Sandy Valley Local Schools 5362 State Route 183, Magnolia, Oh 44643 330.866.3339

Opt Out -- Media Release Form

Throughout the year a student’s name, photograph, video, or writing may be used in Sandy Valley publications, website and social media. In addition, there are times a student’s name, photograph, video, or writing may be released for use by area newspapers, radio, and television stations.

Parents/Guardians agree to the release of their child’s name, photograph, video, or writing to local news publications and in school publications unless they complete the Opt Out information below. Please complete and return the request below to the main office ONLY if you wish to Opt Out of the Release.

____ I DO NOT agree to the release of my child’s name, photograph, video, or writing to any organization.

____ I DO NOT agree to the release of my child’s name, photograph, video, or writing to any organization. However, I agree to my child’s photo appearing in only the yearbook. ___________________________________________________________________

Student’s Name: ______________________________ Grade : __________

Parent/Guardian’s Name: ______________________________

Parent/Guardian’s Signature: ____________________________

PARENTS: DO NOT SIGN AND DO NOT RETURN UNLESS YOU WISH TO OPT OUT

Acceptable Use of Technology Agreement

Including Internet Use & Safety

Student

Education Purpose Statement

The District provides access to technology, including Internet access to enhance the instruction of its

students and achieve the goals established by the District Board of Education and the Ohio

Department of Education. This Agreement is established to promote the use of technology, including

Internet access in a manner that leads to a safe and worthwhile educational experience for all.

Therefore, the District is committed to providing teaching on Internet safety.

Scope/Definitions

Technology, including the Internet, is a source of instructional material to which students and

employees have access both inside and outside the boundaries of the school physical and temporal

environment. This Agreement and the associated rules and regulations refer to all devices including

but not limited to computers, smart phones, digital tablets, electronic computing communication,

recording or imaging devices including but not limited to MP3 players, portable memory storage

devices, calculators with interfacing capability, cell phones and digital cameras as well as technology

infrastructure, associated peripheral devices and software:

Owned by, leased by or on loan to the District or any third party engaged in providing services for

the District.

Any computing or telecommunication device owned by, in the possession of or being used by

district students that are operated on the grounds of any district facility, off grounds at a school

sponsored function or connected to any equipment at any district facility by means of direct

connection, telephone line or other common carrier or any type of connection including both

hardwired, fiber, Virtual Private Network (VPN), infrared and/or wireless.

This Agreement applies to any online service provided directly or indirectly by the District for student

use. Examples of online services include but are not limited to electronic mail, web sites, cloud based

computing applications and social media sites. Students agree to abide by any license agreement

established with a third party.

This Agreement is in effect for any school sponsored activity at any time or any place.

The Internet can be accessed by a variety of electronic devices including those not provided by the

District. Because the material available on the Internet varies in quality and appropriateness and

instructional material obtained from the Internet may have not been selected ahead of time in a

manner similar to the way other instructional material is selected such as textbooks, software, or

library books, the District cannot guarantee accuracy, appropriateness and opinions expressed in the

materials.

Any implementation of the use of student-owned device for instructional use must follow all district

rules and policies and may require a separate signed approval by parent or guardian.

Statement of Procedures

In order to maintain and encourage appropriate and effective use of Internet access , computer

technology and connectivity, a set of rules for computer and network use have been established.

Students must read and abide by these rules established by the District and their respective buildings

and classrooms.

Acceptable Use of Technology Agreement

Including Internet Use & Safety

Student

The District provides technology and Internet access in a good faith attempt to promote the safe,

ethical, responsible, and legal use of this instructional resource. This access is intended to promote

the effective use of technology and the Internet for educational purposes, protect students against

potential dangers and ensure accountability. This access is not intended to function as a public access

service or a public forum. The District reserves the right to restrict this access to ensure that its use is

in accord with its educational purpose.

The District prohibits student-teacher interaction on social networking sites unless such interaction is

specifically educational in nature. Any digital communication between district employees and students

is expected to follow all district policies and the Ohio State Board of Education's Licensure Code of

Professional Conduct for Ohio Educators.

