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HENRY HUDSON REGIONAL SCHOOL DISTRICT • SERVING THE BOROUGHS OF ATLANTIC HIGLANDS AND HIGHLANDS •
One Grand Tour, Highlands New Jersey 07732
Mrs. Lenore M. Kingsmore Henry Hudson Regional School Principal
Ms. Kate Caldwell Ms. Rachel DeWyngaert School Counselor School Counselor Email: [email protected] Email: [email protected]
STUDENT REGISTRATION
Please call or email Mrs. Shaw in the guidance department at (732)-872-0900 ext. 2055 or [email protected] to make an appointment for registration. When you come in to register, please bring the following with you: Parent ID: Parent photo ID such as a driver’s license or passport. Proof of Age: ORIGINAL BIRTH CERTIFICATE with the RAISED SEAL of the town where the child was born, must be presented at registration. (Hospital certificates are not acceptable for Proof of Age). Proof of Residency: TWO FORMS OF RESIDENCY ARE REQUIRED. You must reside in either Highlands or Atlantic Highlands in order to register your child at Henry Hudson Regional School. You must provide one item from Group A and one item from Group B. Group A Group B Current Lease Agreement Current Insurance Statement Mortgage Statement Vehicle Registration Property Tax Bill Current Utility Bill Sewer Tax Bill Bank Statement Medical Records: Immunization records (most current) must be presented at registration. Educational Records: A copy of the student’s most recent report card (and current grades for high school students) must be presented at registration. Custody Paperwork: Any court documents pertaining to custody of the student must be presented at registration, if applicable. Special Education: A copy of the current IEP must be presented at registration if applicable.
HENRY HUDSON REGIONAL SCHOOL DISTRICT GUIDANCE DEPARTMENT
ONE GRAND TOUR HIGHLANDS NJ 07732
GUIDANCE PHONE: 732-872-0900 EXT. 2055
GUIDANCE FAX: 732-291-1535
SPECIAL SERVICES PHONE: 732-872-0900 EXT. 2054 SPECIAL SERVICES FAX: 732-872-2206
AUTHORIZATION FOR RELEASE OF STUDENT RECORDS PLEASE PRINT Date: ______________________________________ Student’s Name: _______________________________________________________ Student’s Date of Birth: _______________________ Present Grade: _____________ The above named student has enrolled. Please send the following information as soon as possible.
Health Records
Transcript (please include current grades to date of withdrawal)
Standardized Test Scores
Discipline Records
Special Services Records (IEP, Evaluations, etc.)
New Jersey Smart SID (student information data)
Previous School: _______________________________________________________
Street Address: ________________________________________________________
City/State: ____________________________________________________________
Parent/Guardian Signature: ______________________________________________
Student Signature if 18 or older: __________________________________________
HENRY HUDSON REGIONAL SCHOOL DISTRICT
REGISTRATION
TODAY’S DATE:__________________ COUNSELOR:_______________________________
LAST GRADE COMPLETED: __________ PRESENT GRADE: _____________ SCHOOL YEAR: ________________
SECTION 1 – Please fill out entirely.
Name of Pupil _______________________________________________________________________________________________________
(Last) (First) (Middle)
___________________________________________________________________________________________________________________
(Street Number/Name) (City) (State) (Zip) (Home Phone)
Sex M ____ F ____ Date of Birth ________/______/_________
Place of Birth** (City & State) ______________________________**IF not born in United States, please fill out below:
Country of Birth:___________________ Date first entered US: _____________ Date first entered US Schools:___________________
Have you ever attended school in New Jersey? Yes/No________ YEARS___________ STATE SID#: _____________________________
SECTION 2 – Fill out only if applicable.
Has student ever been classified or received special education services? ___________________(Yes/No) Classification:________________________________________________________________________
Is student currently classified or receiving special services? _____________________________(Yes/No)
Classification:________________________________________________________________________
Please indicate placement in any Special Education Program:
_________________________________________________________________________________
Does Student have an IEP? _______________YES/NO (If classified, please provide a copy of IEP at time of
registration.)
Ethnicity: Are you Hispanic: YES or NO
RACE:
(Must select at least one.)
