Fiske School Dismissal and Permission Form 2011-2012

Student Name: ______

LastFirstMI

Grade ______Teacher ______

Dismissal Information - Please check one box for each day, including bus numbers.

Bus # / Walk/ Playground / Colony Road / Ext. Day / Other-Be Specific
Monday
Tuesday
Wednesday
Thursday
Friday

My child may be dismissed to the following adults other than parents/guardians:

______

______

Please indicate your give permission for each item by checking YES or NO and signing below.

YES / NO / SPECIFIC PERMISSIONS
I give permission for the following information to be published in the school directory as long as my child attends Fiske: Address, Phone, Email Address, Parents Names. Please cross out any information you do NOT want in the directory.
I give my permission for my child to be photographed/ videotaped and quoted for school purposes to inform the community about school activities via the School, PTO, or Community Newspaper.
I give my permission for my child to be photographed/videotaped and quoted for School purposes to inform the community about school activities via: School Website (Photos or students work only. Names will NOT be used).
I give my permission for my child to be photographed/videotaped and/or quoted for School activities via photographs and/or videotapes for display in school or for parents. NOTE: The law provides that students may be photographed during special events open to the public.
I give permission for my child (grade 3-5 only) to ride his/her bike to and from school unaccompanied. I understand that it is my responsibility to help my child find a safe route home, to teach my child bicycle safety rules, ensure that my child is wearing a helmet, and is responsible for locking his/her bike on school premises. Note: Skates, rollerblades, skateboards are not permitted on school property.

Your signature below indicated that you give your permission for all items checked yes above. Your signature will also indicate that you and your child have read and understand the Internet Policy on the back of this sheet as well as the School Behavior/Discipline Policy in the school handbook.

______

Signature of Parent/GuardianDate

Please Turn Over Sheet for Internet Rules for Elementary Students

Lexington Public Schools

Internet Rules for Elementary Students

2011 - 2012

  1. I will not use the Internet without a teacher’s permission and will only go to web sites approved by a teacher or librarian.
  1. I will never give out personal information about myself, family, or classmates, such as my address or telephone number.
  1. I will tell a teacher immediately if I come across any information that is

inappropriate or makes me feel uncomfortable.

  1. I will not use any Lexington Public School computer for accessing, sending or checking personal e-mail from any outside account. This includes free sites such as Hotmail, Yahoo, Juno, MySpace, Face Book, Twitter, etc.
  1. I will not respond to or send any messages that are threatening, harassing, or otherwise inappropriate.
  1. I will not participate in any chat sessions unless part of a class project and supervised by a teacher. I will not agree to meet with someone I “met” online. If a personal meeting is suggested, I will immediately inform my teacher.
  1. I will not share passwords with anyone.
  1. I will not enter contests or sign up to receive free information or material while using a Lexington Public School computer.
  1. I will not download any software from the Internet.
  1. I will not attempt to gain unauthorized access to the Lexington Public Schools computers, including access to another person’s account or personal files.

______

Student Signature Date

______

Parent/Guardian Signature Date

Please Turn Over Sheet for Dismissal and Permission Form