access to controversial material. However, I also recognize that it is impossible to restrict all access to controversial material and I will not hold Troy School District #1 responsible for materials acquired from the Network.

Required

Chromebook Use Agreement (for those using District issued Chromebooks)

The full Chromebook Use Agreement is found in the Troy School District Student Handbook.

I will take good care of my Chromebook and know that I will be issued the same Chromebook each year.

I will never leave my Chromebook unattended in an unsecured or unsupervised location.

I will never loan out my Chromebook to other individuals.

I will know where my Chromebook is at all times.

I will charge my Chromebook’s battery to full capacity each night.

I will keep food and beverages away from my Chromebook since they may cause damage to the device.

I will not disassemble any part of my Chromebook or attempt any repairs.

I will protect my Chromebook by always carrying it in a secure manner to avoid damage.

I will use my Chromebook in ways that are appropriate for education.

I will not place decorations (stickers, markers, writing, etc.) on the Chromebook.

I understand that the Chromebook I am issued is subject to inspection at any time without notice and remains the property of Troy Public Schools.

I will follow the policies outlined in the Student Handbook and the Troy Public Schools Acceptable Use Policy as outlined in board policy and the Student Handbook while at school as well as outside the school day.

I will file a police report in case of theft or damage from vandalism.

I will be responsible for all damage or loss caused by neglect or abuse.

I agree to pay the full replacement cost of my Chromebook, power cord/charger, and bag in the event that any of these items are lost or intentionally damaged.

I agree to return the Chromebook, power cord/charger, and carrying case in good working condition at the end of each school year.

In consideration of the privileges and opportunities afforded by the rental and use of the Chromebook, I hereby release Troy Public Schools from any and all claims of any nature arising from my student’s use or inability to use the Chromebook. I have read and understand the contents of the Chromebook Contract including the rules, regulations, and policies. I fully understand its meaning and consequences and support the implementation of the contract.

Open Gym Liability Release Agreement *

It is the policy of the Troy School District to require a signed liability release before allowing anyone to participate in a non-school activity on school property. In the event it becomes necessary for the School District staff to obtain emergency care for me/my child, neither he/she nor the School District assumes financial liability for expenses incurred because of an accident, injury, illness and/or unforeseen circumstances. PLEASE SELECT ALL

I/We fully understand that some activities involve inherent risks to me/my child regardless of reasonable safety measures that may be taken by the District. In consideration of the District’s agreement to allow me/my child to participate in open gym, I agree to accept responsibility for any loss or injury to me/my child that occurs during my/my child’s participation that is not the result of fraud, willful injury or the willful or negligent violation of a law by a trustee, employee or agent of the School District.

I/We agree that if the District’s rules and regulations are not complied with, the District may deny me/my child the privilege of participation in non-school activities that take place on school property;

I/We agree to release, indemnify and hold harmless therefrom the District, for itself, officers, Board members, administrators, employees, agents, sureties, assigns, successors, insurers, and indemnitors from any and all sums of money, accounts, suits, proceedings, claims, causes of action, rights, damages, attorneys’ fees, costs and demands of any nature whatsoever, whether real or contingent, known or unknown, direct or indirect, liquidated or otherwise, arising out of or relating in any way to my/my child’s participation in non-school activities that take place on school property.

Required

Student Vehicles (high school)

I have read and understand the contents of the Troy School District Student Handbook, specifically the sections—Student Vehicles, Search & Seizure, etc. Further, I understand the expectations of student vehicle use, parking, search, seizure, etc. as outlined in the Troy School District Student Handbook.