Internet safety issues may arise around the access to and use of the Internet, internet-ready, and

other electronic devises in a manner that promotes safe, civil and legal online activity for children,

digital citizenship and literacy and recognizing and responding to cyber bullying. The District will offer

training in the use of the Internet and students are required to participate in training. The training will

address appropriate online behavior, cyber bullying awareness and response as well as proper

etiquette when interacting with other individuals in social networking sites and chat rooms. Training

relating to online safety issues may be made available for parents and guardians.

Student activities will be structured in a manner that is appropriate to the age and skill level of

students. This approach is adopted in recognition of the importance of providing more secure

environments for younger students and supporting safe, responsible and independent use by older

students.

Disclaimers/Hold Harmless Clause

The District makes no warranties of any kind, expressed or implied, in connection with its provision of

access to the Internet or online services, technology or technology infrastructure provided to its

students, staff or visitors. The District is not responsible for any personal documents or information

stored on district technology or associated services nor is it responsible for any harm from the release

of confidential information. The District will not be responsible for any damage users may suffer,

including but not limited to loss of data, interruptions of service, or exposure to inappropriate material

or people. The District is not responsible for the accuracy or quality of the information obtained

through Internet access. The District will not be responsible for financial obligations arising through

unauthorized or inappropriate use. It is impossible for the District to restrict access to all offensive

and controversial materials. It is the responsibility of the students to abide by the policy to avoid such

content.

Copyright/Ownership

Copyrighted materials may not be placed on any service accessed via the Internet or any system

connected to the District’s system(s) and used in conjunction with District initiatives without

permission from the holder of the copyright and materials must be licensed directly to the District.

Only the owners or authorized individuals may upload or download copyrighted material to and from

the district’s systems. Unauthorized copyrighted materials will be removed upon notification.

Privacy/Monitoring/Confidentiality

Users shall have no expectation of privacy when utilizing district technology or related services. At

any time and without prior notice, the District reserves the right to monitor, inspect, copy, review

and/or store any and all results of computers, network and/or Internet access and any and all

Acceptable Use of Technology Agreement

Including Internet Use & Safety

Student

information transmitted or received in connection with such usage. This includes, but is not limited to,

information contained in online services provided by the District. All such information shall be and

remain the property of the District. The creator of original works may retain specific rights to use as

applicable under U.S. copyright law.

Students shall maintain and protect the confidentiality of any confidential information housed,

processed or maintained by the District. This includes but is not limited to account information,

passwords and personal information.

Prohibited Practices

The use of technology for any purpose that violates the student code of conduct, board policies, rules

or regulations regarding the use of technology in the district, building or classroom or any use which

is outside the educational purpose is prohibited. This includes, but is not limited to:

Theft, destruction of property

Purchasing goods or services

Bullying

Interfering with the normal functioning of computers, systems or networks

Accessing, modifying or deleting files/data that do not belong to you

Giving your username or password to any other student, or using the username or password

of someone else to access any part of the system

Viewing, transmitting or downloading pornographic, obscene, vulgar and/or indecent

materials

Sending or publishing offensive or harassing messages/content

Accessing dangerous information that, if acted upon, could cause damage or danger to others

Violating copyright laws and/or district policy on plagiarism

Recreational/non-educational use of electronic communication

“Hacking” and other illegal activities in an attempt to gain unauthorized access to restricted

files, other computers/systems. Uploading any harmful form of programming, bypassing filters;

installing any type of server, aliasing/spoofing, peer-to-peer networking or remotecontrol

software. Possession of and/or destruction of any of software tools designed to facilitate any of

the above actions will also be considered an offense

Saving inappropriate files to any part of the system, including but not limited to music files,

movies, video games offensive images/files, programs which can be used for malicious

purposes, any files for which you do not have a legal license, hobby or personal interest files,

even if not offensive or inappropriate

Any file which is not needed for school purposes or a class assignment

Students are required to report any occurrence of a prohibited practice to the school building

administrators immediately. It is recognized that the use of technology, including but not limited to

Internet access is a privilege and not a right. The District reserves the right to withdraw access to

technology, including but not limited to, the Internet through its network and to determine what

constitutes improper use.

