2nd Quarter

VIRTUAL TO IN-PERSON or
IN-PERSON TO VIRTUAL INSTRUCTION

PLEASE PRINT CLEARLY

Please complete this form if you wish to move your child from virtual to in-person instruction or in-person to virtual instruction. If your child is virtual or in-person and you wish to remain virtual or in-person, there is no need to complete a form.

STUDENT INFORMATION

Date of Request*

School Name*

Last Name*

First Name*

Middle Initial*

Address*

Address Apt # City ZIP Code

PARENT/GUARDIAN INFORMATION

Last Name*

First Name*

Parent/Guardian’s Email Address*

Primary Phone Number*

Emergency Phone Number

PART A

COMPLETE IF YOU WISH TO MOVE YOUR CHILD
FROM VIRTUAL TO IN-PERSON INSTRUCTION

I would like to enroll my child into in-person at-school instruction
I will transport my kids to and from School
I will need transportation to and from school

PARENT/GUARDIAN MUST INITIAL ON EACH LINE BELOW ACKNOWLEDGING UNDERSTANDING AND COMPLIANCE

I understand my child must attend school on all assigned days
I understand my child must wear a face covering every day
I understand my child will be required to submit to a temperature check every day

PART B

COMPLETE IF YOU WISH TO MOVE YOUR CHILD
FROM IN-PERSON TO VIRTUAL INSTRUCTION

I would like to enroll my child into Virtual Instruction

My child has access to his/ her own device at home*

Yes
No

My child has internet access at home*

Yes
No

PARENT/GUARDIAN MUST INITIAL ON EACH LINE BELOW ACKNOWLEDGING UNDERSTANDING AND COMPLIANCE

I understand attendance to virtual class is mandatory
I understand student work, participation, and tests are graded and recorded in JCampus
I understand I must sign the virtual learning code of conduct acknowledgment form
understand the Procedures and Policies for Parents and Students applies to virtual learning as well as in-person learning.

Parent/Guardian’s Signature*