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SchoolMax Student Registration – January 2014

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Please complete one Student Registration Form for each child to be enrolled

STUDENT INFORMATION: SASID

Last Name First Name M I Preferred Name

M / F MM/DD/YY / / LEP ONLY

Y / N Y / N Grade Gender Date of Birth US Entry Date Birth Place Special Ed/IEP 504 Plan

Ethnic Background

In order to identify students correctly (as mandated by federal and state law). Please identify child’s Ethnicity & Race. Answer BOTH questions: 1. Is the Child Hispanic or Latino? (MUST check YES or NO) YES NO 2. What Race is your Child? (MUST check ONE or MORE)

American Indian or Alaska Native Asian Black or African American

Native Hawaiian or Other Pacific Islander White

PP RR EE VV II OO UU SS SS CC HH OO OO LL II NN FF OO RR MM AA TT II OO NN Please enclose a copy of this request with the records.

School Name:

Street Address: City/Town/Zip:

Attention: Records Department Phone Fax:

Dear Sir or Madam: The above mentioned student has registered in the Middletown Public Schools. We are requesting all academic and health records be forwarded to the address indicated below. Thank you in advance for your immediate attention to this request.

Yours truly,

/S/ Rosemarie K. Kraeger Superintendent

In order to receive the necessary records from your son/daughter’s previous school, it is required that a release form be signed. The following form, signed by the ppaarreenntt oorr lleeggaall gguuaarrddiiaann of the above named student, will grant the Middletown Public Schools the necessary permission to request and receive previous school records. I hereby request that you release the records for the above named student to the Middletown Public Schools.

Date: Signature: (Parent/Legal Guardian) Records to be released to:

J. H. Gaudet Middle School & Learning Academy Guidance Department 1113 Aquidneck Avenue Middletown RI 02842 401-846-6395

Middletown High School Guidance Department 130 Valley Road Middletown RI 02842 401-846-7250

Oliphant Administration Administration Office 26 Oliphant Lane Middletown RI 02842 401-849-2122

F o r O f f i c e U s e O n l y

Y / N Y / N / / / / Y / N Birth Certificate Immunization Verified Start Date Transcript Requested School ELL Screening Resident Status

8 1

RI Department of Education Home Language Survey The information requested on this form is necessary for the most appropriate placement for your child as required by Rhode Island Law (R.I.G.L. § 16-54-2) and the Equal Educational Opportunity Act (20 U.S.C. §1703(f)) and will not be used for any other purposes. Thank you for your cooperation. To be completed by parent or guardian: Student Name:_________________________________________________ Registration Date of Date: _______________________ Birth:___________________________ 1. What language do you use most often when speaking to your child? ____________________________________________________________ 2. What language did your child first learn to speak? ____________________________________________________________ 3. What language does your child use most often when speaking to you? _____________________________________________________________ 4. What language does your child use most often when speaking to other adults in the home or to their primary caretaker? _____________________________________________________________ 5. What language does your child use most often when speaking to siblings or other children in the home? _____________________________________________________________ 6. What language does your child use most often when speaking to friends or neighbors outside the home? ______________________________________________________________ ______________________________________________________________ Signature of Parent or Guardian Date

Print Parent/Guardian Name

Deborah A. Gist Commissioner

Revised 7-10

STATE OF RHODE ISLAND

School Name & Address:

Health Care Provider Name and Address: Phone:

SCHOOL PHYSICAL FORM

This form may substitute for any district-issued form. All districts must accept this form. General health examinations shall be documented in a standardized format with one copy available from the Rhode Island Department of Health or in any such format that captures the same fields of information (R16-21SCHO Section 8.4) Student Name: Last First Middle Date of Birth

Sex

Address: Street Apt # City State Zip Code Home Phone

PLEASE COMPLETE ALL INFORMATION BELOW (May attach immunization transcript). IMMUNIZATIONS Please enter dates in MM/DD/YYYY format

Hepatitis B

Diphtheria-Tetanus-Pertussis DTP/DTaP

Check if DT

Check if DT

Check if DT

Check if DT

Check if DT Pneumococcal Conjugate

PCV

Polio

Haemophilus Influenzae Type B Hib

Measles-Mumps-Rubella MMR

Varicella

Student has history of varicella disease

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Check if Td

Check if Td

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Hepatitis A

Meningococcal

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Hep B DTaP PCV Polio Hib MMR Varicella Td/Tdap Rotavirus Hep A Mening HPV PHYSICAL EXAMINATION