Consequences

Those who violate this Agreement and those failing to report violations shall be dealt with following

established student discipline guidelines. The District also reserves the right to administer the

appropriate disciplinary action in accordance with the “Student Code of Conduct” which includes but is

not limited to detention, in school suspension, out of school suspension or expulsion. Any infractions

Acceptable Use of Technology Agreement

Including Internet Use & Safety

Student

that fall under the provisions of the Ohio and Federal Criminal Codes will be referred to the

appropriate law enforcement agencies.

Ban of Criminal and Illegal Acts

In addition to the rules and guidelines stated in this Agreement, the District prohibits the use of any

technology or service in the commission of any criminal or illegal act or the preparation for,

communication about or the cover up of such actions and will refer offenders to proper law

enforcement agencies. The District also reserves the right to seek monetary and/or other damages

resulting from any criminal or illegal act or violation of this Agreement.

Signatures/Acknowledgement

Students and residential parent(s) or guardian(s) shall agree to and acknowledge the information

disclosed in this agreement by signing below. This agreement is in effect until the student leaves the

District or a new agreement is required. For students 18 years and older, the student agrees that they

understand and agree to abide this agreement. For all other students, the parent agrees that they

have explained this agreement to their child and that the child agrees to abide by the agreement.

__________________________________ ___________________________________

Student Name (please print) Last, First,

M.I.

___________________________________

Parent Name (please print)

__________________________________

_

Student Signature

Parent Signature

___________________________________ ___________________________________

Date Date

___________________________________ ___________________________________

SV Board Approved 7/15/19

Financial Responsibility Notice

As part of the Sandy Valley Local School District, students may be provided with a laptop computer. In addition, students may be provided with electronic textbooks and additional software (school supplies) for use while enrolled in the district.

This equipment and school supplies are the property of the Sandy Valley Local School District and assigned to you (your child) for use while enrolled in the District. By signing this agreement, you assume responsibility for the equipment and school supplies issued to you (your child) and agree to take due care in the handling and use of this equipment and school supplies.

You and your child are not to add, delete, alter, load unapproved software, or reconfigure this equipment and/or its contents in any manner. This equipment is your “school environment” and any changes to it may affect the equipment capabilities and the educational process.

All repairs to this equipment are to be provided directly by Sandy Valley Local. The computer comes with a warranty that covers normal wear and tear. In the event that your computer is lost or requires repairs outside the bounds of the warranty and/or your insurance policy (due to unapproved alterations, negligence or misuse, etc.), you will be held financially responsible and will be billed for necessary repairs. In the event that your child withdraws from the district, it is your responsibility to return the equipment to the district in good repair within 10 business days from the date of withdrawal.

*********************************************************************************************************************

I understand my financial and due care obligation to Sandy Valley Local Schools and assume full responsibility of the computer system(s) and all necessary supplies issued to me (my child/children). I understand that I/my child(ren) may not alter, tamper with, add additional software, or reconfigure this equipment and that all repairs are to be performed by Sandy Valley Local. I understand that it will be my responsibility to transport the equipment to locations designated by the district for any maintenance or repairs, and I further agree that I will return all equipment and supplies upon termination from the program.

____________________________________________ ________________________ Student Name Date

____________________________________________ ________________________ Student Signature Date

____________________________________________ ________________________ Parent/Guardian Signature Date

SANDY VALLEY LOCAL SCHOOLS

5362 State Route 183 NE

Magnolia, Ohio 44643

330-866-3339

High School/Middle School Elementary School

330-866-9371 330-866-9225

2020-2021 INDIVIDUAL HEALTH PLAN

Dear Parent/Guardian:

In order to provide the best care for your child, we need to be prepared to meet their individual

health concerns. If your child has a chronic health problem such as diabetes, seizure disorders,

severe allergies, or any condition which may require special care from us, please complete in

detail the form provided on the back of this page. We do not administer medications without a

doctor’s order and the parent’s consent. Please do not list allergies to medications on this sheet.

Medication allergies should be included on the emergency medical form.

Please provide all necessary information so that it’s available in the school clinic. All

information will be kept confidential. However, it may be shared with appropriate school

personnel.

If medical management requires any epi pens, inhalers, medications, or equipment, please bring

them to school along with a doctor’s order. These items will be kept in the clinic unless

otherwise ordered by the doctor.

This form is to be updated yearly and when any changes in your child’s medical condition occur.

Thank you for your cooperation.

