Language
English (US)
Español
ROCS Enrollment 2023-2024
Start classes anytime Aug 10 - Sep 5th
Parent Information
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In which language do you read/write? (Parent/Guardian)
*
Please Select
English
Español
Chinese
French
German
What's your preferred language?
*
Please Select
English
Español
How many students are you enrolling?
*
Please Select
1
2
3
4
5
6
7
8
9
10
Are any of the students you're enrolling currently with a USD 340 school?
*
Yes
No
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Student Information
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Other
Grade Enrolling
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
Adult
Do you have a High School Diploma?
Yes
No
What year were you expected to graduate High School?
Student Residence Information
Primary Address (Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your current address a temporary living arrangement? (A motel, shelter, living with relatives or another family, campsite, temporary trailer, abandoned building, car, awaiting foster care, etc.) Foster students are not considered homeless.
*
Yes
No
Enrollment History
Previous School Name
*
Has your child ever attended a USD 340 school?
*
Yes
No
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
MH
Does this student receive Special Education Services?
*
Yes
No
Student Place of Birth
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload student birth certificate (optional)
Browse Files
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of
Student Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Check any additional races which apply
*
N/A
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Ethnicity
*
Please Select
No, not Hispanic/ Latino
Yes, Hispanic/ Latino
What language did your child first learn to speak/use?
*
Please Select
English
Spanish
Chinese
French
German
What language does your child most often speak/use at home?
*
Please Select
English
Spanish
Chinese
French
German
What language do you most often speak/use with your child?
*
Please Select
English
Spanish
Chinese
French
German
What language do the adults at home most often speak/use?
*
Please Select
English
Spanish
Chinese
French
German
Migrant Education Program Info
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
*
Yes
No
Does your student have an active Certificate of Eligibility for Migrant services from a previous school?
*
Yes
No
Is your student a Foreign Exchange student?
*
Yes
No
Was your student born in the United States?
*
Yes
No
Has your student attended US Schools for more than 3 years?
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Family Information
With whom does the child live?
*
Please Select
Both Parents
Mother Only
Father Only
Joint Custody
Mother and Stepfather
Father and Stepmother
Grandparents
Foster Parents
Other
Please specify relationship to child
Who has legal custody of the child?
*
Please Select
Parents
Mother
Father
Joint
Court
Grandparent(s)
Foster Parent
Other
Please specify relationship to child
Are there any legal alerts regarding this student?
*
Yes
No
Is this student the youngest school-age child in the family?
*
Yes
No
How many people live in your household? (Include all children and adults)
*
What title would you like us to use when addressing mail?
*
Please Select
MR.
Mrs.
Ms.
Mr. and Mrs.
To whom should school mailings be addressed?
*
Is there a parent or guardian that does not live in the student's household that needs to receive separate grade cards?
Please Select
Yes
No
Name
Relationship to Student
Full Mailing Address
Military Connection
Is your child a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Is your child a dependent of a member of the National Guard or Reserve Forces?Is your student a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Emergency Contact Information
Contacts must be outside of the student's household.
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
*
e
Last Name
Secondary Emergency | Phone Number
*
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
*
Health Information
Diabetes
*
Yes
No
Allergies
*
Yes
No
Does your student need to carry an epi-pen at school?
Yes
No
Asthma
*
Yes
No
Does your student need to carry an inhaler at school?
Yes
No
Vision or Hearing Corrections
*
Yes
No
Does your student wear corrective lenses?
Yes
No
Does your student wear hearing aids?
Yes
No
Frequent Ear Infections
*
Yes
No
Does your student have vent tubes?
Yes
No
Has your child had any life threatening diseases, surgeries or injuries?
*
Yes
No
Please explain:
Are there any other medical comments/considerations/alerts for this student?
*
Yes
No
Will your child take prescription medication at school?
*
Yes
No
Healthcare Provider: Doctor's Name
*
Healthcare Provider: Doctor's Phone
*
Please enter a valid phone number.
Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.
Please upload your Immunization records (optional)
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Day Care Provider (if applicable)
Day Care Phone Number
Please enter a valid phone number.
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Additional Students
Do you have additional students to enroll?
