1 ________________________________________ _____________________________ (Parent/Guardian Signature) (Date) Christian County Public Schools Student Enrollment Form Entry Date: __/__/___ Demographic Information Student’s Legal Name _______________________________________________________________________________________ Last First Middle “Nickname” Address: Street City State Zip Home Phone: Student Cell Phone (if applicable): Birthdate: _____/_______/______ Place of Birth (State):______ Place of Birth (Country): ________________ GRADE: ______ Month Day Year Student Social Security # Sex: Male Female Student Email Address (if applicable): __________________________________________ Race/Ethnicity: Is this student from one or more of these races? (Please check all that may apply) Hispanic/Latino American Indian or Alaska Native Asian African American Native Hawaiian or Other Pacific Islander White Other____________________ Last School Attended (for transfer students only) Name of School: ________________________________________________________ Grade: ______________ Physical Address: City, State & Zip Phone Number: _________________________________ Fax Number: ___________________________________ I give permission to request all records from this school. ____________________________________________________ (Parent Signature) Have you been in a Christian County School before? Yes No Which school and when? ______________________ If not, have you been in a Kentucky school before? Yes No Which district and when? ______________________ Transportation Does this student ride a bus? Yes No If YES: Both ways Only TO school Only FROM school If you know the Bus Number(s) please list here: A.M. _______________ P.M. _______________ If a car rider, who will pick the student up? ______________________________________________________ Military/Federally Connected Is parent/guardian Active duty military Retired military Current civilian employee (Example: Fort. Campbell) Is this student military connected? Yes No Service member name: Relationship to student: Branch of Service: Current Battalion: Current Company: Work/duty phone # (for emergency contact) Participation in Programs Please check any special programs in which the student has participated: Speech/Language Special Education *If yes, please specify disability ____________________________ 504 Plan Gifted/Talented Migrant English Second Language Limited English Proficiency Is child attending on Hardship? Yes No If yes, what is his/her zone school_________________________ FOR OFFICE USE ONLY: Birth Certificate Immigrant Status Immunizations Eye Exam Physical Dental Screen/Exam Social Security Card T-code ____________ Homeroom Teacher _____________________ _
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Christian County Public Schools Entry Date: Student ...
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I give permission to request all records from this school. ____________________________________________________
(Parent Signature)
Have you been in a Christian County School before? Yes No Which school and when? ______________________
If not, have you been in a Kentucky school before? Yes No Which district and when? ______________________
Transportation Does this student ride a bus? Yes No If YES: Both ways Only TO school Only FROM school
If you know the Bus Number(s) please list here: A.M. _______________ P.M. _______________
If a car rider, who will pick the student up? ______________________________________________________
Military/Federally Connected
Is parent/guardian
Active duty military
Retired military
Current civilian employee (Example: Fort. Campbell)
Is this
student
military
connected?
Yes
No
Service member name:
Relationship to student:
Branch of Service:
Current
Battalion:
Current Company: Work/duty phone # (for
emergency contact)
Participation in Programs
Please check any special programs in which the student has participated:
Speech/Language Special Education *If yes, please specify disability ____________________________
504 Plan Gifted/Talented Migrant English Second Language Limited English Proficiency
Is child attending on Hardship? Yes No If yes, what is his/her zone school_________________________
FOR OFFICE USE ONLY:
Birth Certificate
Immigrant Status
Immunizations
Eye Exam
Physical
Dental Screen/Exam
Social Security Card
T-code ____________
Homeroom Teacher
_____________________
_
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CHRISTIAN COUNTY BOARD OF EDUCATION
NON-DISCRIMINATION POLICY STATEMENT
As required by federal law, the District does not discriminate on the basis of race, color, or
national origin, sex, genetic information, disability or age in its programs and activities and
provides equal access to its facilities to the Boy Scouts and other designated youth groups.
Notice of the name, work address and telephone number of the Title IX Coordinator and the
Section 504 Coordinator for the district shall be provided to the employees, applicants for
employment, students, parents/guardians, and other beneficiaries such as participants in
activities offered to the public.
Christian County Public Schools Registration Process Survey
Please complete the following survey online about Christian County Public Schools registration process.
