COVID Sign Up 2020/2021
Only parents of students in grades K-6 need to complete this document.

Please complete one survey per student.

Please return this form no later than Tuesday, November 3, 2020

This document is being sent in the event the district must transition to Model 5. Model 5 would mean all students PreK-12 would engage in distance learning. The district would stay in Model 5 for a minimum of two weeks with the goal of transitioning to a less restrictive model as soon as safely possible (meaning Covid 19 case rates are decreasing). PLEASE KNOW AT THIS TIME THE DISTRICT IS NOT MOVING TO MODEL 5. WE ARE COLLECTING THIS INFORMATION SO THAT IF NEEDED WE ARE READY! Please review the Braham 2020 Fall Reopening plan on the district website for more detailed information regarding all five learning models.

Key changes in Model 5 include:

*Learning for all students (grades PreK through 12) is done from home.
*School aged child care (ages 3-12) is provided for eligible children of essential workers.
*Meals are provided (delivery or pick up).

Email *
Parent/Guardian Name *
Student Name *
Student Grade Level *
Secondary Address: Only provide this address if you will require transportation for B.A.S.K care (within district boundaries) or food delivery and it is different from your regular address:
Only answer this question for students in grades K-3. We have collected this information for grades 4-12. Would you prefer a hard copy packet of learning activities or prefer to do learning on-line?___________. Please understand that ALL students will be required to participate in on-line learning opportunities (Google Meet or Seesaw) regardless if you have a hard copy packet or not. *
Technology has become a vital educational resource. While we’re fortunate to have devices and internet access for students at school, we know that some families do not have these resources at home. The following questions will help us to plan appropriate extended-learning activities and modify assignments for students, as needed.
What types of electronic device(s) do you allow your child to use at home?
Does your child have internet access? (Select no internet access if from cell phone only)
Clear selection
If you have internet access please go to and enter your results below.
If you do not have internet access. Are you able to purchase high-speed internet from either CenturyLink or Midcontinent?
Clear selection
Everyone (PreK-6) should answer this question. This meal is DIFFERENT than the Model 4 program.
Do you want your school-aged children to participate in the school meals program (the district will be preparing ready to be eaten food packets which contain a lunch and a snack)? NO COST. *
If Yes: Choose One:
Clear selection
If you have a child AGES 3-12 AND you qualify (see page 4), AND you are planning to participate in the free school-based child care program (BASK), please complete the questions below.
My children qualify as parents/guardians (at least one) work in the following field:
Field of work
Place of work
Work address
My child(ren) will require transportation for BASK
If No: You may drop your child(ren) off starting at 6:30 a.m. and MUST pick your child up prior to 6:00 p.m. Please indicate the times you expect to drop off and pick up:
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