American Indian/Alaska Native _______________
Asian __________ White________________
Black or African American __________________
Native Hawaiian or Other Pacific Islander _______
Language Spoken at Home:__________________**
**If not English are you receiving ESL Services?_______
LAST SCHOOL ATTENDED:
_____________________________________________________
(School)
_____________________________________________________
(Street Address)
_____________________________________________________
(City, State, Zip)
_____________________________________________________
(District)
_____________________________________________________
(Date Left)
SECTION 3 - Please fill out entirely – PRINT PLEASE.
STUDENT IS LIVING WITH: (Please indicate Yes or No)
Yes No
___ ___ Father ________________________________________ Work # ____________________________________
(Last) (First)
Cell Phone # __________________________Email Address ________________________________________
Occupation ___________________________ ____Employer ________________________________________
Home Address ______________________________________________________________________________
___ ___ Mother _______________________________________ Work # _____________________________________
(Last) (First)
Cell Phone # _________________________ Email Address _________________________________________
Occupation _______________________________ Employer ________________________________________
Home Address ______________________________________________________________________________
___ ___ Guardian _______________________________________________ Work # ____________________________
(Last) (First)
Cell Phone # ___________________________________ Email Address _______________________________
Occupation ____________________________________ Employer ___________________________________
Home Address ______________________________________________________________________________
SIBLINGS NAME BIRTHDATE RELATIONSHIP TO PUPIL LIVING AT HOME?
Y N
IN CASE OF AN EMERGENCY WHEN SCHOOL IS UNABLE TO REACH PARENT/GUARDIAN, CALL:
________________________________________________________________________________________________________
(Name) (Relationship) (Telephone)
If applicable, please list any special custody conditions - (Court documents must be provided.)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Parent/Guardian Custody
The Guidance Office has received for our records a copy of a divorce decree stating custodial relationship: YES _____NO____
Please check all applicable boxes and SIGN below.
This signature allows Henry Hudson to provide information for the Online Grade Book through the Parent Portal
using the email provided above. Registration for the Parent Portal can only be obtained with a Parent Email Address.
I give the Henry Hudson Regional High School Guidance Department permission to obtain copies of any of my child’s
records that they deem necessary for registration.
PARENT/GUARDIAN SIGNATURE___________________________________________________
I UNDERSTAND THAT THE STUDENT-PARENT HANDBOOK WITH OUR DISCIPLINE POLICY AND
DRESS CODE ARE AVAILABLE ONLINE AND I WILL REVIEW THAT WITH MY CHILD.
PARENT/GUARDIAN SIGNATURE: _____________________________________________________________
HENRY HUDSON REGIONAL SCHOOL
School Health Services Program
(Fax) 732-872-1609 / Phone (732) 872-0900 x2042
______________________________________________________________________________
HEALTH OFFICE DOCUMENTS
(Complete and return by 1st day of school!!)
The following forms for the HHRS School Nurse must be completed and returned on or before the first
day of the school year:
Emergency Card: REQUIRED
Parent’s Request For Giving Non-Prescription Medication: REQUIRED
Health History: REQUIRED information to protect student safety and well-being
Scoliosis Screening Decline Letter: Complete ONLY TO DECLINE screening.
Medication order - Physician/Parent: IF NEEDED for student who carries Inhaler/EpiPen OR for other medication to be administered during school hours.
HENRY HUDSON REGIONAL SCHOOL DISTRICT
School Health Services Program
Phone (732) 872-0900 ext. 2042 Fax (732) 872-1609
SCOLIOSIS SCREENINGS
Dear Parents,
In accordance with the regulation of the State of New Jersey and the Henry Hudson Regional School Board of
Education, scoliosis screenings will be conducted by the school nurse or physical education teachers for all
students in grades 7, 9 and 11.
Scoliosis is a lateral curvature of the spine most commonly detected during the adolescent growth period. In
order to provide a view of the entire spine, shirts will need to be removed for accurate assessment. The student
will be asked to stand up straight to check for proper spine alignment, then to bend forward toward the toes to
have a full assessment. Each screening takes less than a minute to conduct.
