Parental Consent for Remote Distance Instruction for Fall 2020 Semester
By completing this form, I am electing to keep my child home for the entire Fall 2020 Semester (20-week commitment), and am opting into a remote distance instruction model, as offered by the Central Valley Central School District as part of its Reopening Plan.

I understand that I am responsible for ensuring that my child is in attendance, fully participating in the instruction, completing assigned coursework, and is logged into the school online instruction platform for the entire school day.

I acknowledge that failure to comply with the requirements imposed by the District for virtual learning may require that my child return to the in-school setting.  

I also certify that my child[ren] have access to stable internet and devices with internet capabilities to allow them to participate fully in the remote distance instruction and coursework each school day.  

Any questions should be directed to the applicable building's main office and principal.

Harry M. Fisher Elementary, Michele Pilla, 315.866.4851
Barringer Road Elementary, Aaron Carey, 315.894.8420
Gregory B. Jarvis Middle School, Charles Pratt, 315.866.2620

Sign in to Google to save your progress. Learn more
Student's First Name *
Student's Last Name *
Grade *
Parent Information and consent
By completing this form I understand and agree to the guidelines set forth in the Central Valley Central School District's Remote Distance Instruction policy for the Fall 2020 semester.
Contact email
Signature acknowledgement *
Type your first and last name below to acknowledge agreement of the above mentioned Remote Distance Instruction Policy.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Central Valley Central School District. Report Abuse