Acknowledgement of Nursing Services *

Troy School District has a part time school nurse on campus. This allows you as the parent/guardian to understand how these nursing services can impact your child’s health. Below is a sample list but services are not limited to only those listed. If there is a specific concern/request for any child, please call the nurse at the Lincoln County Health Department: 406-283-2447 and it can be discussed further. Services include: Vaccination administration and records management; Health education and screenings as appropriate; Student health records and management forms; Monitoring sickness and student health; Acute illness/injury care and referral to treatment by Provider; Consulting parents and students with any questions on health and wellness. School nurses are NOT able to medically diagnose, prescribe medication or treat moderate/severe illness/injury. PLEASE SELECT ALL:

I give my consent for my child to utilize these health services at Troy Schools for the school year.

I authorize the District and the County nurse to collect, enter, and receive my child’s immunization records from the Department of Public Health and Human Services Immunization System (IIS). The IIS is a confidential computer system that contains immunization records and is the primary medical record the District uses. I understand that information in the registry may be released to a public health agency as well as my health care providers to assist in medical care and treatment. I understand that I can revoke my authorization for this at any time.

I agree that I have been offered to have read the Districts Student Privacy Policy and understand my rights regarding my child’s health information.

In the event of a life-threatening emergency I give consent for life saving measures to be taken to preserve my child’s life. I understand that life saving measures include but are not limited to, CPR/AED/First aid, anaphylactic shock treatment, oxygen therapy, and overdose treatment. 911 could be called if needed as well. on 4

Required

Permission to Administer Medication

The selected items below authorizes Troy School District to administer to your child age-appropriate doses of the medications selected below. The school office keeps a supply of aspirin and Tylenol on hand, other medications must be provided by the parent or guardian.

Ibuprofen

Tylenol

Benadryl

Midol

Health Enhancement & Sex Education (only grades 6-12)

Health, family life, and sex education, including information about parts of the body, reproduction, and related topics, will be included in the instructional program as appropriate to grade level and course of study. Parents may ask to review materials to be used and may request that their child be excluded from sex education class sessions without prejudice. SELECT THE OPT OUT IF YOU WOULD LIKE YOUR CHILD TO BE EXCUSED FROM THE DISTRICT'S SEXUAL EDUCATION PROGRAM:

[OPT OUT] I would like my child to be excused from the entire comprehensive sexual health education curriculum and anonymous surveys or questionnaires. I understand that I am requesting to excuse my child from curriculum that is required by state law for the current school year. I also understand that an alternative assignment may be assigned by the teacher.

Photo and News Release Permission Verification *

From time to time Troy School District may wish to publicize special programs or the academic/extracurricular achievements of students through District and/or news websites, newspaper articles, or television broadcasts. Such publications or broadcasts may include the names and/or photographs of students. PLEASE SELECT ONE OF THE FOLLOWING OPTIONS FOR YOUR CHILD:

Yes, I grant permission for the Troy School District to use and/or release the name and/or image of my child

No, I do not grant permission for the Troy School District to use and/or release the name and/or image of my child

Required

Student Directory Information Notification *

If you do not want directory information about your child disclosed to third parties in accordance with the Family Educational Rights and Privacy Act (FERPA) you must sign and return the Student Directory Information Opt-Out Form located in the back of the Student Handbook within ten (10) days of the receipt of this form. If we receive no response by that date, we will disclose student directory information at our discretion and/or in compliance with law. Directory Information may include the following: Student’s name, address, telephone listing, participation in officially recognized activities and sports, e-mail address, photograph (including electronic version), weight and height of members of athletic teams, date and place of birth, honors and awards received, dates of attendance, grade level. NOTE: If a student’s name, grade level, or photograph is to be withheld, the student will not be included in the school’s yearbook, program events, or other such publications.

I have received and understand the Troy School District Student Directory Information Notification

Required

Residency

Please answer the questions below concerning your residency. The information you provide is CONFIDENTIAL.The purpose of this information is to ensure the rights of your child and youth under the McKinney-Vento Law (42 US code 11431 and Title X under ESEA/NCLB). PLEASE SELECT ALL THAT APPLY:

Is your address a temporary living arrangement.

Is your living arrangement due to loss of housing or economic hardship.

Not applicable.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Troy Public Schools. Report Abuse

Forms