Date of PE _____/_____/_____ Height ___________ Weight___________ BP____________ Please note any health problem, chronic health condition or disability that may affect behavior or health at school:

ASTHMA: No Yes DIABETES: No Yes OTHER: ___________________________________________________________________

Significant Systems Findings: __________________________________________________________________________________________________________________

ALLERGIES: No Yes (Please explain) ___________________________________________EPINEPHRINE AUTO-INJECTOR REQUIRED: No Yes Treatment Plan: ____________________________________________________________________________________________________________________________ MEDICATION (REQUIRED AT SCHOOL): No Yes (Please list) _______________________________________________________________________ Other medication(s) that may affect behavior or health at school: _____________________________________________________________________________________ RESTRICTIONS: Can participate in physical education: Fully With limitation _____________________________________________________

Can participate in sports: Fully With limitation _____________________________________________________

LEAD SCREENING (Required for children < 6 years of age only) Student is in compliance with lead screening requirements:

Yes No

SCOLIOSIS SCREENING Yes No

VISION SCREENING (Children entering Kindergarten) Passed screening Screened and referred for comprehensive exam Referred for comprehensive exam, but not screened

TUBERCULOSIS (If required by school district) Date of TB test:

Screening Date: Comprehensive Exam Date:

HEALTH CARE PROVIDER SIGNATURE: ________________________________________________________________ DATE: _________________________________

PRINT NAME: ________________________________________________________________

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Student Health History‐SY 2014‐15‐Revised January 2014

MIDDLETOWN PUBLIC SCHOOLS

Office of the School Nurse-Teacher, Middletown, RI

STUDENT HEALTH HISTORY AND RELEASE Dear Parent or Guardian: Please fill out this Health History form as completely as you can so that the school will have all of the necessary information to safeguard your child’s health and well-being during school hours. Please contact your school Nurse-Teacher at your earliest convenience if your child has a potentially life threatening medical condition. According to RI Rules and Regulations for School Health Programs, 18.13.1 and 18.17, medical plans need to be put into place. Thank you.

Child’s Name: DOB:

Address: Telephone:

Previous School: (Name) (City) (State)

DOCTOR’S NAME: Telephone: Health Condition of Which School Should Be Aware: Asthma Physical Disability Diabetes (Family history of?) Yes No Ear Infections Eczema Emotional Problems Glasses Hearing Problems Headaches Speech Problems Seizure Heart Conditions Other Health Concerns Able to participate in full physical activity? Yes No Illnesses, Injuries, Operations (include dates): Chicken Pox Scarlett Fever Whooping Cough Pneumonia Bronchitis Other Medications? Name & Reason: Allergies: (if yes, be specific and describe what happens to your child): Release: Health information required by the Department of Health may be reviewed with my child’s physician. Parent’s Name (Print): Date: Parent’s Signature:

Medication Procedure Form/January 2014

In cases where your child’s health care provider has determined the necessity for medication to be administered at school, the following must be signed by the parent and completed by the health care provider.

MEDICATION PROCEDURE I authorize the school to give the following medication under my health care provider’s directions. The school nurse may contact the health care provider, if necessary, regarding this medication. Student’s Last Name First Name Student’s DOB School Grade & Teacher Parent’s Last Name First Name Parent’s Signature Date Parent’s daytime phone number

MEDICATION PROCEDURE – PHYSICIAN’S ORDERS Name of Physician (Print) Telephone I request that the following medication be administered to my patient as directed: Name of Patient: Name of Medication: Amount of Medication: Time of Medication: Duration of Medication: Possible side effects of medication: Reason for medication: PLEASE INITIAL THE FOLLLOWING THAT APPLY: For inhaler, epi-pen or , student may self-carry: Yes No In the event of a field trip, this medication: May be omitted Will be given upon return to school May be self-administered *Parent will consult with school nurse for all medication on field trips. Signature of Physician Date

26 Oliphant Lane, Middletown, RI * T: 401-849-2122 F: 401-849-0202

NOTE: MEDICATION MUST BE BROUGHT TO SCHOOL IN A CONTAINER PROPERLY LABELED BY THE PHARMACY. PLEASE

ASK PHARMACY TO GIVE YOU TWO LABELED BOTTLES, ONE FOR HOME AND ONE FOR SCHOOL. ALL MEDICATIONS

MUST BE TRANSPORTED TO SCHOOL BY A RESPONSIBLE ADULT.