Yes
No
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Student 2
Student Information
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Other
Grade Enrolling
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
Student Residence Information
Primary Address (Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your current address a temporary living arrangement? (A motel, shelter, living with relatives or another family, campsite, temporary trailer, abandoned building, car, awaiting foster care, etc.) Foster students are not considered homeless.
*
Yes
No
Has your student ever attended a USD 340 School?
*
Yes
No
Enrollment History
Previous School Name
*
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
MH
Does this student receive Special Education Services?
*
Yes
No
Student Place of Birth
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload student birth certificate (optional)
Browse Files
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of
Student Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Ethnicity
*
Please Select
No, not Hispanic/ Latino
Yes, Hispanic/ Latino
What language did your child first learn to speak/use?
*
Please Select
English
Spanish
Chinese
French
German
What language does your child most often speak/use at home?
*
Please Select
English
Spanish
Chinese
French
German
What language do you most often speak/use with your child?
*
Please Select
English
Spanish
Chinese
French
German
What language do the adults at home most often speak/use?
*
Please Select
English
Spanish
Chinese
French
German
Migrant Education Program Info
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
*
Yes
No
Does your student have an active Certificate of Eligibility for Migrant services from a previous school?
*
Yes
No
Is your student a Foreign Exchange student?
*
Yes
No
Was your student born in the United States?
*
Yes
No
Has your student attended U.S. Schools for more than 3 years?
Yes
No
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Family Information
Student 2
With whom does the child live?
*
Please Select
Both Parents
Mother Only
Father Only
Joint Custody
Mother and Stepfather
Father and Stepmother
Grandparents
Foster Parents
Other
Please specify relationship:
Who has legal custody of the child?
*
Please Select
Parents
Mother
Father
Joint
Court
Grandparent(s)
Foster Parent
Other
Please specify relationship:
Are there any legal alerts regarding this student?
*
Yes
No
Is this student the youngest school-age child in the family?
*
Yes
No
How many people live in your household? (Include all children and adults)
*
Military Connection
Is your child a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Is your child a dependent of a member of the National Guard or Reserve Forces?Is your student a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Health Information
Diabetes
*
Yes
No
Allergies
*
Yes
No
Asthma
*
Yes
No
Vision or Hearing Corrections
*
Yes
No
Frequent Ear Infections
*
Yes
No
Has your child had any life threatening diseases, surgeries or injuries?
*
Yes
No
Are there any other medical comments/considerations/alerts for this student?
*
Yes
No
Will your child take prescription medication at school?
*
Yes
No
Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.
Please upload your Immunization records (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
*
First Name
Last Name
Secondary Emergency | Phone Number
*
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
*
Day Care Provider (if applicable)
Day Care Phone Number
Please enter a valid phone number.
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Next
Save
Additional Students
Do you have additional students to enroll?
Yes
No
Back
Next
Save
Student 3
Student Information
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Other
Grade Enrolling
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
Student Residence Information
Primary Address (Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your current address a temporary living arrangement? (A motel, shelter, living with relatives or another family, campsite, temporary trailer, abandoned building, car, awaiting foster care, etc.) Foster students are not considered homeless.
*
Yes
No
Enrollment History
Previous School Name
*
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
MH
Does this student receive Special Education Services?
*
Yes
No
Student Place of Birth
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload student birth certificate (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Student Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Ethnicity
*
Please Select
No, not Hispanic/ Latino
Yes, Hispanic/ Latino
What language did your child first learn to speak/use?
*
Please Select
English
Spanish
Chinese
French
German
What language does your child most often speak/use at home?
*
Please Select
English
Spanish
Chinese
French
German
What language do you most often speak/use with your child?
*
Please Select
English
Spanish
Chinese
French
German
What language do the adults at home most often speak/use?
*
Please Select
English
Spanish
Chinese
French
German
Migrant Education Program Info
Was your student born in the United States?
*
Yes
No
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
*
Yes
No
Does your student have an active Certificate of Eligibility for Migrant services from a previous school?
*
Yes
No
Is your student a Foreign Exchange student?
*
Yes
No
Back
Next
Save
Family Information
Student 3
With whom does the child live?
*
Please Select
Both Parents
Mother Only
Father Only
Joint Custody
Mother and Stepfather
Father and Stepmother
Grandparents
Foster Parents
Other
Who has legal custody of the child?
