KCSD Registration Packet

Restrictions of Contact and Information (when applicable)

For KCSD to enforce "no contact" or "no release" orders, court documentation must be provided.
Choose any that may apply

Custody Papers specifying restrictionsOther documentation providedOrder of protectionName of person and Expiration Date
Pick Up and Drop Off

*Please notify school or any changes made*
Please describe usual pick-up/drop-off routine:
District bus transportation eligibility

To be eligible for bus, students residence or pick-up/drop-off location must be 1.5 miles or more away from schoo, with the exception of Kindergarten students after-noon drop-off.
Bus Request Form will need to be filled out before the first day of school
Medical Information & Medication Notice:

District personnel shall not dispense or administer any medication to students without prior written authorization by a healthcare provider with written instructions and with written authorization or parent/guardians, except where, in the judgement of medical personnel, emergengy provision of medication is necessary to prevent serious harm to the student. The District may decline for administration of medication in certian instances.
List any medical conditions of the student:
Does this student have any life-threatening food, medication,
Is student currently taking any prescription medications? Please list:
Recurring illness of the student (frequent sore throats, cold, etc.):
Student may qualify for the following
JOM / Indian Education (if applicable)

Yes, form must be submitted
Migrant Education: Has your child particpated in any type of commerical fishing this past summer? Did your family or any of your children camp for subsistence for commercial fishing purposes this summer?*

NoYes, if yes you will be contacted by a migrant
PARENT SIGNATURE: I understand I must notify the office of any changes to this information*

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Klawock City Schools - Permission to Publish & Internet/Computer Use Contract

We are pleased to offer students of Klawock City School District access to the district computer network and the internet. To gain access to the internet, all students under the age of 18 must obtain parental permission and must sign and return this form to the principal’s secretary. Parents may request alternative activities for their children that do not require internet access. Any violation of this acceptable use policy may result in loss of network and/or computer privileges, disciplinary action, and/or legal referral.
Access to the internet will enable students to explore thousands of libraries, databases, and bulletin boards throughout the world. Families should be warned that some material accessible via the internet might contain items that are illegal, defamatory, inaccurate, obscene or profane. We currently have in place a commercial quality filtering system that blocks out most of this inappropriate material and can also record where iStudent Agreement
As a student of the Klawock City School District, I acknowledge that I have read, understand and agree to abide by the procedures, guidelines, rules and regulations as stated in this Internet / Computer Use Contract as well as the Klawock Student Handbook. I further understand, agree and acknowledge that I will be held accountable for actions and will be subject to discipline actions. If I do not abide by this agreement, my access privileges will be revoked and school disciplinary action and/or appropriate legal action may be taken.t is being accessed. While our intent is to make the internet access available to further educational goals and objectives, students may find ways to access other materials as well. We believe that the benefits to students from access to the internet in the form of information resources and opportunities for collaboration exceed any disadvantages. It is not practically possible for the District to monitor and endorse a wide range of social values in student use of the internet.
Ultimately, parents and guardians of minors are responsible for setting and conveying the standards that their children should follow when using media and information sources. To that end, the Klawock City School District supports and respects each family’s right to decide whether or not to apply for access, and we encourage parents to specify to their children what material is and is not acceptable for them to access through the District System.

District Policies:
*Students are responsible for their behavior on school computer networks. Communications on the network are often public in nature. General school rules for behavior and communications apply. (See Klawock Student Handbook)
* The network is provided for students to conduct research and communicate with others. Access to network services is given to students who agree to act in a considerate and responsible manner. Parent permission is required. Access is a privilege – not a right. Access entails responsibility.
*Individual users of the district computer networks are responsible for their behavior and communications over those networks. It is presumed that users will comply with district standards and will honor the agreements they have signed. Beyond the clarification of such standards, the district is not responsible for restricting, monitoring or controlling the communications of individuals utilizing the network.
*Network storage areas may be treated like school lockers. Network administrators may review files and communications to maintain systems integrity and insure that users are using the system responsibly. Users should not expect that files stored on district computers or servers will be private.
*Within reason, freedom of speech and access to information will be honored. During school, teachers will guide students toward appropriate materials. Outside of school, families bear the same responsibility of such guidance as they exercise with information sources such as television, telephones, movies, radio and other potentially offensive media.

Specific Rules:
1. Do not use the internet without direct adult supervision.
2. Do not send or receive personal e-mail during class time.
3. Never send, display, copy or print offensive messages or pictures or use rude, inappropriate or obscene language.
4. Do not damage computers, computer systems or computer networks.
5. Do not violate copyright laws.
6. Do not use another person’s password or trespass in another person’s folders, work or files.
7. Do not employ the network for commercial purposes.
8. Do not use chat lines, streaming audio or instant message services.
9. Do not use internet e-mail accounts without teacher permission.
10. Do not use software without teacher/ administrative permission.
11. Do not print, download information, graphics, or music from the internet without teacher permission.
12. Do not access, submit, post, publish or display any defamatory, inaccurate, abusive, obscene, profane, sexually oriented, threatening, racially offensive, harassing, or illegal material.

