Beresford 6-12 School Registration Forms
Name of Parent/Guardian Completing Form *
-By entering your name below, you are indicating that you are the person you say you are and this electronic signature indicates you are providing permission, consent, and/or information for the questions that follow.
Student Last Name *
Student(s) First Name *
-If you have more than one student, enter all first names in the space below (please separate names with a comma and start with your oldest child).
Grade(s) of Student *
-If you have more than one middle/high school student, select all that apply.
Required
Student Birthdate *
-If you have more than one school student, enter all dates by starting with your oldest child and separating entries with a comma.
Primary Household Address *
Secondary Household Address -If applicable
Primary Telephone Number *
-What is the best number(s) to contact you?
Secondary Telephone Number -If applicable
-What is the best number(s) to contact you?
Primary Parent Email Address *
-What is the best email address to use when sending out informational updates?
Secondary Parent Email Address -if applicable
-What is the best email address to use when sending out informational updates?
Has your contact information changed since last year? *
Would you like to receive text messages from the Beresford School District? *Text Messaging Rates May Apply *
Active Military or Deployed Status -Are either parent/guardian activity military or currently deployed? *
-To comply with SDCL 13-28-9, we are working on updating records indicating military and deployment status to assist in the enrollment process.
Acceptable Use Policy *
Please read and review the following link pertaining to the Beresford School District's Acceptable Use Policy: https://drive.google.com/open?id=1uhJYrpfxyi0rYAuFHjtpI5Qo5DMacQWf.
Student Health Conditions *
Please identify any health conditions your child has that may at some time pose a problem for him/her in the classroom or at school-related activities (examples—asthma, epilepsy, diabetes, allergies, etc.). If YES, check other and list child's name and health condition.
Required
Field Trip Permission *
In order to help parents, children, and the schools, we are asking for your written/electronic consent to take your child on class field trips during their middle and high school years. This authorization will eliminate the need for special permission before each trip and will assure each child an opportunity to be included in such excursions. An attempt will be made by the supervising teacher to inform parents of the times and places that the class may visit. Class field trips may include trips in and out of town. Students will be transported in school buses or school vehicles.
Acknowledgment of Review of Student Handbook *
Please read the contents of the student handbook. The direct link to the BHS handbook is: https://docs.google.com/document/d/1kQqEm0bwNQn013AOOASSAkRsL5CYPcitzyl7j0iy23k/edit. The direct link to the BMS handbook is: https://drive.google.com/file/d/1RYj44F5W3blWTDRogUQeN0K9IxGBwNZ-/view?usp=drivesdk. If you would like a hard copy, please contact the appropriate school office. If you have any concerns or questions, please contact the principal. Each student/learner and parent is expected to review and understand the contents of applicable student handbooks.
Activities Code of Conduct/Eligibility Rules *
We have read the Beresford School District “Co-Curricular Activities Code of Conduct/Eligibility Rules." Having done so, we understand, support, and will abide by these guidelines. Link to Code of Conduct section: https://drive.google.com/open?id=1G8ZQGZDYet7KQvLzwrSm02V9c9EVO-tE.
Catastrophic Trauma Insurance *
The Beresford School District 61-2 provides catastrophic trauma insurance for all student-athletes who are participating in interscholastic athletic activities only. The School District does not provide separate student accident coverage or separate dental coverage for any students. Separate student accident insurance and separate dental insurance forms are available to all students at student orientation at the beginning of the school year for purchase at the option of the parent/guardian. This consent question needs to be answered by all parents/guardians even if you are not taking the insurance and/or your child is in co-curricular activities.
Co-Curricular -Parent or Guardian Permission *
I give my permission for my son/daughter to participate in organized athletics, realizing that such activity involves the potential for injury that is inherent in all sports.
Co-Curricular -Parent Consent for Medical Treatment *
I am the mother/father/legal guardian for the child listed on this form (or children listed on this electronic form) who participates in co-curricular activities for Beresford Schools. I hereby consent to any medical services that may be required while said child is under the direct supervision of an employee of the Beresford School District while on a school-sponsored activity and hereby appoint said employee to act on behalf in securing necessary medical services from any duly licensed medical provider.
Co-Curricular -Child Consent for Medical Treatment
I, enter name below (e.g. child enters name below, if more than one child -each child's name needs to be entered), have read the above Parent Consent for Medical Treatment section that has been signed by my parent/guardian and join with him/her in the consent. If your child does not participate in co-curricular activities, please leave this question blank.
Consent for Release of Medical Information (HIPPA) -Form to be completed annually and must be available for inspection at the school. *
1. I authorize the use or disclosure of the above named individual’s health information including the Initial and Interim Pre-Participation History and Physical Exam information pertaining to a student’s ability to participate in South Dakota High School Activities Association sponsored activities. A Health Care Provider generating or maintaining such information may make such disclosure. 2. The information identified above may be used by or disclosed to the athletic trainer, coaches, medical providers and other school personnel involved in the care of this student. 3. This information for which I am authorizing disclosure will be used for the purpose of determining the student’s eligibility to participate in extracurricular activities, any limitations on such participation and any treatment needs of the student. 4. I understand that I have a right to revoke this authorization at any time. I understand that if I revoke this authorization, I must do so in writing and present my written revocation to the school administration. I understand that the revocation will not apply to information that has already been released in response to this authorization. I understand that the revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy. 5. This authorization will expire on July 1, 2020. 6. I understand that once the above information is disclosed, it may be re-disclosed by the recipient and the information may not be protected by federal privacy laws or regulations. 7. I understand authorizing the use or disclosure of the information identified above is voluntary. However, a student’s eligibility to participate in extracurricular activities depends on such authorization. I need not sign this form to ensure healthcare treatment.
