2020-2021 Registration Form for PreK-12 Plainville, USD 270

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The following form will serve as an electronic registration for your student. Registration must be filled out completely by a parent or guardian. Please provide the email address of parent or guardian filling out this form. (Emails are used as a form of contact and school communication).

Email *

Student First Name *

Student Middle Name

Student Last Name *

Date of Birth *

YYYY

Gender *

Female

Male

Home Landline Phone # (if applicable)

Grade *

Home Address - Street *

Home Address - City *

Home Address - Zip *

Is the student Hispanic or Latino? *

Yes

Student's race *

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian/Other Pacific Islander

Medical issues *

Allergies *

7th-12th Grade Student Cell # (for automated school alerts)

I give my permission for my child to go on school or classroom trips in the Plainville area during the school year. (This authorization covers ONLY the trips in the Plainville area.) *

Yes

I give my permission for the Plainville School District to allow my child's picture and name to be published on the school district website or social media accounts. Examples may include class pictures, class trips, student projects, extra-curricular activities, etc. *

Yes

I give my permission for the Plainville School District to release appropriate pictures or information about my child to the media or press. Examples may include class pictures, class trips, student projects, extra-curricular activities, etc. *

Yes

Is anyone LEGALLY barred from seeing this student? *

Yes

If you answered yes above, please list who (court documentation MUST also be provided to the school office).

The USD 270 Student Handbook is available in digital form on the USD 270 website, www.plainville270.net, in the Parents section. The above named student and I are responsible for reading and understanding the contents. A hard copy of this handbook may be requested at any time by calling either Plainville Grade School at 785-434-4508 or Plainville Jr/Sr High School at 785-434-4547. *

I have read, and acknowledge, the above statement.

Required

The Annual Notice of Authorized Student Data Disclosures is available in digital form on the USD 270 website, www.plainville270.net, in the Parents section. *

As the parent or legal guardian of the above named student, I acknowledge that I have been provided with notice of authorized student data disclosures under the Student Data Privacy Act.

Required

Information on Kansas statute KSA 21-6206, making harassing, threatening and bullying behaviors a crime, is available on the USD 270 website, www.plainville270.net, in the Parents section. *

As the parent or legal guardian of the above named student, I acknowledge that I have been provided with information on KSA 21-6206

Required

TECHNOLOGY ACCEPTABLE USE POLICY

The Technology Acceptable Use Policy is available in digital form on the USD 270 website, www.plainville270.net, in the Parents section.

Do you give permission for your child to use the school computers, network, and to access the Internet? *

Yes

No, I DO NOT give permission for my child to use USD 270 computers or access to the Internet. I also understand that my child may not bring personal devices to use with the USD 270 network.

CHROMEBOOK CHECKOUT POLICY - Grades 7-12

* 7-12 grade students are allowed to check out a Chromebook from the high school library for a term of one day or over the weekend.
* Students must return the device before the start of school on the next day.
* Failure to return the device on time will result in a loss of technology privileges until the device is returned.
* Students must follow the Acceptable Technology Use Policy. Disciplinary action will be enforced when policy is not followed.
* Cost to repair or replace the device will be covered by the student who checked out the Chromebook.
* Students will lose technology privileges until the matter of repair or replacement is resolved.

Do you give permission for your 7-12 grade student to check out a Chromebook? *

Yes

Not applicable - my child is not a 7th-12th grader

USD 270 TRANSPORTATION

Do you live in the USD 270 district AND live 2.5 miles or further from school? *

Yes

If yes, will your student need transportation services for this school year? *

Yes

Not applicable, I live less than 2.5 miles from school

If transportation is needed, when will this student need transportation on a regular basis?

In the morning

In the afternoon

Both morning and afternoon

Only when requested

Clear selection

HEALTH SCREENINGS

During the school year, the health nurse will schedule health screenings. Those screenings include: vision, hearing, and a dental screening.

I want my child included in the Vision Screening *

Yes

I want my child included in the Hearing Screening *

Yes

I want my child included in the Dental Screening *

Yes

HUMAN SEXUALITY EDUCATION - Grades 4-6

As part of your child's education, we offer information on puberty and human sexuality.
At the 4th grade level, this information will be provided to the female students by the health nurse. She will meet with the students as a group in her office.
At the 5th & 6th grade level, this information will be provided to the female students as a group and the male students as a group. The health nurse will provide the instruction to the two separate groups.

If your preference is for your child to "opt out" of the puberty and human sexuality education, please indicate your preference below. By so doing, your child will attend study hall and will not attend class sessions which are identified as addressing puberty and human sexuality. *

I DO NOT grant permission for my child to participate in the puberty and human sexuality education

I DO grant permission for my child to participate in the puberty and human sexuality education.

Not applicable - my child is not a 4th, 5th or 6th grader

KANSAS COMMUNITIES THAT CARE SURVEY - Grades 6, 8, 10, 12

Our school will be administering the Kansas Communities That Care Student Survey. This survey is taken by 6th, 8th, 10th, and 12th grade students statewide. I believe this survey is a valuable tool to help us understand how students behave, think and feel about alcohol, marijuana and other drug use, bullying and school safety. The KCTC survey measures teen substance use, delinquency, and related problem behaviors in schools and communities. The survey gives us insight into the problems students face and shows what we can do to help them succeed. The information is important for planning effective prevention programs in our school and community and provides data to assist in applying for grant funding.

The survey and parent information can be viewed at www.kctcdata.org. You may also be interested to know the following:

1. It is completely anonymous. Students will not be asked for their names on the questionnaire, nor will anyone be able to connect any individual student with his/her responses. School staff will not see any one student's responses, but only summaries of results.

2. Participation is entirely voluntary. Your child may decline to participate in the survey, or may simply skip any particular question they do not wish to answer.

3. Annual participation is important. Even if your child has participated in previous surveys, annual data is extremely helpful in determining the effectiveness of previous efforts and changes in program areas.

I hope you will allow your child to participate. Please check the appropriate option below. Thank you in advance for your cooperation.

Jeremy Krob
Plainville Jr/Sr High Principal

Please check one: *

Yes, I give permission for my child to participate in the Kansas Communities That Care Student Survey

No, I do not give permission for my child to participate in the Kansas Communities That Care Student Survey

Not applicable - my child is not in 6th, 8th, 10th, or 12th grade

EMERGENCY MEDICAL TREATMENT AUTHORIZATION *

I acknowledge that, in case of a medical emergency, USD 270 will transport my student to the appropriate healthcare facility, if needed. I accept all financial responsibility for medical treatment and/or to submit bills to my insurance.

Required

VERIFY & SUBMIT

By entering my name below, I verify that all information given is correct and accurate. In the event of any changes that would affect this information, I will contact the school to make the appropriate updates. I understand that entering my name serves as an electronic signature.

First Name of parent/guardian filling out this form *

Last Name of parent/guardian filling out this form *

Today's Date *

YYYY

Send me a copy of my responses.

Submit

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