Steel Valley School District: Start of School Required Forms

Steel Valley School District

Back to School: Required Forms
Student Information
Name*

Last NameFirst Name
Grade*
Birthdate*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Primary Parent/Guardian Name*

First NameLast Name
Phone Number *
(primary number for school communication)
Email*
example@example.com

Emergency Care/Contact Form
For your child's welfare, we ask that you fill in this form as completely as possible to avoid delay at the time of emergency. In case of a serious accident or illness, it is imperative that school personnel be able to contact a parent/guardian. If unable to contact a parent/guardian, permission is granted to arrange for emergency hospital treatment if deemed appropriate. I hereby agree to hold the Steel Valley School District and their representatives harmless for exercising judgement in an emergency situation.

NOTE: Treatment of any child is the priority. Every effort will be made to contact the primary parent/guardian first.

In case of emergency, illness, or accident to the student named above, the school is authorized to call the following numbers:
#1 Emergency Contact*

Full NamePhone #Relationship
#2 Emergency Contact*

Full NamePhone #Relationship
#3 Emergency Contact*

Full NamePhone #Relationship
#4 Emergency Contact

Full NamePhone #Relationship
List any health problems you or your child's physician feel should be known to the school nurse:*
If none, please indicate with n/a
List any medications your child is allergic to*
If none, please indicate with n/a
Primary Parent/Guardian Signature*

Clear

Internet Etiquette and Required Signatures
This is your agreement with the Steel Valley School District regarding Internet conduct. It is suggested that you read this page carefully.

Student:

I understand that the Steel Valley School District's Internet service is provided for educational purposes only. I agree that I will use the Internet only for educational purposes and that I will not misuse it by accessing areas that are explicitly non-educational. Misuse can come in many forms, but can be viewed as solicitation of pornography, other unethical or illegal solicitations, racism, sexism, inappropriate and vulgar language, as well as any other use that does not have an explicit educational purpose. I understand that I am responsible for my conduct if I am found accessing unacceptable Internet sites.

I understand and will abide by the provisions of this contract. I understand that any violation of the above may result in disciplinary action, the revoking of my access privileges, and appropriate legal action. I will not hold the Steel Valley School District responsible for, or legally liable for, materials distributed from or acquired through the Internet. I also agree to report any misuse of the Internet to my teacher, the building principal, or the Technology Director.
Student Name*

First NameLast Name
Student Signature*

Clear
Date*

MonthDayYear
Date
Parent/Guardian:

As the parent/guardian of , (student name)* , I have read this contract and understand that the Steel Valley School District's Internet service is provided for educational purposes only. I also understand that it is impossible for Steel Valley School District to restrict access to all controversial materials. I will not hold the Steel Valley School District responsible for, or legally liable for, materials distributed from or acquired through the Internet. I understand that any violation of the above provisions may result in disciplinary action, the revoking of my student's access privileges, and any appropriate legal action.

I accept full responsibility for supervision if my student accesses the Internet either in or out of the Steel Valley School District setting.
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Student Pick-Up Authorization Form
I, Parent/Guardian's Name*, authorize the Steel Valley School District to release my child(ren) to the person(s) designated. This is in agreement with the Steel Valley School District Emergency Management Plan.
Note: Parent(s)/guardian(s) should designate themselves as designated custodians. Friends, neighbors, and other relatives may be so designated.
Designated Custodian (Primary Parent/Guardian)*

Full NameRelationship to Student
Designated Custodian *

Full NameRelationship to Student
Designated Custodian *

Full NameRelationship to Student
Designated Custodian *

Full NameRelationship to Student
Designated Custodian

Full NameRelationship to Student
Designated Custodian

Full NameRelationship to Student
Designated Custodian

Full NameRelationship to Student
Parent/Guardian Signature*

Clear
Should be Empty:

Steel Valley School District

Student Information

Parent/Guardian Information

Emergency Care/Contact Form

Internet Etiquette and Required Signatures

Student Pick-Up Authorization Form