*
Please Select
Parents
Mother
Father
Joint
Court
Grandparent(s)
Foster Parent
Other
Are there any legal alerts regarding this student?
*
Yes
No
Is this student the youngest school-age child in the family?
*
Yes
No
How many people live in your household? (Include all children and adults)
*
Military Connection
Is your child a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Is your child a dependent of a member of the National Guard or Reserve Forces?Is your student a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Health Information
Diabetes
*
Yes
No
Allergies
*
Yes
No
Asthma
*
Yes
No
Vision or Hearing Corrections
*
Yes
No
Frequent Ear Infections
*
Yes
No
Has your child had any life threatening diseases, surgeries or injuries?
*
Yes
No
Are there any other medical comments/considerations/alerts for this student?
*
Yes
No
Will your child take prescription medication at school?
*
Yes
No
Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.
Please upload your Immunization records (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
*
First Name
Last Name
Secondary Emergency | Phone Number
*
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
*
Day Care Provider (if applicable)
Day Care Phone Number
Please enter a valid phone number.
Back
Next
Save
Additional Students
Do you have additional students to enroll?
Yes
No
Back
Next
Save
Student 4
Student Information
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Other
Grade Enrolling
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
Student Residence Information
Primary Address (Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your current address a temporary living arrangement? (A motel, shelter, living with relatives or another family, campsite, temporary trailer, abandoned building, car, awaiting foster care, etc.) Foster students are not considered homeless.
*
Yes
No
Enrollment History
Previous School Name
*
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
MH
Does this student receive Special Education Services?
*
Yes
No
Student Place of Birth
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload student birth certificate (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Student Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Ethnicity
*
Please Select
No, not Hispanic/ Latino
Yes, Hispanic/ Latino
What language did your child first learn to speak/use?
*
Please Select
English
Spanish
Chinese
French
German
What language does your child most often speak/use at home?
*
Please Select
English
Spanish
Chinese
French
German
What language do you most often speak/use with your child?
*
Please Select
English
Spanish
Chinese
French
German
What language do the adults at home most often speak/use?
*
Please Select
English
Spanish
Chinese
French
German
Migrant Education Program Info
Was your student born in the United States?
*
Yes
No
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
*
Yes
No
Does your student have an active Certificate of Eligibility for Migrant services from a previous school?
*
Yes
No
Is your student a Foreign Exchange student?
*
Yes
No
Back
Next
Save
Family Information
Student 4
With whom does the child live?
*
Please Select
Both Parents
Mother Only
Father Only
Joint Custody
Mother and Stepfather
Father and Stepmother
Grandparents
Foster Parents
Other
Who has legal custody of the child?
*
Please Select
Parents
Mother
Father
Joint
Court
Grandparent(s)
Foster Parent
Other
Are there any legal alerts regarding this student?
*
Yes
No
Is this student the youngest school-age child in the family?
*
Yes
No
How many people live in your household? (Include all children and adults)
*
Military Connection
Is your child a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Is your child a dependent of a member of the National Guard or Reserve Forces?Is your student a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Health Information
Diabetes
*
Yes
No
Allergies
*
Yes
No
Asthma
*
Yes
No
Vision or Hearing Corrections
*
Yes
No
Frequent Ear Infections
*
Yes
No
Has your child had any life threatening diseases, surgeries or injuries?
*
Yes
No
Are there any other medical comments/considerations/alerts for this student?
*
Yes
No
Will your child take prescription medication at school?
*
Yes
No
Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.
Please upload your Immunization records (optional)
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Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
*
First Name
Last Name
Secondary Emergency | Phone Number
*
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
*
Day Care Provider (if applicable)
Day Care Phone Number
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Additional Students
Do you have additional students to enroll?
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Student 5
Student Information
Student Name
*
First Name
Middle Name
Last Name
Birth Date
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Gender
*
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Grade Enrolling
*
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0
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Student Residence Information
Primary Address (Student)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your current address a temporary living arrangement? (A motel, shelter, living with relatives or another family, campsite, temporary trailer, abandoned building, car, awaiting foster care, etc.) Foster students are not considered homeless.
*
Yes
No
Enrollment History
Previous School Name
*
City
*
State
*
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Does this student receive Special Education Services?
