BRISTOL EASTERN HIGH SCHOOL FORMS DAY AUGUST 2, 2016 BEHS CAFETERIA

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3 Completed (For BE staff sign off only) Included with Letter ü BRISTOL EASTERN HIGH SCHOOL FORMS DAY AUGUST 2, 2016 BEHS CAFETERIA Form Title Description Completed for Student/Family Handbook Pink Please review the student/family handbook for online here: Signing this form indicates you have read and understood all policies. All students ü Registration Information Update White Also note that the photo restriction option is included on this form. For students currently attending BEHS, you will receive a copy of the information that is currently in our system. Please make any necessary changes on this form. If you have moved, we will need to have proof of your residency. ü ü Internet Access Agreement Yellow, side 1 Bring Your Own Device Agreement Yellow, side 2 Physical Form Blue Also note that the military opt-out option is on this form. This form details the Board of Education policies related to internet access. *Students will not be able to access the school provided Gmail or Google accounts until this form is returned. This form details the Board of Education policies related to bring your personal electronic device to school. All juniors must have a physical completed in the year prior to the start of their junior year on record with the nurse. All students All students Juniors Athletes All athletes must have a current physical (physical completed within one year). ü Emergency Information This information updates our school nurses All students Card and administration with information related Goldenrod to student wellness and emergency care. Free/Reduced Lunch Families who believe they could qualify for Qualifying students Application Free and Reduced Lunch should review the application and complete as needed. Additional Insurance This is optional for families who wish to Optional Application purchase supplemental school insurance. No Outstanding School Debts may include library fines, textbook All students Debts fees, unreturned athletic equipment Los documentos están disponible en Español: Los documentos estarán en forma de papel en el dos de agosto "Día de Documentos" grados y el diecisiete de agosto para el grado 9.

4 EMERGENCY INFORMATION CARD SCHOOL YEAR Name of Child Date of Birth Grade HomeAddress Phone Mother/GuardianName Cell Mother s Place of Employment Phone Father/Guardian Name Cell Father s Place of Employment Phone Designated contact person if parent/guardian is unable to be reached during school hours in case of emergency, illness, or injury. This person is authorized to pick up the student from school as needed: Name Relationship Phone Name Relationship Phone Name Relationship Phone Health Care Provider Phone I authorize the school nurse or school personnel to arrange for medical assistance or transportation to a hospital at my expense if needed. I understand that I must notify the school office and school nurse with any changes of the information above. Parent / Guardian Signature Date Rev. 2/2012cp PLEASE TURN OVER AND COMPLETE THE OTHER SIDE. Does your child have health insurance? Yes No If yes, type of insurance - Private Ins. Husky Is your child taking any medication? yes no Name of medications Medication Allergies and Symptoms Food allergies and symptoms Food allergy requires use of Epipen/Benadryl: yes no Severe Bee Sting Allergy: yes no Requires use of Epipen /Benadryl: yes no Asthma: yes no If yes: Mild Moderate Severe Exercise Induced Date of last episode Asthma Medication: yes no Seizures: yes no Date of last seizure Type Diabetes: yes no Use of insulin pump pen injection other Other special medical needs/considerations PLEASE NOTIFY THE SCHOOL OFFICE AND SCHOOL NURSE WITH ANY CHANGES.

5 Internet Access and Technology Policy Agreement The Computers: Acceptable Use of the Internet, Other Computer Networks and Internet Safety policy ( ) is included in the Student-Parent Handbook, available online at Paper copies are available by request to the Bristol Central or Bristol Eastern front office. Please review the contents and implications of this policy with your child. Your signature below confirms that you have read, understand and agree to abide by the terms of this policy and that access privilege may be revoked and disciplinary action may be taken. Our school will issue accounts to all of our students for purposes of student teacher communications, and to develop technology related skills to meet new standards and curriculum requirements. Every user, regardless of age, must read and sign below: I have read, understand, and agree to abide by the terms of the foregoing Acceptable Use and Internet Safety Policy. Should I commit any violation or in any way misuse my access to the school district's computer network and the Internet, I understand and agree that my access privilege may be revoked and disciplinary action may be taken against me. User's Name (print clearly): User's Signature: Home Phone: Date: Address: Status: [ ] Student [ ] Staff [ ] Other Patron [ ] I am 18 or older [ ] I am under 18 If I am signing this policy when I am under 18, I understand that when I turn 18, this policy will continue to be in full force and effect and agree to abide by this policy. Parent or Guardian: (If applicant is under 18 years of age, a parent or guardian must also read and sign this agreement.) As the parent or legal guardian of the above student, I have read, understand and agree that my child or ward shall comply with the terms of the school district's Acceptable Use and Internet Safety Policy for the student's access to the school district's computer network and the Internet. I understand that access is being provided to the students for educational purposes only. However, I also understand that it is impossible for the school to restrict access to all offensive and controversial materials and understand my child's or ward's responsibility for abiding by the policy. I am, therefore, signing this policy and agree to indemnify and hold harmless the school, the school district, and the Data Acquisition Site that provides the opportunity to the school district for computer network and Internet access against all claims, damages, losses, and costs, of whatever kind that may result from my child's or ward's use of his or her access to such networks or his or her violation of the foregoing policy. Further, I accept full responsibility for supervision of my child's or ward's use of his or her access account if and when such access is not in the school setting. I hereby give permission for my child or ward to use the building approved account to access the school district's computer network and the Internet. Parent or Guardian (please print): Parent or Guardian Signature: Home Phone: Date: Address (if different from above): This agreement is valid for the school year only.

6 Student-Parent Handbook Agreement The Student-Parent Handbook is available online at Paper copies are available by request to the Bristol Central or Bristol Eastern front office. The Bristol Board of Education requires all parents/guardians of students within the Bristol Public Schools to: acknowledge receipt and understanding of the Student/Parent Handbook; grant permission or denial for media and school/district web site involvement; agree to the Internet Access and Technology Policy to approve your child s use of the Internet and electronic mail for educational purposes (on yellow paper); agree to the Bring Your Own Device (BYOD) Policy to approve your child s use of personal electronic devices in school (on yellow paper). Please pay special attention to handbook sections regarding Attendance, Discipline, Technology Use, and Graduation Requirements. We suggest you spend time discussing these and other policies described in the Student/Parent Handbook with your child. Media and Web Site Involvement - Permission There will be times when the school or other media representatives such as The Bristol Press or The Hartford Courant will wish to feature our students or the school community in a web or print article and/or photograph. Additionally, teachers sometimes videotape lessons to be viewed by others to improve our instructional practices. For permission or denial regarding your child s being photographed, interviewed and/or videotaped, please indicate your preference below: I give permission for my child to be interviewed, photographed, and videotaped for school/public relation purposes or instructional improvement ONLY. I do not give permission for my child to be interviewed, photographed, and videotaped. Acknowledgement of Receipt of Student and Parent Handbook As a parent/guardian of a student within the Bristol Public Schools, I acknowledge receipt of the Student/Parent Handbook. I have reviewed and discussed the Student/Parent Handbook with my child. STUDENT NAME (PLEASE PRINT) PARENT/ GUARDIAN NAME (PLEASE PRINT) STUDENT SIGNATURE PARENT/ GUARDIAN SIGNATURE DATE This agreement is valid for the school year only. --- Please read and sign the two policy agreements on yellow paper and hand-in with this form ---

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