Any user determined to be a security risk will be denied access to the network and the internet and may be liable for disciplinary action or prosecution. Violations may result in a loss of access as well as another disciplinary or legal action.

This contract between the Klawock City School District, the student and the student’s parent/guardian, must be completed, signed and returned to the office before a student can access the internet from any school computer. Once completed and on file, this contract is valid for the entire school year.
The Klawock City School District makes no warranties of any kind whether expressed or implied for services it is providing. The District will not be responsible for damages you suffer while on the system. These damages include loss of data as a result of delays, non or miss-deliveries, or service interruptions. Use of any information obtained is at your own risk and the school does not guarantee the accuracy of any information. By entering into this Contract, the student and the parent/guardian agrees to be bound by this release of liability and waives any and all rights to assert claims which may arise due to use of these electronic services.

Student Agreement
As a student of the Klawock City School District, I acknowledge that I have read, understand and agree to abide by the procedures, guidelines, rules and regulations as stated in this Internet / Computer Use Contract as well as the Klawock Student Handbook. I further understand, agree and acknowledge that I will be held accountable for actions and will be subject to discipline actions. If I do not abide by this agreement, my access privileges will be revoked and school disciplinary action and/or appropriate legal action may be taken.
Name of Student*
Name of Parent / Guardian*
Parent/Guardian Agreement: As a parent(s) / guardian(s), I (we) acknowledge that I (we) have read the Internet / Computer Use Contract and the specific information in the Handbook related to computer / internet use and I (we) grant permission for my (our) child to access networked computer services such as e-mail and the internet. I (we) understand that access is designated for educational purposes and I (we) also recognize it is impossible for Klawock City School District to restrict access to all controversial material and I (we) will not hold them responsible for materials acquired on the network. Further, I (we) accept full responsibility for supervision if and when my child’s use is not in a school setting. I (we) hereby give permission to issue an account for my child and certify that the information on this form is correct. *

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Field Trip Permission

Klawock City School District, 2024 - 2025
Dear Parent / Guardian, During the course of the school year your child’s class will be going on several field trips in connection with their studies. All field trips will be properly supervised.Each student must have this signed permission form on file with the school office before being allowed to go on any class-connected field trip. Please sign and return this form as soon as possible.Prior to each field trip your student’s teacher will send home a note providing you with information regarding destination, date and time of trip. You may send that note back with your signature if you would prefer your child not attend.*
Enter Student Name and Grade Here
The above student has my permission to attend planned field trips in connection with class studies while she/he is enrolled at the Klawock School. I agree that a copy of this permission slip is as valid as the original. *

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Your consent is require for your child to recieve flouride varnish application at Klawock City School District

Fields automatically entered: Name, Date of Birth, Mailing Address of Parent/Guardian 1, Phone number of Parent/Guardian 1
Please Mark:*

NO, I DO NOT give consent for my child to particpate. (SKIP FOLLOWING QUESTIONS & SIGNATURE)YES, I DO give consent for my child to recieve flouride varnish application
Health Information: Does you child have any current tooth or dental problems? (if yes, describe
Please list any physical conditions, allergies, illness, or surgeries that the dental staff should be aware of (asthma, recurring illnesses, disablities, chronic illness, etc.):
Billing Information: Does your child have Medicaid / Denali KidCare?

NoYes, please provide # below
Billing Information: Does your child have insurance?

NoYes, please provide insurance name and policy number below
Insurance holder's first and last name
Insurance holder's Date of Birth

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Date
By signing below, I acknowlege, understand, and give consent for my child to recieve flouride varnish application at Klawock City School District. I hereby authroize any third-party insurance benefits to be paid directly to the Southeast Alaska Regional Health Consortium (SEARHC). I also authorize SEARHC to release to my insurance company, Medicare or Medicaid any information required to process this clain. I am financially responsible for non-covered services.
Parent or Guardian's Name:
Signature

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2024-2025 Klawock School Student Registration

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact(s)

Emergency Contact 1

Emergency Contact 2

Emergency Contact 3

Emergency Contact 4

Restrictions of Contact and Information (when applicable)

Pick Up and Drop Off

District bus transportation eligibility

Bus Request Form will need to be filled out before the first day of school

Medical Information & Medication Notice:

Student may qualify for the following

Field Trip Permission

Your consent is require for your child to recieve flouride varnish application at Klawock City School District