Middletown Public Schools

Middletown Public Schools 26 Oliphant Lane, Middletown, RI 02842 * T: 401-849-2122 F: 401-849-0202

SEVERE ALLERGY PROCEDURE

This form MUST be completed by a Health Care Provider

Student’s Name: DOB:

Specific Allergy:

Has this student had prior anaphylactic reaction? (Circle YES or NO):

Please describe student’s prior allergic reactions and dates.

Please indicate by initialing the procedure to be followed for allergic reaction.

Give Benadryl dose; Observe for symptom of body itch, hives, rash, difficulty breathing, swallowing or loss of consciousness then give EpiPen dose.

OR

Give EpiPen dose immediately upon exposure.

Other treatments:

NOTE: Students treated with EpiPen will be transported via rescue to the Emergency Room for medical evaluation.

Health Care Provider Printed Name Date

Health Care Provider Signature Phone Number

Parent/Guardian Printed Name Date

Parent/Guardian Signature Phone Number

Severe Allergy Procedure Form Revised January 2014

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Middletown Police Department Office Of The Chief Of Police Telephone (401) 846-1144

9 Berkeley Avenue Fax (401) 846-0175

Middletown, Rhode Island 02842-5397

Dear Parent: The Rhode Island Sex Offender Registration and Community Notification Act (Meaghan’s Law) provides for notification to parents when certain sex offenders enter the community. Community notification is required for sex offenders whose risk assessment indicates a high risk of reoffense. While local police are responsible for notification, the school district must give the police a directory of the names and addresses of parents whose children attend each school. You have the right to have your name deleted from the directory that is given to the police for community notification purposes. This form is for you to have your name and address deleted from the directory. To have your name deleted from the notification directory, return the completed and signed bottom of this page by mail to Middletown Public Schools within 5 days. In summary:

IF YOU DO NOT WANT TO BE NOTIFIED OF HIGH RISK SEX OFFENDERS

WHO ENTER THE COMMUNITY, RETURN THE BELOW FORM. TO: Middletown Public Schools ATTN: Superintendent 26 Oliphant Lane Middletown, RI 02842 Please remove my name and address from the directory provided to Middletown Police Department for the purpose of sex offender notification. I understand that by submitting this form, I will not be notified by the Middletown Police of high risk sex offenders who enter the community. NAME: ADDRESS:

Signature Date

ANTHONY PESARE

Chief of Police

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Middletown Public Schools Transportation Policy Signature Form - Page 1

School Bus Transportation Policy Sections I, II & Signature Form Bus transportation is available, as required, for

students attending the Middletown Public Schools. Schedules, which list the school, the bus number and stops, approved by the police department, are published in the local newspapers prior to the start of the new school year. Copies of the schedule are available at the Superintendent’s Office in Oliphant School. Students who ride the school bus must understand that proper behavior is expected at all times. Bus transportation will be withdrawn from students who fail to observe the prescribed rules and regulations, herein listed, or who threaten the health or safety of other students or are discipline problems on the bus. I. SCHOOL BUS RULES AND REGULATIONS 1. The driver is in full charge of the bus, monitors and

students. Students must obey the driver and monitor promptly.

2. Students shall ride their regularly assigned bus at all times. They will board and leave the bus at their assigned stops unless permission has been granted by the appropriate school authorities to do otherwise.

3. Each student may be assigned a seat by the School Principal, or his/her designee and/or the driver or monitor.

4. Outside of ordinary conversation, classroom conduct must be observed. Abusive language, obscene gestures or fighting will not be tolerated.

5. Students are to assist in keeping the bus clean by keeping their wastepaper or other refuse off the floor. Students must also refrain from throwing refuse out of the windows. To help keep the bus clean, no food or drink is to be consumed on the bus.

6. No person shall smoke, light matches or light cigarette lighters on any school bus or at any school bus stop.

7. No person shall have possession of, consume, or be under the influence of alcoholic beverages or illegal drugs on any school bus or at any school bus stop.

