Parent Approval Form 21-22
Please check your response to the information below. Refer to the Parent-Student Handbook for
additional explanation of the items.
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First and Last Name of my STUDENT:
    COVID-19 Student Self-Review: I agree to monitor my student's temperature before entering the building. If his temperature exceeds 100.4 degrees Fahrenheit or has exceeded 100.4 in the last 72 hours, I will keep my child home from school and school activities.  Also, I will monitor my student's symptoms and if my student experiences any COVID-19 symptoms recognized by the CDC: fever, new cough, shortness of breath, fatigue of an unknown cause, muscle aches, or causes unknown, new onset of moderate to severe headache, new loss of taste or smell, sore throat, vomiting or diarrhea, I will keep my student home from school and school activities. *
Acceptable Use and Internet Safety: My child may access the internet under the supervision of the teacher or administration and will abide by the Acceptable Use & Internet Safety Policy. In the case of remote learning, my child and any family member who access the device will also abide by the district's Acceptable Use andInternet Safety Policy. *
Technology Device Responsibilities: I understand that if the administration deems any school assigned device to be purposely or neglectfully damaged by my student, I will be responsible for the full repair or replacement costs. In the case of remote learning, this applies to my child and any family member utilizing the device. *
Student Photograph and Video Usage:  My child’s first name, last name, and photo may appear on the District website, in the local newspaper (which includes its web page), and mentioned on the radio. Video/Audio may also be used. The child’s photo will be included in the annual yearbook. *
Field Trip Permission:  My child may participate in all scheduled class trips within the district boundaries during the school year (i.e. LP High School, LaSalle Public Library, IVCC, Baker’s Lake). I will be notified of any trips outside of the Illinois Valley area. *
Library Book Check Out: I understand that any book my child has checked out from the library that is lost or damaged will result in the charging of the replacement cost for that book. This fee must be paid prior to additional books being checked out and allowed to take home. *
Extra-Curricular Code: I hereby give my consent for my child to participate in extracurricular activities, including intramural sports. I understand the Board of Education is not liable in case of injury. My child will abide by the rules set forth in the district’s Extra-Curricular Code. *
Mobile Text Services: By specifying YES, I agree to receive text messages from the district. I understand that I am responsible for any standard messaging charges from my cell phone carrier that may apply. Specify 'NO' if you do not want to participate. *
Alternate Learning: I agree that my child can participate in remote learning opportunities including phone and / or online, web-based interactions provided through virtual platforms such as Google Hangouts, Zoom, etc. This may include individual or group instructional, educational, and / or related service sessions via live stream video conferencing. While privacy risks do exist, our staff will take reasonable measures to ensure confidentiality and security of information exchanged while supporting students through these virtual platforms. This agreement also includes group and individual special / and or related services identified on the student's IEP or Section 504 Plan. *
Parent-Student Handbook:  I hereby confirm that I have reviewed the Parent-Student Handbook and agree that my student abides by the handbook. I understand that the handbook is available on the LaSalle Elementary Schools website, and if I would like a paper copy of the handbook I can request it in the school office. *
First and Last Name of Parent/Guardian submitting this form: *
By answering "Yes" to this question, the person submitting this form acknowledges that they are the parent/guardian of the child/student to whom this form is submitted and the parent/guardian is certifying that they have answered the above questions accurately and to the best of their knowledge. *
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