If your student has any questionable curvature or uneven shoulder height, you will receive a written referral
requesting that you take your child to the pediatrician for follow up evaluation. Students are often referred to
their doctor because their shoulder blades are uneven. This may be a result of carrying heavy backpacks on
one side. Please do not panic if you receive a referral for the follow up. It is simply an indication of possible
curvature that should be further evaluated by the student’s pediatrician. Once you have completed the follow
up, please forward the doctor’s evaluation to the school nurse for record keeping.
Please indicate below if you DO NOT WISH your student included in the schools scoliosis screening or if
your student is already being followed/treated for scoliosis. This form should be returned to the health
office on the first day of school.
Thank you for your attention to this important notice.
Sincerely,
Amy Marsh R.N.
School Nurse
Student Name: ___________________________________________________________
_______ I DO NOT wish to have my child screened for scoliosis
_______ My child is currently being treated for Scoliosis and does not need to be screened.
HENRY HUDSON REGIONAL SCHOOL DISTRICT
• SERVING THE BOROUGHS OF ATLANTIC HIGLANDS AND HIGHLANDS •
One Grand Tour, Highlands New Jersey 07732
. Parents Request for Giving Non-Prescription Medication
In the event that my student reports minor injury or discomfort during school hours, I give permission
for my student to receive:
• Acetaminophen 325 mg. (Tylenol)
• Ibuprofen 200 mg. (Motrin, Advil)
1tablet
1tablet
2 tablets
2 tablets
• Antacid, Oral analgesics (Chloroseptic spray,
Anbesol, etc.
Yes No
• First Aid Wash/Ointment/Cream (such as rubbing
Alcohol, aloe, normal saline, anti-bacterials, etc.)
Yes
No
• Hygiene Products (deodorant, toothpaste, saline
Solution, face wash, etc.)
Yes
No
Additionally, this student's health information may be shared with pertinent school staff as necessary to
maintain well-being and safety.
Signature of Parent/Guardian Date
Henry Hudson Regional School
Highlands, NJ
Name_________________________ Grade_____ Age_____ Date_______________
Health Questionnaire and Developmental History
Does student have any of the following health conditions now or in the past?
CONDITION YES NO EXPLAIN
Asthma
Cardiac problems
Car sickness
Chronic ear infections
Chicken pox
Concussion
Congenital condition (Specify)
Diabetes
Environmental allergies
Fractured bones
Wears orthopedic device
(splint, brace, etc.)
Frequent headaches
Head injury
Hearing problem
Wears hearing aid
Hives
Lyme disease
Migraine headaches
Seizure disorder
Sinus infections
Speech problem/concern
Strep throat
Urinary/bowel problems
Vision problem
Wears glasses or contact lenses
(Circle one)
Other
1. Does student have a life-threatening allergy (requires an Epipen) to the following:
ALLERGY YES NO EXPLAIN
Foods
Insects
Other
2. Does student have any other allergies? Circle YES or NO. If yes, please specify type of allergy and
reaction (hives, etc.):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
3 Does student take any medications either daily or as needed? Circle YES or NO. If yes, please list the
name of the medication, reason for use and how often the student takes the medication:
_______________________________________________________________________
_________________________________________________________________________
4. Has student had any serious illness, injury or surgery? Circle YES or NO. If yes, please give details and
date(s) of illness, injury, hospitalization or surgery:
_______________________________________________________________________
_______________________________________________________________________
5. Check any of the following patterns that you have observed in student:
BEHAVIOR YES NO EXPLAIN
Easily frustrated
Completes tasks slowly
Aggressive behavior
Shyness
Talks a lot
Temper tantrums
Moody
Short attention span
Overly active
Difficulty
communicating needs
and wants
Other
6. Has student ever qualified or been enrolled in a specialized program? Please check all that apply:
PROGRAM YES NO EXPLAIN
Early Intervention
Second Language
Gifted and Talented
Other
9. Has student ever had an IEP ______ or 504 Plan __________?
10. Has student ever received any private therapies? If so, please specify:
_______________________________________________________________________
_______________________________________________________________________
11. Do you have any concerns about student’s developmental behavior or emotional well-being that the
school should be aware of? __________________________________________
_______________________________________________________________________
_______________________________________________________________________
12. Do you have any other concerns that you would like to share with us? ______________
_______________________________________________________________________
_______________________________________________________________________
Sharing of Information:
I acknowledge that the information noted above may be shared with school staff members on a need-to-know
basis for the safety and well-being of the above named student.