8. No student shall, at any time, extend his/her head, hands or arms out of the window, whether the school bus is in motion or standing still.

9. Students must have nothing in their possession that may cause injury to others.

10. Each student must keep his/her books and personal belongings out of the aisle.

11. No one other than the driver shall sit in the driver’s seat. No one shall be located to the immediate left or right of the door.

12. Students are to remain seated while the bus is in motion and are not to get on or off the bus until it has come to a full stop.

13. Students must leave the bus in an orderly manner. They must not cross the road until given permission by the school bus driver. When boarding or leaving the bus, students should be in view of the driver at all times.

14. Students must cross the road at least ten (10) feet in front of the school bus and never behind it.

15. Students must not stand or play in the roadway while waiting for the bus. Students should leave home early enough to arrive at the bus stop before the bus is due.

16. Self-discipline will be exercised by students at the bus loading area. Students will refrain from pushing and shoving other students.

17. Students walking to and from bus loading areas should use sidewalks where available.

18. In the event of an emergency, emergency exit procedures, as established by the emergency exit drills, will be followed.

19. Students should never chase after any item that has fallen under or in front of any school bus. Immediately notify the bus driver, monitor or teacher.

20. Parents of students causing damage to school buses will be held responsible for full statutory reimbursement. Parents will be afforded the opportunity to make restitution within ten (10) school days, after which a complaint will be filed in accordance with the General Laws of the State of Rhode Island.

21. No student shall throw anything at or within a school bus.

22. Students must not, in any way, interfere with the safe operation of the school bus.

23. Students in grades 4 through 8 will be seated by grade level, oldest in the back.

24. No high school student shall be allowed to ride on a K-8 bus.

25. All parents must sign off that they have read sections I and II of this policy.




II. DISCIPLINE PROCEDURES 1. School bus transportation is an extension of the

school system. A student’s misconduct at a bus stop or on a bus will be sufficient reason to discontinue providing bus transportation to the student involved.

2. Violations of the Student Bus Code shall be reported to the Bus Company Manager, and shall in turn be reported to the appropriate Building Principal on standard form.

3. The Building Principal or his/her designee shall investigate the violation and, if substantiated, the Principal will proceed as stated in the Violation Section of this policy (see below):

4. Due process will be followed at all levels, including the right of appeal to the next level of authority.

5. Serious or extreme offenses of misconduct which endangers others on a bus may result in immediate suspension of bussing.

6. Principals shall maintain an independent administrative file of all actions dealing with disciplinary suspensions or warnings regarding transportation.

7. Principals will inform the person filing the report of such violation as to the action taken on the report.

VIOLATION SECTION FIRST VIOLATION – ALL STUDENTS K-12 The student shall be given a verbal warning for a first offense. If the violation is deemed to be one of a serious nature, one or more of the penalties listed in this section may be administered. SECOND VIOLATION – GRADE K-8 STUDENTS A letter will be sent home to parent and possible disciplinary action determined by principal or his/her designee. .

SECOND VIOLATION – GRADE 9-12 STUDENTS Student suspended from transportation for five school days and conference with parent. Letter to parent and one or more of the penalties listed herein if the violation is determined to be a serious offense. THIRD VIOLATION – GRADE K-8 STUDENTS Mandatory parent conference and possible temporary suspension or termination of bus services. THIRD VIOLATION – GRADE 9-12 STUDENTS Suspension of transportation and letter to parent. FOURTH VIOLATION – GRADE K-8 STUDENTS Termination of bus services for remainder of school year.




PLEASE RETURN A COMPLETED FORM TO THE MAIN OFFICE.

Middletown Public Schools – Student Transportation Policy Signature Form

Please read this agreement carefully: Bus transportation is available, as required, for students attending the Middletown Public Schools. Students

who ride the school bus must understand that proper behavior is expected at all times. Bus transportation will be withdrawn from students who fail to observe the prescribed rules and regulations or who threaten the health or safety of other students or are discipline problems on the bus.

School bus safety is everyone’s responsibility. Violations of school bus policy or motor vehicle laws and

unsafe conditions should be reported to the proper authority. If you have questions concerning school bus policy or safety, contact your child’s Building Principal.

