A separate form will be required for each student enrolled in our school district.

STUDENT INFORMATION:

Sometimes photographs, video footage, or other images of students are taken during school activities by the district or under its direction. The images may then be presented in various school-sponsored media, including photographs, video productions, newspapers, television programs, brochures, handbooks, programs, on the district Website, and in the live Internet broadcast of the district's graduation ceremony. Do you give consent to use your student's photo/image in these ways?

I understand that my student's computer use is not private and that the district will monitor all activity on the computer system. I have read the district's Internet/Acceptable Use Policy. In consideration for the privilege of my student using the district's electronic communications system, and in consideration for having access to the networks, I hereby release the district, its operators, and any institutions with which they are affiliated from any and all claims and damages of any nature arising from my student's use of, or inability to use, the system, including, without limitation, the type of damage identified in the district's policy and administrative regulations. Do you authorize internet access for your student?

Google Access Agreement: At Collinsville Public Schools, we use G Suite for Education account for your child. G Suite for Education is a set of education productivity tools from Google including Gmail, Calendar, Docs, Classroom, and more used by tens of millions of students and teachers around the world. At Collinsville Public Schools, students will use their G Suite accounts to complete assignments, communicate with their teachers, sign into their Chromebooks, and learn 21st century digital citizenship skills. You can click here for common questions about what Google can and can't do with your child's personal information. Do you give permission for Collinsville Public Schools to create/maintain a G Suite for Education account for your child and for Google to collect, use, and disclose information about your child only for purposes described in the notice above?

Transportation Safety and Behavior Code for Bus Riders: In order for you to understand and become familiar with the regulations covering the conduct of your child while riding a Collinsville Public School Bus, as well as your own responsibilities, we are sending you excerpts from SCHOOL BUS TRANSPORTATION, COLLINSVILLE PUBLIC SCHOOLS, POLICIES, REGULATIONS AND PROCEDURES, pertaining to you. It is requested that you and your child read these responsibilities and regulations. Your cooperation with us will make it possibile to provide a safer and more efficient transportation program. Do you agree that you and your student have reviewed the Bus Transportation Policies, Regulations and Procedures and will abide by them?

Collinsville School District wants to make sure you are informed about policies, procedures, and practices related to your student. Please read all the information provided regarding school policies, handbooks, media and technology that may impact your student.

The following policies can be located here on the school website. A hard copy may be requested from the school office if needed.

I have been informed where to obtain a copy of the Student Parent Handbook and accept the responsibility to review and discuss it with my parent/guardian/student. I understand that the handbook contains information I may need during the school year and that all students will be held accountable for their behavior and will be subject to the disciplinary consequences outlined in the handbook.

I hereby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System ("OSIIS") to Collinsville Public Schools.  The information may be disclosed for the following purpose(s): to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3 T

I understand that by voluntarily signing this authorization:

* I authorize the use or disclosure of my PHI as described above for the purpose(s) listed.
* I have the right to withdraw permission for the release of my information and revoke this authorization at any time in writing.
* I have the right to receive a copy of this authorization.
* I understand that unless the purpose of this authorization is to determine payment of a claim for benefits, signing this authorization will not affect my eligibility for benefits, treatment, enrollment, or payment of claims.
* I understand I may change this authorization at any time in writing. However, I understand I cannot restrict information that may have already been shared based on this authorization.
* Information used or disclosed pursuant to the authorization may be subject to redisclosure by the recipient and may no longer be protected by HIPAA Privacy Regulations.

Unless revoked or otherwise indicated, this authorization’s automatic expiration date will be one year from the date of my signature or upon the occurrence of the following event [ e.g., child no longer enrolled in school/day care center]

No Weapons Policy: This district has a strict no weapons policy. Do you agree that you and your student will abide by it?

Collinsville Public School District's automated messaging service includes but is not limited to: school closings, upcoming events, emergency situations at school, absences, lunch account balances, enrollment, or any other notice related to school that District officials determine should be communicated by automated message.