Parent/Guardian Signature _____________________________ Date ____________
HENRY HUDSON REGIONAL SCHOOL
School Health Services Program
(Fax 732-872-1609/ Phone 732-872-0900 x2042)
Family:
HEALTH HISTORY
(To be completed by parent/guardian)
Student's name: Date of Birth: ________________________
Mother's name: Custodial parent?___ Father's name:. __________
Custodial parent?___
Legal Guardian's Name: _________________________________________________________________
This child is# of children.
Recent changes in family life: ______________________________________________________________________
Chronic diseases in family: ___________________________________________________________________
Medical History:
Frequent headaches: _ Frequent ear infections: _ Stomach complaints: _
Chicken Pox: Yes No Date: Speech difficulties: _
Hearing difficulties: _
Glasses: Contacts: Used to improve: Near Vision: Far Vision: _
Asthma: __________(If your child has asthma, please see the school nurse.)
Uses Inhaler: Name of Inhaler: Uses Nebulizer: Yes. No _
Allergies: ____________ (If allergy exists, please see the school nurse.)
Epi-pen prescribed?: ______Other Medications Prescribed:--------------------------------------------------------------------------------
Seizures: _____ Heart murmur: ____ Anemia or blood conditions: _____
Serious Illness: ______________Head Injury: ________ Orthopedic Conditions: __________________
Recent Surgery: __________________________ Hospital izations:_____________________________
Chronic health Conditions: ____________________________________________________________________
Provide details for above:
Current Status: Routine medication(s):_____________________ (If medications need to be taken during school hours, please see the school nurse.)
Current restriction(s)_____________________
Additional information that you think would be helpful for school personnel to be aware of:
Note: This student's health information may be shared with pertinent school staff as necessary to maintain well-being and safety.
Parent/Guardian Signature _ Date: _
Note Medication Policy: The following Over-the-Counter medications will be administered as needed by the school nurse, to students with completed/signed medication consent at the bottom of the Emergency Card: Acetaminophen (e.g. Tylenol), artificial tears, cough drops, Ibuprofen (e.g. Motrin), oral analgesics (e.g. Anbesol), oral antiseptics, topical analgesics, topical antimicrobials, and topical antiseptics. If other medications are to be administered at school, parent/guardian and MD must complete and return the MEDICATION ORDER- PHYSICIAN/PARENT form. (Pink) Health History Rev. 06.14 AM
HENRY HUDSON REGIONAL SCHOOL School Health Services Program
(Fax 732-872-1609 I Phone 732-872-0900 x2042)
HEALTH QUESTIONNAIRE
(Optional information to be completed by student)
Student's Name_____________________________________ Date of Birth _________________________
The following is a list of conditions that sometimes concern young people. Check each one as to whether you are
concerned by it often, occasionally, or never.
Often Occasionally Never
Headaches
Stomach pains
Vision problems
Hearing problems
Toothaches
Skin problems (rashes or pimples)
Loneliness
Anger and/or temper problems _____________
Nervous or Anxious problems _____________
Trouble sleeping or getting to sleep _____________
Tired all the time
Yes No
Do you think you are a healthy person? ______________
Are you content with your weight and height? ______________
Are you content with your social life? _____________
Are you glad to come to school?
List any information you want or would like the school to know about your health and well-being: _
(Pink) Health History.Rev 06.14.AM
HENRY HUDSON REGIONAL SCHOOL
School Health Services Program
(Fax) 732-872-1609 / Phone (732) 872-0900 x2042 MEDICATION ORDER - PHYSICIAN/PARENT
Parents and legal guardians are encouraged to administer medications to students at home whenever possible as
medication should be administered in school only when necessary for the health and safety of students.
Administration of any prescription drug, over the counter medicine, or nutritional supplement requires a
parent/guardian to provide a written request for the administration of the medication at school, in addition to the
signed physician’s statement.