All students that ride the school bus must abide by all the rules and regulations of the Middletown

Public Schools School Bus Transportation Policy. (The complete policy and details can be found at www.mpsri.net.) Sections I and II of the School Bus Transportation Policy are attached to this form. These sections must be read and reviewed with your child. Please sign this form and return to your child’s school indicating that this has been done.

Print Student’s Name Student’s Signature

School Grade

Print Parent/Guardian’s Name Homeroom/Advisory

Parent/Guardian’s Signature Date

Attention Schools - Please forward this completed request form to the school’s Main Office.

Office Use

Date Rec’d Complete: ST208 (Tran Type)

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Notes:

Computer and Internet Acceptable Use Policy Page 1

MIDDLETOWN PUBLIC SCHOOLS COMPUTER AND INTERNET ACCEPTABLE USE POLICY

For the purpose of this document, the term Computer applies to all district technology assets, whether or not they are connected to the network. Policy The School Committee recognizes that as telecommunications and other new technologies shift the ways that information may be accessed, communicated and transferred by members of the society, those changes may also alter instruction and student learning. The School Committee supports access by students to rich information resources and the acquisition of appropriate skills to analyze and evaluate such resources. It also recognizes both the need and legal requirement to implement a program that will protect students from access to materials and information deemed inappropriate to the district. The district affords the opportunity to parents/guardians to explicitly grant or deny access to the Middletown Public Schools’ Computers and Internet access, as well as permission to publish student work on the Internet. The Middletown Public Schools also recognizes the need for faculty and staff to support appropriate use of the Computers and Internet access and to abide by parent/guardian’s decision regarding student access. Program In partnership with students, parents, and community of the Middletown Public Schools provides a comprehensive, safe educational environment that is learner-centered, enabling all students to succeed in the global economy of the 21st Century. This environment provides rich opportunities for students to find and utilize current information and resources, and apply academic skills for solving real-world problems through the use of technology. Certain conditions are necessary for schools to effectively use this technology for learning, teaching, and educational management. Middletown Public Schools is pleased to offer all students, faculty and staff in our district access to its Computer and Internet services. Access to the Internet will enable our students, faculty, and staff to explore thousands of libraries, databases, and educational sites throughout the world. Although the Internet offers extraordinary resources for education, it also hosts a vast collection of inappropriate sites. All users should be warned that some materials accessible via the Internet might contain items that are illegal, defamatory, inaccurate, or potentially offensive to some people. In order to prohibit access to these sites and to meet the Children's Internet Protection Act requirement for e-rate eligibility, Middletown Public Schools has implemented Internet content filtering provided by Rhode Island Network for Educational Technology (RINET). Internet content filtering is a process by which requests for sites on the Internet are inspected and then allowed or denied based upon a selected set of filtering criteria. It is important to note that no filtering solution is perfect and Internet access entails user responsibility. We believe the benefits to our students from access to the Internet, in the form of information resources and opportunities for collaboration, exceed any disadvantages. Parents and guardians are responsible for setting and conveying the

standards their children should follow when using media and information services. Middletown Public Schools supports and respects each family's right to decide whether or not to apply for access in our schools. Students will be given the privilege to use the Computers and Internet along with the responsibility of using it properly by returning a Student-Parent/Guardian Acceptance and Permission Form, completed and signed by the student and parent/guardian, to his/her school principal. In addition, students will need the permission of and must be supervised by the Middletown Public School’s faculty and staff. Internet access is coordinated through a complex association of government agencies, as well as regional and state networks. The smooth operation of the network relies upon the proper conduct of those who use it. In general, this requires efficient, ethical, and legal utilization of the network resources, as well as adherence to school and district codes of conduct. If a user violates any of these provisions, disciplinary action will result. In a case where codes of conduct or laws are broken, further consequences may result. Middletown Public Schools will cooperate fully with local, state, and federal officials in any investigation concerning or relating to illegal activities conducted through Middletown Public Schools' Network. The signature(s) on the Student-Parent/Guardian Acceptance and Permission Form are legally binding and indicate that the parties who signed have read the terms and conditions carefully and understand their content. Computer and Internet Responsibilities and Guidelines Responsibilities of Students � Learn and follow the guidelines set forth in this Acceptable Use Policy. � Return permission form signed by the student and a parent/guardian stating that they agree that the student will adhere to all guidelines and assume responsibility for their actions. � Report any Computer and Internet contacts that are defamatory, obscene, racially or sexually oriented or which may contain illegal materials, to the supervising teacher or principal. Responsibilities of Parents/Guardians � Review and provide support for this Acceptable Use Policy with your child. � Provide guidance in the ethical and appropriate use of the Computer and Internet as provided in this Acceptable Use Policy