Sincerely,

Mary Leopold, R.N., BSN

School Nurse

Sandy Valley Local School District

SANDY VALLEY LOCAL SCHOOLS

5362 State Route 183 NE

Magnolia, Ohio 44643

330-866-3339

High School __ Middle School __ Elementary School ___

330-866-9371 330-866-9371 330-866-9225

2020-2021 INDIVIDUAL HEALTH PLAN

Student’s Name _________________________________________________ Date ________________

Date of Birth ___________________________________________________ Grade _______________

Parent/Guardian:_____________________________________________________________________

_____________________________________________________________________________________

Street Address P.O. City Zip Code

Home Phone: ________________________ Work Phone: __________________________

_______ My child takes the following routine medication/s. Please List.

______________________________ ______________________________________

Medication Dosage

______________________________ ______________________________________

Medication Dosage

_______ No, My child does not have any chronic health concerns.

If NO, do not complete the section below.

_______ Yes, My child does have chronic health concerns.

Examples: Asthma, ADD, ADHD, Diabetes, Seizure Disorders, etc

If Yes, please complete the form below.

Physician’s Name ____________________________ Physician’s Phone # ______________________

Medical Concern(s): _________________________________________________________________

What to Look for (Symptoms):

____________________________________________________________________________________

____________________________________________________________________________________

Emergency steps to be followed:

1. _________________________________________________________________________________

2. _________________________________________________________________________________

3. _________________________________________________________________________________

Sandy Valley Local Schools 5362 State Route 183 Magnolia, Ohio 44643

330–866–2528 [ ] SV HS [ ] SVE [ ] SV MS [ ] Saint James

Transportation Request

Name: _________________________________________________________________

Residential Address: _____________________________________________________ Street

________________________________________________________________________ City State Zip Code

Pick up address if different from above:

________________________________________________________________________________________________ Street City

Drop off address if different from above:

________________________________________________________________________ Street City

Phone: _____________________________ Birthdate: _____________________ Grade______________

Entry Date: _____________________________________ Start Date: __________________________

Medical Alert Information: ________________________________________________________________FAX to 330 – 866 – 2351

________________________________________________________________________________________________Transportation Department Use Only

AM Bus Assigned ____________ Stop Location _______________________

PM Bus Assigned ____________ Stop Location _______________________

AM Transfer Bus ____________

PM Transfer Bus ____________

Approved By: ___________________________________________________________ Doug Neading, Transportation Supervisor 2019-20

SANDY VALLEY LOCAL SCHOOLS 5362 State Route 183 Magnolia, Ohio 4443

330-866-3339

2020-2021 Student Emergency Plan

Student Name: ______________________________________ Date: ____________________

Teacher: ___________________________________________ Grade: ___________________

______ Follow usual dismissal (Ride bus home; Walk if home walker; Drive if high school student. ______ Other (Please complete the following)

____________________________________________________________________________ Alternate Name ____________________________________________________________________________ Alternate Address ____________________________________________________________________________ Bus Number

Parent/Guardian Signature: ____________________________________ Date: __________ All students MUST HAVE an “Emergency Plan”

In case of an emergency such as maintenance problems, threatening weather, bomb threats, etc., there could be a need for emergency dismissal or early dismissal. In the event of such an emergency, it is impossible to phone all parents for dismissal instructions. In some cases phones may be inoperable, so phone calls will NOT be made. An automated ALL CALL will be placed district wide.

Therefore, if this event should occur, your student should know where he or she is to go.

Inform your student of the Emergency Early Dismissal Plan. Make arrangements with a neighbor, close relative, or friend to care for your student if there is an early dismissal. Supply name, address, and a different bus number for the person responsible for your child. If your student is older, instruct how he/she is to get into the house in the event no one is at home. Let your student know where you can be reached once he/she arrives at home. Have them notify you. If you suspect an early dismissal because of bad weather, please listen to the radio stations and TV stations for announcements: WHBC, WJER, Fox 8, News Channels 3 & 5. Review these instructions regularly with your student.

Your Family Support Specialist

Support and empower families by guiding and connecting them to independently navigate resources available in their community.