*
Yes
No
Student Place of Birth
*
Street Address
Street Address Line 2
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State / Province
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Please upload student birth certificate (optional)
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Student Race
*
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Ethnicity
*
Please Select
No, not Hispanic/ Latino
Yes, Hispanic/ Latino
What language did your child first learn to speak/use?
*
Please Select
English
Spanish
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What language does your child most often speak/use at home?
*
Please Select
English
Spanish
Chinese
French
German
What language do you most often speak/use with your child?
*
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English
Spanish
Chinese
French
German
What language do the adults at home most often speak/use?
*
Please Select
English
Spanish
Chinese
French
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Migrant Education Program Info
Was your student born in the United States?
*
Yes
No
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
*
Yes
No
Does your student have an active Certificate of Eligibility for Migrant services from a previous school?
*
Yes
No
Is your student a Foreign Exchange student?
*
Yes
No
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Family Information
Student 5
With whom does the child live?
*
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Both Parents
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Mother and Stepfather
Father and Stepmother
Grandparents
Foster Parents
Other
Who has legal custody of the child?
*
Please Select
Parents
Mother
Father
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Court
Grandparent(s)
Foster Parent
Other
Are there any legal alerts regarding this student?
*
Yes
No
Is this student the youngest school-age child in the family?
*
Yes
No
How many people live in your household? (Include all children and adults)
*
Military Connection
Is your child a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Is your child a dependent of a member of the National Guard or Reserve Forces?Is your student a dependent of a member of the Active Duty Military Forces (full-time)?
*
Yes
No
Health Information
Diabetes
*
Yes
No
Allergies
*
Yes
No
Asthma
*
Yes
No
Vision or Hearing Corrections
*
Yes
No
Frequent Ear Infections
*
Yes
No
Has your child had any life threatening diseases, surgeries or injuries?
*
Yes
No
Are there any other medical comments/considerations/alerts for this student?
*
Yes
No
Will your child take prescription medication at school?
*
Yes
No
Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.
Please upload your Immunization records (optional)
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Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
*
Secondary Emergency | Contact Name
*
First Name
Last Name
Secondary Emergency | Phone Number
*
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
*
Day Care Provider (if applicable)
Day Care Phone Number
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Agreements
Emergency Safety Interventions Acknowledgement
Kansas regulations now require that we provide all parents with notice of our written policies regarding Emergency Safety Interventions. We will provide a copy of the district policy at any time upon request. To view the Emergency Safety Intervention document, please click here. For the Spanish document, please click here.
Please select one of the following options:
*
I have been informed of the district policy and I do NOT want a copy of the policy.
I have been informed of the district policy and I do want a copy of the policy.
Directory Information
For purposes of the Family Educational Rights and Privacy Act, Rocket Online Schools and USD 340 designates the following information contained in educational records as directory information, which may be disclosed for any purpose without your prior consent. This information would not generally be considered harmful or an invasion of privacy if disclosed. The following information is considered directory information: name, address, telephone number, electronic mail address, photograph (including video and the internet), date and place of birth, major field of study, dates of attendance, attendance center, grade level enrollment status (e.g. undergraduate or graduate; full-time or part-time), participation in officially recognized activities and sports, weight and height of members of athletic teams, degrees, honors and awards received, and class designation. In addition, the district and/or any of it employees or agents may use the student's likeness, or voice, or all to be recorded and exhibited as still photographs, transparencies, motion pictures, television, videotape recordings or other similar media, including Internet applications. The custodian of records shall make student recruiting information (name, address and telephone listing) available to military recruiters and post-secondary institutions unless parents or eligible students request the information not be released without written consent. You have a right to refuse to permit the designation of any or all of the above information as directory information, video and still photograph information, or student recruiting information. If you refuse, you must file written notification to this effect with Rocket Online Schools and USD 340 at the District Office, 74th Street, PO Box 267 Meriden, Kansas 66512 on or before August 31, 2022. If a written refusal is not filed, Rocket Online School and USD 340 assumes you have no objection to the release of the directory information or recruiting information designated.
I have read the above and agree.