Return completed permission form that indicates agreement to student adherence to all guidelines and responsibility for their actions. Responsibilities of Staff Members It is expected that staff and faculty members in Middletown Public Schools will use the computer and Internet for research and/or instructional purposes only. Staff and faculty members should maintain the highest ethical behavior in using the Internet and faculty members should promote that behavior among students. Employee violations of the Acceptable Use


Policy will be handled in accordance with law, school policy, and collective bargaining agreements, as applicable. � Learn and follow the guidelines set forth in this Acceptable Use Policy. � Make every attempt to maintain the curricular focus of Internet use by locating and directing students toward educational sites on the Internet. � Supervise student use at all times. � Ensure that all student users have signed permission slips from a parent/guardian. � Model and provide instruction in the ethical and appropriate use of the Computer and Internet in a proper school setting as provided in the following guidelines. � Agree not to share access codes, accounts or passwords with any student. � Report incidences of Computer and Internet misuse and abuse to the Information Technology Office

Make appropriate accommodations for students who have been denied access to the Network and/or Internet by their parents/guardians Guidelines Middletown Public Schools' Computers and Internet access are to be used in a responsible, efficient, and legal manner and must be in support of the educational goals and objectives of Middletown Public Schools and the State of Rhode Island. Middletown Public Schools’ strongly believes in the educational value of electronic services and recognizes their potential to support curriculum and to allow staff to efficiently provide educational services. The District goal in providing this service is to promote educational excellence by facilitating research, innovation, communication, and business efficiency. All rules and policies of the Middletown Public Schools' apply, and are not limited to the following:

1. All users are responsible for appropriate behavior when using the Computer and the Internet just as they are when involved in any school activity. General school rules and policies apply to all computer use and Internet activity and communication.

2. The purpose of using the Internet at school is to support research and educational goals. Use of the Computers and Internet must always support those goals.

3. Games and electronic mail may only be used if a student has explicit permission from a staff member.

4. All users must: Protect oneself and others by not sharing their

passwords or using another user’s password Protect oneself and others by not revealing personal

addresses or phone numbers Use appropriate language Abide by all copyright laws, including but not limited

to unauthorized copying of software

5. The following actions are prohibited: Participating in commercial activity (defined as

buying, selling, bartering, or advertising; including, but not limited to the use of credit cards)

Downloading and/or installing software, shareware or freeware

Using electronic mail, chat rooms, and other forms of direct electronic communication without permission of the supervising teacher

Disrupt the use of the network or others Destroying, modifying, or abusing hardware or

software in anyway Wasting limited resources such as disk space or

printing capacity

Sending or displaying offensive messages or photos Using another person's password or account Accessing other people's folders, files or programs Harassing, insulting or attacking other users Willfully destroying or vandalizing other people's

