Southern Door County School District 2073 County Trunk DK Brussels, WI 54204

HIGH SCHOOL ANNUAL PARENTAL CONSENT FORM FOR 2014-15 This form must be returned to your building principal as part of the registration process prior to the start of school. If you have specific questions regarding the above information, please direct them to your building principal. Student’s name:

School: Last

Grade:

First

Dear Parents/Guardians: Each year, we request your consent on a number of issues. This letter asks you to give permission on four separate issues. We only ask for your consent on these four issues at the beginning of the school year. Please fill out your child’s name above. This form must be returned along with your child’s enrollment card information. Your signature is required at the end.

1. Release of Student Directory Data (Board Policy 5270 and Rule 5270.1)—State law protects the confidentiality of student records. An exception has been made, however, for student information considered to be directory data. Unless you decline release of this directory data (below), directory data becomes a public record—open to the public. The Southern Door County School District defines directory data as student name, address, telephone listing, date and place of birth, dates of attendance, photographs and the name of the school the student most recently attended. For example, some of this information could appear in a student handbook, classroom/school directory, student newspaper or yearbook.  Yes, you may release my child’s directory data.  Yes, but please release only my child’s name, grade, teacher, and yearbook photo (minimum required for student/family handbook/directory listing/yearbook).  No, please do not release any data other than my child’s name. (This includes for memory/yearbook purposes).

2. Student Directory Data Provided to Military and Institutions of Higher Learning (No Child Left Behind Act of 2001 and Board Policy 5270 and Rule 5270.1)—As part of this education legislation, local school districts receiving federal assistance are required to provide, when requested by military recruiters or institutions of higher education, access to secondary school students’ names, addresses and phone numbers. A secondary school student, or the parent

of student, may request that the student’s information not be shared. You may share personal information (name, address, phone number) about my child with: Military recruiters

Yes No

Higher educational institutions

Yes No

3. Permission for Students to be Interviewed, Photographed or Videotaped in School (Policy 5270 and Rule 5270.1)— From time to time, TV, radio, newspapers, websites or other entities request to interview, photograph or videotape students. Interviews, photographs and videos of your children may be considered confidential student records. The district requires your permission if interviews or images will appear outside the district including those on the World Wide Web. Such consent is not required when photos, film or interviews will be available only to school district personnel or other students or when photographing or videotaping large groups of students.  Yes, my child may be photographed, videotaped or interviewed if the principal or my child’s teacher believes it to be appropriate.  No, my child may not be photographed, videotaped or interviewed, except as noted above. 1. Student Access to Internet (Board Policy 5280) — I give permission for my child to access networked computer services, such as e-mail or the Internet, under the supervision of school staff. There are certain online academic assessments (e.g. MAPS) that my child is required to take. We are aware of the Student Acceptable Use Guidelines.  Yes, I grant my child permission for school purposes. My child understands that inappropriate behavior may result in loss of privileges.  No, I do not grant my child permission. I DO understand that my child will still be responsible for completing assigned school work.

This form must be returned to your building principal as part of the registration process prior to the start of school. If you have specific questions regarding the above information, please direct them to your building principal.

I have indicated my preferences above regarding my child for the 2014-15 school year.

Parent/Guardian’s Printed Name

Parent/Guardian’s Signature

Date