Part I - TO BE COMPLETED IN FULL BY THE STUDENT’S MEDICAL PROVIDER
I certify that it is essential to the health of __________________________________________________ that the following medication be administered during school hours as directed. DIAGNOSIS_________________________________________________________________________
NAME OF MEDICATION_____________________________________________________________
PURPOSE OF ITS ADMINISTRATION__________________________________________________
DOSAGE AND MODE________________________________________________________________
TIME AND FREQUENCY OF ADMINISTRATION________________________________________
SIDE EFFECTS, IF ANY_______________________________________________________________
LENGTH OF TIME THE ORDER IS VALID (may not exceed school year) ____________________
IS CHILD AUTHORIZED TO MEDICATE SELF? YES_____ NO____ (ONLY FOR INHALER OR EPI-PEN!!)
_____________________ ____________________________________________ DATE SIGNATURE OF PHYSICIAN/ APN/DENTIST
TELEPHONE NUMBER________________________
---------------------------------------------------------------------------------------------------------------------------
Part II - TO BE COMPLETED BY THE STUDENT’S PARENT/GUARDIAN
I hereby request that the school nurse administer the above medication as directed by my physician/dentist
to my child _______________________________________. I will supply the medicine in an ORIGINAL
CONTAINER and will deliver it in person. I will notify the school nurse promptly of any change in this
order.
_________________________ __________________________________________ DATE SIGNATURE OF PARENT/GUARDIAN
TELEPHONE NUMBER________________________
(Lilac) Medication Order-Physician-Parent Rev 06.2014.AM
HENRY HUDSON REGIONAL SCHOOL DISTRICT • SERVING THE BOROUGHS OF ATLANTIC HIGHLANDS AND HIGHLANDS •
ONE GRAND TOUR • HIGHLANDS, NEW JERSEY 07732
Permission to Participate in HHRS School Spirit Video
I give permission for ____________________to participate in a Henry Hudson Regional School spirit video. (Student's Name)
I realize that this video may appear in the following media: television, local and national
magazines, newspapers, professional periodicals or internet. During this time your son/daughter
will be under the supervision of a faculty member.
Parent/Guardian's Name- Please Print
Parent/Guardian's Signature
If you have any questions, please contact [email protected] or [email protected].
Student-Effective July 2012 revised and approved June, 2012
HENRY HUDSON REGIONAL ACCEPTABLE USE AND INTERNET SAFETY POLICY OF COMPUTER
NETWORK/COMPUTERS AND RESOURCES
The Henry Hudson Regional Board recognizes as new technologies shift the manner in which information is accessed, communicated, and
transferred; these changes will alter the nature of teaching and learning. Access to technology will allow pupils to explore databases,
libraries, Internet sites, and bulletin boards while exchanging information with individuals throughout the world. The Board supports
access by pupils to these information sources, but reserves the right to limit in-school use to materials appropriate for educational purposes.
The Board directs the Superintendent to effect training of teaching staff members in skills appropriate to analyzing and evaluating
resources as to appropriateness for education purposes.
The Board provides access to computer network/computers for educational purposes only. The Board retains the right to restrict or terminate pupil
access to the computer network/computers at any time, for any reason. School district personnel will monitor networks and online activity to
maintain the integrity of the networks, ensure their proper use, and ensure compliance with Federal and State laws that regulate Internet Safety.
Students and teachers have access to electronic mail communicating with people all over the world. With this access, comes the availability of
material that may not be considered to have educational value in the context of the school setting. Although Henry Hudson has taken
precautions and uses a commercial filtering product, the Board also recognizes that technology allows pupils access to information sources that
have not been pre-screened by educators using Board-approved standards. The Board therefore adopts the following standards of conduct
for the use of computer networks and declares unethical, unacceptable or illegal behavior as just cause
for taking disciplinary action, limiting or revoking network access privileges and/or instituting legal action.
Standards for Use of Computer Networks/Digital Devices
Any individual engaging in the following actions when using computer networks/computers and/or digital devices shall be subject to
discipline or legal action:
A. Using the computer network(s)/computer(s) for illegal, inappropriate or obscene purposes, or in support of such activities. Illegal
activities are defined as activities that violate federal, state, local laws and regulations. Inappropriate activities are defined as those that violate
the intended use of the network. Obscene activities shall be defined as a violation of generally accepted social standards for use of
publicly owned and operated communication vehicles.