Parental Insurance Waiver *
We wish to emphasize that the Beresford School District does not provide any type of health or accident insurance for injuries incurred by your child at school. We encourage families to have accident coverage on their children, prior to participation in any sports or school sponsored activities. Since children are particularly susceptible to injuries, we encourage you to review your present health and accident insurance program to determine if your coverage is adequate. If you do not feel your insurance is adequate because of a deductible or coinsurance clause, or if you do not have insurance, we encourage you to review the student insurance program. This plan will provide benefits for medical expenses incurred because of an accident. An explanation of the cost and benefits is explained on the premium envelope. Plan options can be reviewed by browsing the insurance brochure(s) located in the middle and high school offices.
Transcript Information *
When sending a child's transcript, we can include a child's ACT scores, NCRC results, and other earned credentials. By selecting "Yes" below, you provide consent for us to include this information on your child's transcript (e.g., a common practice since 2020, however, privacy requirements have changed that require us to seek consent).
Protection of Pupil Rights Amendment (PPRA) *
Rights of Parents under the (PPRA) PPRA affords parents of students certain rights regarding, among other things, participation in surveys, the collection and use of information for marketing purposes, and certain physical exams. These include, but are not limited to, the right to: Consent before students are required to submit to a survey that concerns one or more of the following eight protected areas (protected information survey) if the survey is funded as part of a program administered by the Department –Political affiliations or beliefs of the student or student’s parent ;2. Mental or psychological problems of the student or student’s family; 3. Sex behavior or attitudes; 4. Illegal, anti-social, self-incriminating, or demeaning behavior; 5. Critical appraisals of others with whom respondents have close family relationships; 6. Legally recognized privileged or analogous relationships, such as with lawyers, doctors, orministers; 7. Religious practices, affiliations, or beliefs of the student or student’s parent; or 8. Income, other than as required by law to determine program eligibility. Receive notice and an opportunity to opt a student out of –1. Any protected information survey administered or distributed to a student by an local educational agency that is a recipient of funds under an applicable program (LEA) if the protected information survey is either not funded as part of a program administered by the Department or is funded as part of a program administered by the Department but to which a student is not required to submit; 2. Any non-emergency, invasive physical examination or screening required by an LEA as a condition of attendance; administered by the school and scheduled by the school in advance; and, that is not necessary to protect the immediate health and safety of a student, with some exceptions; and 3. Activities of an LEA involving collection, disclosure, or use of personal information collected from students for the purpose of marketing or sale (or to otherwise distribute such information to others for that purpose), with some exceptions. Inspect, upon request –1. Protected information surveys and surveys created by a third party, before the administration or distribution by an LEA of the surveys to a student;2. Any instrument used by an LEA to collect personal information for the purpose of marketing or sale (or otherwise distributing such information for that purpose), before the instrument is administered or distributed to a student, with some exceptions; and3. Instructional material, excluding academic tests or academic assessments, used by an LEA as part of the educational curriculum for a student. These rights transfer from the parents to the student when the student turns 18 years old or becomes an emancipated minor under applicable State law.Requirements for LEAs under the PPRALEAs are required to develop and adopt policies, in consultation with parents, to address the protection of student privacy and parents’ rights under PPRA, including those discussed above. In addition, LEAs must directly notify parents of these policies at least annually, at the start of each school year, and within a reasonable period after any substantive change to the policies.LEAs must also directly notify, such as through U.S. Mail or email, parents of students who are scheduled or expected to be scheduled to participate in any of the activities or surveys listed below and must provide an opportunity for parents to opt their child out of participation. LEAs must make this notification to parents at least annually at the beginning of the school year, and this notification must include the specific or approximate dates when the activities or surveys are scheduled or expected to be scheduled. For activities or surveys that are scheduled after the school year starts, LEAs must provide parents with reasonable notification and an opportunity to review, as well as an opportunity to opt their child out. These activities and surveys involve: Collection, disclosure, or use of personal information collected from students for the purpose of marketing or sale (or otherwise distributing such information to others for that purpose), with some exceptions; Administration or distribution to a student of any protected information survey not funded as part of a program administered by the Department or funded as part of a program administered by the Department but to which students are not required to submit; and Certain non-emergency, invasive physical examinations or screenings, as described above.Parents who seek additional resources on student privacy under the PPRA may visit the Department’s Student Privacy Policy Office website at https://studentprivacy.ed.gov/. Parents who believe their PPRA rights have been violated may file a complaint online by selecting the PPRA complaint form option at https://studentprivacy.ed.gov/file-a-complaint or by mailing the form to the following address:Student Privacy Policy Office U.S. Department of Education 400 Maryland Avenue, S.W. Washington, D.C. 20202
HSPAC (High School Parent Advisory Committee) or MSPAC (Middle School Parent Advisory Committee) *
The purpose of the committee is to be a sounding board for the principal (e.g. members will review and analyze school practices, help project future needs, and provide valuable input about school practices). More so, group members will be kept informed about events happening at the school and their input will be utilized in the decision-making process by the principal and administrative team. The MSPAC and HSPAC will meet every two months.
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