work, computers or computer programs and files

Sanctions

� Privileges. The use of the Computers and Internet at Middletown Public Schools is a privilege, not a right. Inappropriate use will result in disciplinary action. � Vandalism. Vandalism will result in disciplinary action. Vandalism is defined as a willful or ignorant defacing, disabling, or destruction of data of another user, software, computers, peripherals, or other network resources. This also includes, but is not limited to, uploading, creating, or transmitting computer viruses. � Security. Security on any computer system is a high priority, especially when the system involves many users. Attempts to login to the system as any other user or to share a password will result in school disciplinary action. If a security problem is identified by you, notify the supervising teacher. Do not demonstrate the problem to other users. � Privacy. System administrators may review files and communications at any time to maintain system integrity and insure that users are using the system responsibly. There should be no presumption of privacy for communications stored, sent, received, or accessed through Middletown Public Schools’ computers, network, e-mail system, and Internet connection. It is a matter of law that any document pertaining to the public business on a publicly funded system is a public record. All electronic correspondence and data, is subject to the discovery process based upon the Federal Rules of Civil Procedure. � Disciplinary Action. Disciplinary action may be taken in the event that the provisions of this policy are violated. The disciplinarian administrator and the technology department will have discretion in deciding on what action, if any will be taken against persons violating the provisions of this policy. Handling of violations to this policy may vary according to the particular situation. Where the use of the computer is an integral part of the instructional program, violators need to be disciplined immediately and regain access to the computer so that instruction may continue. Disciplinary action may consist of 1) parent contact 2) restitution/restoration for damages and time involved 3) detention 4) suspension 5) legal action 6) access suspended. If a users access is suspended as a result of violations, the user may appeal the suspension to the Technology Committee. Employee violations of the Acceptable Use Policy will be handled in accordance with law, school policy, and collective bargaining agreements, as applicable. � Disclaimer. Middletown Public Schools will not be responsible for any damages suffered, including loss of data resulting from delays, non-deliveries, service interruptions, or inaccurate information. APPENDIX 1) Student-Parent/Guardian Acceptance and Permission for Computer and Internet Use 2) Student-Parent/Guardian Acceptance and Permission for World Wide Web Publishing of Student Work Policy Approved By The School Committee May 29, 2002 Revised - February 15, 2007


APPENDIX 1 Middletown Public Schools

Computer and Internet Acceptable Use Policy

Student-Parent/Guardian Acceptance and Permission for

Computer and Internet Use

The Student (user): I have received my parent(s)/guardian(s) permission and I have read the Middletown Public School’s Computer and Internet Acceptable Use Policy. I understand and agree to all the provisions, rules and regulations outlined within. I understand that any violation of the Middletown Public School’s Computer and Internet Acceptable Use Policy may result in disciplinary action.

Print Student’s Name Student’s Signature Date

School Name Grade The Parent/Guardian: As the parent(s)/guardian(s) of the above named student I have read the Middletown Public School’s Computer and Internet Acceptable Use Policy and I understand and agree to all the provisions, rules and regulations outlined within. I hereby give permission for my child to use the Internet services provided by the Middletown Public Schools. I do understand that my child is required to follow this policy. I further understand that there is a potential for my son/daughter to access information on the Internet that is inappropriate for students and that every reasonable effort will be made on the part of the faculty and staff of the Middletown School Department to monitor access to such information, but that my son/daughter is ultimately responsible for restricting himself/herself from inappropriate information.

Print Parent/Guardian’s Name Parent/Guardian’s Signature Date Please return to the building principal.


APPENDIX 2

Middletown Public Schools Computer and Internet Acceptable Use Policy

Student-Parent/Guardian Acceptance and Permission

for World Wide Web Publishing of Student Work

I give Middletown Public Schools the right to use my son or daughter’s work on the Internet. This material would only be used with regard to activities related to the Middletown Public Schools web site. A student’s last name, address or any other easily identifiable element will not be included.

I grant permission for the World Wide Web publishing as described above.

Print Student’s Name Student’s Signature School Grade Print Parent/Guardian’s Name Parent/Guardian’s Signature

Please return to the building principal.

Release for Child’s image-Updated January 2014

RELEASE FOR CHILD’S IMAGE

There are times during the school year when we take pictures of the children in the Middletown Public Schools. It may be an informational video that we wish to produce for Cox Cable, or it may be a photograph of children at work to be placed on the school web page. Children are never identified by name in either of those cases unless we notify the parent/guardian. It would only be their image that would be used. Sometimes The Newport Daily News and The Providence Journal will take pictures for publication. They like to have permission to use the name of the children in those situations. There are other times when the school or a teacher will create a book for the class or school use. (Our school yearbook is an example). They would use their images of the children for the book and that publication might be sent home or used at a professional conference for demonstration purposes.

PLEASE SIGN THIS FORM AND RETURN IT TO SCHOOL (OR AT TIME OF STUDENT REGISTRATION).

Child’s Name School Teacher Date Parent/Guardian Printed Name Parent/Guardian Signature

PLEASE CHECK ONE:

Yes, I give the school permission to use my child’s image in instances such as those mentioned above. No, please do not use my child’s image for any reason.

Middletown Public Schools 26 Oliphant Lane

Middletown, RI 02842

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