Family Support Specialist Program Vision

Ci A R E3

Stark County ESC’s C.A.R.E. Team Initiative

iCAR

E In

itia

tive - C

onnecting Family, School & Community

FAMILY SUPPORT SPECIALIST

F S S

What is CARE Team?• CARE Team is comprised of

teachers, administrators, andfamily support specialists.

• As a team, we work together toprovide resources that studentsand families need to excel and gainresiliency.

How can CARE Team and the Family Support Specialist help my child?• Students and families are referred to the CARE Team by school counselors, teachers, administrators, community

members and self-referral. If you believe your child would benefit from CARE Team, you can self-refer bycontacting a member of CARE Team.

• Student and family information will remain confidential under FERPA laws.

CARE Team helps kids SUCCEED by . . .

• Developing plans to assist studentsin meeting their potential.

• Connecting families to resources forbasic needs.

• Referring students and families tomental health services.

• Monitoring student’s progress.

Sandy Valley Local Schools and our CARE TeamWelcome You to a New School Year!

Christie Finlayson serves:Sandy Valley High School • 330-866-9371Sandy Valley Middle School • 330-866-9416Sandy Valley Elementary School • 330-866-9225c.finlayson@svlocal.org

Sandy Valley Local Schools and CARE Team strive to fulfill the goal that every student will be successful and happy at school with the purpose to graduate with the knowledge and skills needed to sustain a happy and healthy career and life.

Sandy Valley Local Schools’ Parental Consent for Child’s Participation in CARE Team & Family Support Services

for 2020-2021 School Year   Dear Parent/Guardian:  

Our building has a CARE Team in place that is able to offer additional academic and non-academic support                                   services if your child may need them throughout the school year. By signing this release, you are giving our                                     building CARE Team an opportunity to better meet the needs of your child. Information will be shared with our                                     CARE Team administrators, school counselors, school nurses, and team members in a confidential manner as                             permitted by law.    I, _______________________________________ (parent/legal guardian) have received information regarding CARE Team from 

__________________________________School. I do hereby grant consent for my child, ____________________________to 

participate in my child’s school CARE Team program. 

 

❖ I understand that any information received under my child’s participation in the program by the Sandy Valley Local School District                                       (District), the Stark County Educational Service Center (ESC), or by the CARE Team that is for an educational purpose will be kept                                           confidential pursuant to Family Educational Right and Privacy Act (FERPA) regulations.   

 

❖ I understand that my child’s/my ward’s CARE Team working file might have information about medical issues such as sexually transmitted                                       diseases, acquired immunodeficiency syndrome, or human immunodeficiency virus. It might also have information about mental health                               problems or services, and/or treatment for alcohol or drug abuse. In the event my child’s/ward’s Care Team working file includes such                                         information, I authorize the disclosure of this information to the District, the Stark County Educational Service Center, and to my                                       child’s/ward’s CARE Team. This authorization expires, and may be revoked or canceled, as set forth in this release. 

 

❖ I understand that if my child’s/ward’s CARE Team working file is mandated to be released or subpoenaed, any portion of the working file that                                               does not qualify as an education record under FERPA may be released. If this occurs, you agree to hold the District, ESC, and the CARE                                                 Team harmless, and to release any and all claims against the District, ESC, and the CARE Team. 

 

❖ I understand that if my child transfers to another Stark County ESC school district or attends RG Drage Career Technical School or Day                                             Integrated Learning Center, CARE Teams from the previous district and the new district/RG Drage Career Technical School/Day Integrated                                   Learning Center and any Tech Prep program may discuss information from my child’s/ward’s working file.  

 

❖ This authorization expires one year from the date of signature, or on this date/event: __________  

❖ Furthermore, I understand that all information reported by the District into the CARE Team Information Management System will be used                                       for purposes of the Stark County Educational Service Center iCare Team Initiative/Family Support Specialist program evaluation. Any and all                                     reporting of such data will be in the aggregate and no specific or identifiable student identification will be used or disclosed. 

 

❖ I understand that I can revoke or cancel this Authorization at any time, but this does not apply to records that we already released. If I want                                                     to revoke this authorization, I must notify my child’s district superintendent, in writing. 

   __________________________________________ _____________________________________ Parent/Legal Guardian (print) Student’s Name (print)  __________________________________________ _________________________ Parent/Legal Guardian (signature) Date  CARE Team Parent Consent Form, 2020-2021