SUMMER ENRICHMENT PROGRAM 2016 Emergency /Enrollment Card
Student’s Name ______
Last First MI Student ID# Birth Date
Grade Entering (circle one) 1 2 3 4 5 6 7 8 □ Boy □ Girl
Address: ______Home # (____)______
Street Apt# City Zip
Mother/Guardian Name: ______Work / Cell # (____)______
Father/Guardian Name: ______Work / Cell # (____)______
Caregiver’s Name: ______Work / Cell # (____)______
Name of local emergency contact person (not parent) ______Phone # (____)______
Hospital: ______Doctor’s Name: ______Phone # (____)______
Health Concerns/Allergies: ______
Current Medications: ______
In case of emergency or illness and the school is unable to reach parent/guardian, child may be taken to the nearest emergency facility for treatment.
______
Signature of Parent/Guardian Date
Milpitas Unified School District’s Acceptable Use of Electronic Information Resources Agreement and Media Release Form that accompanies this Registration Form and Emergency/Enrollment card must be signed and turned in during registration. Please note that the Acceptable Use of Electronic Information Resources Agreement must be signed by the student as well as the parent.
Students MUST bring the following on the first day of summer School:
√ Completed Registration Information
√ Completed Emergency/Enrollment Card
√ Parent/Guardian Signature
√ Media Release Form with signature
√ Acceptable Use of Electronic Information
Resources Agreement with signature
Questions? Contact Summer Enrichment Program
1331 E.Calaveras Blvd., Bldg. 400, Milpitas, CA 95035 (408) 635-2692 or email
SIGNATURE REQUIRED
Milpitas Unified School District
1331 E. Calaveras Blvd. • Milpitas, CA 95035 • (408)635-2600
Media Release Form
Student Name: Student ID Number
School
Milpitas Unified School District (MUSD) is proud of the work of its students and may wish to showcase this work on the district or school web pages. The district or schools may wish to highlight individual achievement related to a posted project or report on an individual or team accomplishment and may wish to accompany such acknowledgement with a student picture. Student home addresses and home phone numbers will NEVER be posted on MUSD web pages.
Throughout the school year, staff members or members of the media may come to our classrooms or to school events to photograph students for district publication, video, displays, websites, news stories or other such purposes. Your son/daughter may also appear in a photograph, school/district TV channel, video, have their voice recorded for radio or have their name in a news article.
In order to verify that you have been notified of these possible activities and to ensure that we know your preference should your son/daughter be published, televised, recorded or photographed, please complete this form and return it to your school office.
Thank you for your cooperation. (Check only ONE of the following boxes.)
q I have reviewed this information and give permission to have my son/daughter
included in any or all of the activities mentioned above.
q I have reviewed this information and refuse permission to allow my son/daughter to be included in any of the activities mentioned above.
______
Name of Student School
______
Teacher or Homeroom
______
Signature of Parent/Guardian Date
SIGNATURE REQUIRED
Milpitas Unified School District
1331 E. Calaveras Blvd. • Milpitas, CA 95035 • (408)635-2600
Acceptable Use of Electronic Information Resources Agreement
Student Name Student ID Number School
Milpitas Unified School District (MUSD) believes in the educational value of technology and recognizes its importance for supporting curriculum, instruction, and management. The district network and Internet connection have been developed as tools to promote educational excellence, innovation, and communication for students, staff and district volunteers. Due to its open nature, there is information available on the Internet that is inappropriate for district use. It is the district’s intent to protect students, staff, and volunteers from inappropriate information by:
· meeting or exceeding all state and federal content filtering guidelines;
· requiring adult supervision and monitoring of student Internet use;
· directing each user to accept personal responsibility for managing the resources appropriately.
The following provisions specify the expectations for all users of Milpitas Unified School District network. No user is authorized to access the district network until the Acceptable Use of Electronic Information Resources Agreement is signed by all required persons. Inappropriate use may result in the cancellation of the user’s privileges, disciplinary action and/or legal action. The District reserves the right to retrieve and read any messages composed, sent or received. Users should have no expectation of privacy.
Basic Terms of Use:
Personal Responsibility: I accept personal responsibility for my use of the district network. I understand that all school and district rules of conduct apply when I am on the district network or connected to the Internet through the district. I accept personal responsibility for any costs, liabilities or damages as a result of my use of the network. I also accept personal responsibility for reporting any misuse of the network to an appropriate district staff member. I understand that no technology is perfect and I will not hold the district or district personnel responsible for the failure of any technology systems.
Acceptable Use: I understand my use of the district network is to be limited to educational activities, research, communication, and it will support the educational goals and objectives of the Milpitas Unified School District. In addition, I will follow these guidelines:
a. I will not transmit any material in violation of the law, including copyrighted, threatening or obscene material.
b. I will not use the MUSD network for personal financial gain, advertising or political activities.
c. I will not attempt to hack into the MUSD network or hack from MUSD into another system.
d. I will not use another person’s account or password, nor allow another person to use mine.
e. I will not send chain letters, annoying or unnecessary messages. Nor will I send unnecessary mail to a large number of people.
f. I will be polite: never send or encourage others to send abusive messages.
g. I will use appropriate language: never swear, use suggestive, threatening, obscene or other offensive language.
Network Behavior and Privacy: I understand and will follow the generally accepted rules of network behavior:
a. Privacy: never reveal any person’s home address, phone number or other important personal information. Never ask for personal information from another person.
b. Disruptions: do not use the district network in any way that would disrupt others.
c. Harassment: never send messages, images, or other files or links to harass another person or organization.
d. E-mail: district e-mail is not guaranteed to be private. Sending or receiving encrypted or encoded messages is strictly forbidden.
e. Abusive or threatening e-mail messages may be turned over to law enforcement.
(Check only ONE of the following boxes.)
q I have read and agree to abide by this Acceptable Use of Electronic Information
Resources Agreement.
q I do not wish my child to use the Internet at school.
User Signature: Date:
Parent/Guardian Signature: Date:
(Required for all minors)
Milpitas Unified School District 1331 E. Calaveras Blvd Milpitas, CA 95035 (408) 635-2600