B. Because electronic information is volatile and easily reproduced, respect for the work and personal expression of others is especially critical
in computer/electronic environments. Violations of authorial integrity, including plagiarism, invasion of privacy, unauthorized access, and trade
secret and copyright violations, license agreements or other contracts may be grounds for sanctions.
C. Using the computer network(s}/computers/digital devices in a manner that:
1. Intentionally disrupts network traffic or crashes the network
2. Degrades or disrupts equipment or system performance
3. Uses computing resources of the school district for commercial purposes, financial gain, or fraud
4. Steals data or other intellectual property
5. Gains or seeks unauthorized access to the files of others or vandalizes the data of another person
6. Gains or seeks unauthorized access to resources or entities
7. Violates copyrights, institution or third party copyrights, license agreements or contracts
8. Forges electronic messages (E-Mail) or uses an account owned by others
9. Invades privacy of others
10. Posts anonymous messages
II. Possesses any data which is a violation of this policy
12. Engages in other activities that do not advance the educational purposes for which computer network/computers are
provided.
(See Board Policy 2361-Acceptable Use of Computer Network/Computers and Resources-Available online)
D. Individual users of computer networks/digital devices are responsible for their behavior and communications over the networks.
1. All user accounts will be used only by the authorized owner.
2. It is the responsibility of the owner to log on and log off of their individual accounts.
3. All passwords are to remain confidential by the user,
4. No user shall allow others to utilize his/her account.
Students are responsible for acceptable and appropriate behavior and conduct on school district computer networks/computers.
Communications on the computer networks/computers are often public in nature and policies and regulations governing
appropriate behavior and communications apply. The school district's networks, Internet access, and computers are
provided for pupils to conduct research, complete school assignments and communicate with others. Access to computer
networks/computers is given to pupils who agree to act in a considerate, appropriate, and responsible manner.
Student-Effective July 2012 revised and approved June, 2012
Consent Requirement
Parent(s) or legal guardian(s) permission is required for a pupil to access the school district's computer networks/computers.
Access entails responsibility and individual users of the district computer networks/computers are responsible for their
behavior and communications over the computer networks/computers. It is presumed users will comply with district standards and
will honor the agreements they have signed and the pe1mission they have been granted. Beyond the clarification of such
standards, the district is not responsible for the actions of individuals utilizing the computer networks/computers who violate the
policies and regulations of the Board. No pupil shall be allowed to use the computer network, digital devices and the Internet
unless they filed with the Technology Supervisor an Acceptable Use and Internet Safety Policy Consent and Waiver Agreement
form signed by the pupil and his/her parent(s) or guardian(s).
Violations Computer networks/computer storage areas shall be treated in the same manner as other school storage facilities. School district
personnel may review files and communications to maintain system integrity, confirm users are using the system responsibly, and
ensure compliance with Federal and State laws that regulate Internet safety. Therefore, no person should expect files stored
on district servers will be private or confidential.
Individuals violating this policy shall be subject to appropriate disciplinary action, which includes, but not limited to:
1. Use of the network only under supervision
2. Suspension of network privileges
3. Revocation of network privileges
4. Suspension of computer privileges
5. Revocation of computer privileges
6. Suspension from school
7. Expulsion from school and/or
8. Legal action and prosecution by the authorities
Staff/Students Communications Communication over networks should not be considered private. Network supervision and maintenance may require review and
inspection of directories or messages. Messages may sometimes be diverted accidentally to a destination other than the one intended.
Privacy in these communications is not guaranteed. The district reserves the right to access stored records in cases where there are
reasonable causes to expect wrongdoing for misuse of the system. Courts have ruled that old messages may be subpoenaed and network
supervisors may examine communications in order to ascertain compliance with network guidelines for acceptable use.
Acceptable Use Consent and Waiver Agreement In accepting an account, you state the following: I have read the terms and conditions for the Henry Hudson Regional Acceptable Use and Internet Safety Policy and Board Policy and
Regulations 2361: Acceptable Use of Computer Network/ Computers and Resources (available online). I understand and will abide by
the stated terms and conditions stated in this policy. 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, school disciplinary action may be taken and/or
appropriate legal action. I understand this contract will remain in effect for the duration of my Henry Hudson Regional enrollment.