You will need a QR Reader app (free) on your phone or tablet to scan the code below:
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Attendance Clerk Copy
SCHOOL USE ONLY Court Order on File: _____ Deny release to: _______________________________________ Homeroom _______________________ Bus Info AM __________ PM __________
EMERGENCY CONTACTS & CHECK-OUT CONSENT
Student Name: ______________________________________________________________ LAST FIRST MIDDLE
Parent/Guardian Emergency Contact Information:
Name _____________________________________________________________
Home _________________ Cell _________________ Work _________________
Name _____________________________________________________________
Home _________________ Cell _________________ Work _________________
Please do not list a non-custodial parent if the courts have denied visitation. The school must
have legal documentation on file to deny a student release to his/her parent.
If parents/guardians cannot be reached in the event of an emergency, the following may be
contacted. A person must be at least 18 years of age to check a student out. Students will not be
released to anyone not on this form.
Name Relationship Work/Home Phone Cell Phone
In addition to the emergency contacts, these individuals may check the student out of school:
Name Relationship Work/Home Phone Cell Phone
PLEASE INFORM ALL PEOPLE LISTED ABOVE PICTURE IDENTIFICATION MUST BE
PROVIDED BEFORE YOUR CHILD WILL BE RELEASED INTO THEIR CUSTODY.
School: ________________________________ Family Resource Copy
McKinney-Vento RESIDENTIAL SURVEY
Completion Required/Mandatory ************************************************************************************************** Please complete the following form to see if your child qualifies for Project SHOW, a student service program in the Christian
County Public School. If the student meets one or more of the following housing requirements (due to loss of housing,
economic hardship, or a similar reason) they may be eligible for this program:
Do you live in: Please circle YES or NO
1. Emergency runaway shelter Yes No
2. Motel/Hotel (not vacation) Yes No
3. Public/Private nighttime shelter (Salvation Army) Yes No
4. Special Care Facility Yes No
5. Spouse Abuse Center (Sanctuary House) Yes No
6. Uninhabitable Places (car, bus, old building, etc.) Yes No
7. Friends or Relatives home Yes No
If yes to # 7: With whom are you living?
Relationship of person you are living with?
8. Temporary placed in Foster Care Yes No
9. Unaccompanied Youth - not in custody of parent Yes No
IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE COMPLETE THE SECTION BELOW, IF ALL
NO’S THEN PROCEED TO BOTTOM SIGNATURE LINE (REQUIRED):
How many FAMILIES are living in your place of residence? _________________
REQUIRED INFORMATION:
Name of parent(s) or guardian(s):__________________________________________________________________________
Copy sent to: Liaison Elementary School Middle School High School
Notified: Director of Food Services Infinite Campus marked Needs Assessment Completed
Other: ____________________________
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School Technology Assistant (STA’s) Copy
Technology Acceptable Use Policy
Parent and Student Permission Letter
Christian County Public Schools
We are pleased to offer students of the Christian County Schools access to the district computer network and technology resources. To gain access
to any technology resources, students must obtain parental or legal guardian permission, which must be signed and returned to the school.
Access to technology resources, e-mail, and the Internet will enable students to explore thousands of libraries, databases, and bulletin boards
while exchanging messages with Internet users throughout the world. Families should be warned that some material accessible via the Internet
might contain items that are illegal, defamatory, inaccurate or potentially offensive to some people. While our intent is to make Internet access
available to further educational goals and objectives, students may find ways to access other materials as well. We believe that the benefits to
students from access to the Internet, in the form of information resources and opportunities for collaboration, exceed any disadvantages. But
ultimately, parents and guardians of minors are responsible for setting and conveying the standards that their children should follow when
using media and information sources. To that end, the Christian County Public Schools support and respect each family’s right to decide
whether or not to apply for access.
District Network Rules
Students are responsible for good behavior on school computer networks just as they are in a classroom or a school hallway. Communications on
the network are often public in nature. General school rules for behavior and communications apply.
The network is provided for students to conduct research and communicate with others. Access to network services is given to students who agree
to act in a considerate and responsible manner. Access is a privilege--not a right. Access entails responsibility.
Individual users of the district computer networks are responsible for their behavior and communications over those networks. It is presumed
that users will comply with district standards and will honor the agreements they have signed. Beyond the clarification of such standards, the
district is not responsible for restricting, monitoring, or controlling the communications of individuals utilizing the network.
