Application for Illuminate Home Connection

APPLICATION FOR ILLUMINATE HOME CONNECTION

PALO VERDE UNIFIED SCHOOL DISTRICT

To participate in Illuminate Home Connection, complete this application. Please print clearly, sign where indicated and return this application to your child’s school office. Usernames and Passwords will be released only to parent’s & legal guardians. Others who wish access to student data must have the parent’s or legal guardian‘s authorization. Photo identification must be presented when application is submitted. Upon completion of your application, an email and access code will be sent to you. Follow the instructions to complete you registration.

Parent / Guardian: ______

Address: ______

City, State, Zip: ______

Phone No.: ______

Email Address: ______

I understand that it is my personal responsibility to safeguard my Username and Password. I understand that the privacy of my student’s school information may be at risk if this Username or Password is lost or shared with others.

I agree to change my Password at the Home Connection website if I believe others may have gained access to my Username or Password. I agree to notify my student’s school if I need assistance in changing my password.

I certify that I have the legal right to view the information contained on Illuminate Home Connection for the child/children I have listed below. I also agree that the information I have supplied here is accurate to the best of my knowledge.

Parent / Guardian Signature: ______Date: ______

List students attending Palo Verde Unified School District, their date of birth, your relationship to the student, and their school.

Student Name / Date of Birth / Relationship / School

SCHOOL USE ONLY

Date received ______Received by ______

How confirmed ______PIN ______