*
Yes
No
Surveys
I hereby give permission for my child to participate in the following surveys:
Social-Emotional Learning Survey
*
Yes
No
School Climate Survey
*
Yes
No
Computer Loan Agreement
In order to benefit from the use of the Rocket Online Schools issued device, and to ensure the device is used in a safe, efficient and ethical manner, all students and their parents are required to review and sign this document before receiving a Chromebook. Please click here for the official form. 1. I will ensure the safety of the Chromebook issued to me and prevent negligent damage to the device. 2. I will not leave the device unattended or unsecure, so as to decrease the risk of theft. 3. I will not attempt to repair the device or make unauthorized modifications to the device and I will likewise adhere to the expectations for appropriate use designated by the district. 4. I understand that the district is not responsible for any viruses that may be transferred to or from my personal data storage media, and agree to use my best effort to prevent damage to the device that would render it inoperable. 5. I will report, as soon as possible, any damage or problems with the device to IT via email to support@rocs.org or via the Device Replacement form. 6. I understand that as this is district property, it may be used only for non-commercial purposes in accordance with Rocket Online Schools' District Policy, as well as local, state and federal laws. 7. I agree not to loan the device to anyone, and will use it for my own school use. 8. I understand that the Chromebook is the property of Rocket Online Schools, and as such my activity will be filtered and monitored in accordance with the Children’s Internet Protection Act (CIPA) to prevent the inappropriate use of the Chromebook, whether at home or school. 9. To minimize damage, I agree to keep the Chromebook secure and protected when not in use. 10. I understand that both parent and student are responsible for returning the device and charger in working condition upon request by the school district or upon graduation or withdrawal from the district. 11. If I deliberately damage, or through gross negligence, allow damage or theft of the Chromebook, I will be liable for replacement or repair and/or disciplinary action up to and including loss of computer and/or technology use privileges. 12. I understand that the district retains the right to obtain financial reimbursement from the borrower in the event of damage or loss to the Chromebook. 13. I agree to return the Chromebook, Charger, and accessories in good working condition at the end of the current school year or as requested by Rocket Online Schools. 14. I understand that if the Chromebook and Charger are not returned, a hold will be placed on my account in the amount of $300 until it is returned
I have read the above and agree.
*
Yes
No
Consent to Receive Electronic Communication
I support the district's effort to conserve resources by consenting to receive electronic communication in lieu of paper progress reports, grade cards, etc.
I have read the above and agree.
*
Yes
No
Student Data Privacy Act
In accordance with the Student Data Privacy Act and board policy IDAE, student data submitted to or maintained in a statewide longitudinal data system may only be disclosed as follows. Such data may be disclosed to: The authorized personnel of an educational agency or the state board of regents who require disclosures to perform assigned duties; and the student and the parent or legal guardian of the student, provided the data pertains solely to the student. Student data may be disclosed to authorized personnel of any state agency, or to a service provider of a state agency, educational agency, or school performing instruction, assessment, or longitudinal reporting, provided a data-sharing agreement between the educational agency and other state agency or service provider provides the following: purpose, scope and duration of the data-sharing agreement; recipient of student data use such information solely for the purposes specified in agreement; recipient shall comply with data access, use, and security restrictions specifically described in agreement; and student data shall be destroyed when no longer necessary for purposes of the data-sharing agreement or upon expiration of the agreement, whichever occurs first. A service provider engaged to perform a function of instruction may be allowed to retain student transcripts as required by applicable laws and rules and regulations.Unless an adult student or parent or guardian of a minor student provides written consent to disclose personally identifiable student data, student data may only be disclosed to a governmental entity not specified above or any public or private audit and evaluation or research organization if the data is aggregate data. Aggregate data means data collected or reported at the group, cohort, or institutional level and which contains no personally identifiable student data. The district may disclose: Student directory information when necessary and the student's parent or legal guardian has consented in writing; directory information to an enhancement vendor providing photography services, class ring services, yearbook publishing services, memorabilia services , or similar services; any information requiring disclosure pursuant to state statutes; student data pursuant to any lawful subpoena or court order directing such disclosure; and student data to a public or private postsecondary educational institution for purposes of application or admission of a student to such postsecondary educational institution with the student's written consent.
I acknowledge that I have been provided with notice of authorized student data disclosures under the Student Data Privacy Act.
*
Yes
Parent/Guardian Signature
*
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