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.
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