Parent/Guardian Consent Form I hereby consent to the WV Virtual

Parent/Guardian Consent Form
I hereby consent to the WV Virtual School’s collection, use, and/or disclosure of information about my child
through the course registration process and other manual and/or electronic procedures of the WV Virtual School
or associated course providers. I understand that my child is registering for a virtual course, and that the
information collected is needed for both course registration and grade/progress reporting to my child’s school and
to the WVVS.
This consent form covers all forms of distance learning courses, included but not limited to satellite courses, video
courses, and web-based courses. Your child’s image may be transmitted during video portions of distance learning
and online courses.
The information supplied to the course provider and/or the West Virginia Virtual School may include, but not be
limited to: student name, address, phone number, age, gender, school name, student grade in school, student
email address, student progress and grade in course/s.
Please complete the following and return to your child’s school:
Child's Name (print): ____________________________________________________________________
Parent/Guardian’s Name (print): __________________________________________________________
Address: _____________________________________________________________________________________
_____________________________________________________________________________________
Parent/Guardian’s Home Phone: (_____) ______-_________
Parent/Guardian’s Work Phone: (_____) ______-__________
Parent/Guardian’s Email Address (if available, and if you want to receive progress reports that may be available
from the course provider): ___________________________________________________
Parent/Guardian’s Signature (signature indicates approval to transmit needed student information to the course
provider and/or the West Virginia Virtual School):
Signature: ____________________________________________________________________________
Date ________________________________________________________________________________
The WV Virtual School has taken this step in order to be in compliance with federal legislation for child protection, including The Family
Educational Rights and Privacy Act (FERPA - http://www.ed.gov/offices/OM/ferpa.html) and the Children’s Online Privacy Protection Act
(COPPA http://www.ftc.gov/os/1999/9910/64fr59888.htm).
All students using computers from school locations must agree to abide by school, county, and/or West Virginia Board of Education Policy 2460
(Safety and Acceptable Use of the Internet by Students and Educators). It may be viewed online at
http://wvde.state.wv.us/policies/p2460.html, or you may request a copy from your child’s school. It is the intention of the West Virginia
Department of Education to filter and restrict access to controversial materials from school computers.
However, since the online courses are web-based, content accessed from home or elsewhere outside the school could put the student in
contact with objectionable materials via the World Wide Web. It is the responsibility of the parent/guardian of the student to restrict any
access to materials deemed inappropriate by the parent/guardian.