2020-21 JH/HS Permissions
Please fill out the following permission information and submit the form
STUDENT LAST NAME *
STUDENT FIRST NAME *
GRADE 2020-21 *
INTERNET USE 1 *
Permission for your child to use the district network and access the Internet (to be assigned a “username” and “password”):
INTERNET USE 2 *
We have Internet access at home through Wifi (hotspot or phone access should check NO)
GOOGLE MAIL (GMAIL @LEROYK12.ORG ACCOUNT) - SEE AUP & BYOD POLICY *
Permission for your child to be assigned a Gmail account
NAME IN PRINT *
Permission to have your child’s name in printed form
CONSENT TO RELEASE INFORMATION TO MEDICAID *
See Medicaid Consent Form - District gets reimbursed for services, such as special education
FIELD TRIP *
I give permission for my child to participate in all walking and bus field trips during the 2020-21 school year. I understand that LeRoy Community Unit School District #2 will provide supervision for the trips. I further understand that no special insurance of any kind is provided by the District for this trip; however, the standard liability insurance on school buses and public transportation conveyances will be applicable.
ART ON INTERNET/WEBSITE *
Permission to have examples of your child’s artwork displayed/posted to the Internet/website:
PUBLICITY PHOTO *
Permission to have your child’s photograph used for publicity
PUBLIC INFORMATION *
Federal and State regulations authorize the routine release of “directory information” on students without consent. Examples include: a playbill, school yearbook; honor roll; graduation programs; sports programs.
WEB PHOTO *
Permission to have your child’s photograph used on the Internet/website
VIDEO TAPING/DIGITAL RECORDING *
Permission to have your child video taped/digitally recorded
EMERGENCY PERMISSION 1 *
If transportation is needed for my child in case of illness or injury, I agree that he/she be transported in a privately owned car or commercial vehicle
EMERGENCY PERMISSION 2 *
I hereby give the administration of LeRoy CUSD #2 authorization on my behalf to consent for emergency medical treatment of my son/daughter in my absence. This authorization is valid while my child is attending school or a school sponsored activity.
RELEASE OF NAME TO COLLEGES *
When requested, our high school will release student information to colleges. Do you give us permission to release this information?
RELEASE OF NAME TO MILITARY *
Federal law requires school districts to release student names, address and telephone numbers to military recruiters. Do you give us permission to release this information?
I HAVE READ AND UNDERSTAND THE STUDENT HANDBOOK and HABITS OF SUCCESS DOCUMENT *
The student handbook Habits of Success are available on the school website. If you don’t have computer access, please request a paper copy from the school.
PARENT SIGNATURE *
Please type your first and last name to confirm you are the person completing this form
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