Network storage areas may be treated like school lockers. Network administrators may review files and communications to maintain system
integrity and insure that users are using the system responsibly. Users should not expect that files stored on district servers, school servers, and
or workstations will always be private.
Within reason, freedom of speech and access to information will be honored. During school, classroom teachers will guide them toward appropriate
materials. Outside of school, families bear the same responsibility for such guidance as they exercise with information sources such as television,
telephones, movies, radio and other potentially offensive media.
As outlined in board policies and procedures on Curriculum and Instruction and Telecommunication Devices ( 08.2323 & 09.4261/copies of which
are available in school offices), students will NOT:
Attempt to damage/alter/remove hardware/software/network files/computer systems or networks;
Attempt to access another’s folders, work, or files;
Attempt to gain unauthorized access to technology resources or waste technology resources;
Copy/distribute software owned/licensed to any facility of the Christian County Board of Education;
Attempt to transmit or receive materials in violation of federal or state laws or regulations pertaining to copyrighted, threatening or
obscene language or materials, including sexually explicit materials;
Attempt to violate confidentiality or privacy of another individual(This includes, but is not limited to, taking photographs, video, or audio
recordings of others without the permission of the Principal/designee and the affected individual(s);
Attempt to use CCBOE network for personal or commercial activities, product promotion, political lobbying, or illegal activities;
Attempt to use unauthorized games, interactive messaging, or internet-based email accounts;
Attempt to use unauthorized software products or Internet resources, which affect computer/network performance.
Attempt to use any "hacking tools" that can be used for "computer hacking", as defined in the Kentucky Computer Crime Law, may not be
possessed on school property, on any District premise, or run or loaded on any District system.
Remove Assets Tags or name plates from technology equipment.
VIOLATIONS MAY RESULT IN A LOSS OF ACCESS AS WELL AS OTHER DISCIPLINARY AND/OR LEGAL ACTION:
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Electronic Access/User Agreement Form
As a user of the Christian County School District’s computer network, I hereby agree to comply with the District’s Internet and
electronic mail rules and to communicate over the network in a responsible manner while abiding by all relevant laws and
restrictions. I further understand that violation of the regulations is unethical and may constitute a criminal offense. Should I
commit any violation, my access privileges may be revoked and school disciplinary action and/or legal action may be taken.
User’s Name (Please print)
User’s Signature Date
PRIOR TO THE STUDENT’S BEING GRANTED INDEPENDENT ACCESS PRIVILEGES, THE
FOLLOWING SECTION MUST BE COMPLETED FOR STUDENTS UNDER 18 YEARS OF AGE:
NOTE: FEDERAL LAW REQUIRES THE DISTRICT TO MONITOR ONLINE ACTIVITIES OF MINORS.
CHRISTIAN COUNTY PUBLIC SCHOOLS ARE EDUCATING MINORS ABOUT APPROPRIATE ONLINE BEHAVIOR, INCLUDING
INTERACTING WITH OTHER INDIVIDUALS ON SOCIAL NETWORKING WEBSITES AND IN CHAT ROOMS AND CYBERBULLYING
AWARENESS AND RESPONSE.
As the parent or legal guardian of the student (under 18) signing above, I grant permission for my child to access networked computer services such as electronic mail and the Internet. I understand that this access is designed for educational purposes; however, I also
recognize that some materials on the Internet may be objectionable, and I accept responsibility for guidance of Internet use by setting
and conveying standards for my child to follow when selecting, sharing, researching, or exploring electronic information and media.
Consent for Use
By signing this form, you hereby accept and agree that your child’s rights to use the electronic resources provided by the District
and/or the Kentucky Department of Education (KDE) are subject to the terms and conditions set forth in District policy/procedure.
Please also be advised that data stored in relation to such services is managed by the District pursuant to policy 08.2323 and
accompanying procedures. You also understand that the e-mail address provided to your child can also be used to access other
electronic services or technologies that may or may not be sponsored by the District, which provide features such as online storage,
online communications and collaborations, and instant messaging. Use of those services is subject to either standard consumer terms
of use or a standard consent model. Data stored in those systems, where applicable, may be managed pursuant to the agreement
between KDE and designated service providers or between the end user and the service provider. Before your child can use online
services, he/she must accept the service agreement and, in certain cases, obtain your consent.