User Name: (please print) __________________________________________ Expected year of graduation: ___________________
User Signature: __________________________________________________ Date: ______________________________________
Parent or Guardian: Please read and discuss the AUP with your child.
As parent or guardian of this student: I have read the terms and conditions for the Henry Hudson Regional Acceptable Use and Internet
Safety Policy and Board Policy and Regulations 2361: Acceptable Use of Computer Network/ Computers and Resources (available
online). I understand that this access is designed for educational purposes and Henry Hudson Regional School District has taken
available precautions to eliminate controversial material. However, I also recognize it is impossible for Henry Hudson Regional to
restrict access to aH controversial materials and I will not hold them responsible for materials acquired on the network. I hereby give
Henry Hudson Regional permission to issue an account for my child and certify that the information contained on this form is correct.
Parent or Guardian: (please print) ______________________________________________________________________
Signature:
Student-Effective July 2012 revised and approved June, 2012
Henry Hudson's first priority is the security and safety of its student body. This includes the publication of “personally
identifiable information." We also believe it is important to recognize deserving students and publicize their achievements. We
occasionally like to publish this information in our school newspaper and on our school web page. Bill A592 prohibits
dissemination of personal student information on the internet without parental consent.
PARENTAL/GUARDIAN CONSENT
FORM
We are sending you this parental consent form to both inform you and to request permission for your child's photo/image and
personally identifiable information to be published on the district and/or school's web site.
As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site
since global access to the Internet does not allow us to control who may access such information. These dangers have always
existed; however, we as schools do want to celebrate your child and his/her work. The law requires that we ask for your
permission to use information about your child.
Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or
guardian. Personally identifiable information includes student names, photo or image, residential addresses, e-mail address, phone
numbers and locations and times of class trips.
If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the principal
of your child's school and such rescission will take effect upon receipt by the school.
Check one of the following choices:
We GRANT permission for a photo/image that includes this student without any other personal identifiers to be published on the school and/or district's public Internet site.
We GRANT permission for this student's photo/image and name to be published on the school and/or district's public Internet site.
We GRANT permission for this student's photo/image and all other personal identifiers listed above to be published on The school and/or district's public Internet site.
We DO NOT GRANT permission for photo/image that includes this student to be published on the school and or district's public Internet site.
Student's Name: (please print) Student's Grade:
Year of Graduation:
Print name of Parent/Guardian (print) _____________________________________________________________________________________
Signature of Parent/Guardian: _______________________
Relationship to Student:
Date: Email Address: _____________________________________________________
Daytime Phone:_______________________________________ Evening Phone:
CHROMEBOOK RULES AND GUIDELINES SIGNATURE PAGE
Please completely read the rules and guidelines regarding the HHRS Chromebook Program with your
child. Detach this page, sign the agreement below with your child, and return this page to your
homeroom teacher or Ms.Triplett. Once the agreement has been received, the student will be
scheduled to obtain their Chromebook for use during this school year.
Parent Agreement Statement
By signing this agreement, I agree I have completely read and understand all the rules and guidelines
associated with HHRS Chromebook program. I agree to follow these rules and oversee my child’s use of
the Chromebook. I understand that I am ultimately responsible for any damage or loss of the HHRS
Chromebook and agree to pay any related fees due to damage or loss as outlined in the rules and
guidelines for use. I agree to hold my child accountable for following these rules and guidelines when my
child has the Chromebook off school grounds.
Parent/Guardian Name (printed)
Parent/Guardian Signature: ___________________________________ Date _
Student Agreement Statement
By signing this agreement, I agree I have completely read and understand all the rules and guidelines
associated with the HHRS Chromebook program. I agree to completely follow these rules at all times
while the Chrome book is under my care. I agree to keep the Chrome book safe and secure at all
times and understand I am responsible for returning the Chromebook to HHRS at the end of the
school year (or upon withdrawing from HHRS) in the same condition as I received it.
Student Name (Printed)
________________________________
Student Signature: _____________________________________ Date _
Henry Hudson Regional Google Account Agreement
HHRS encourages the use of student Google accounts as an effective and efficient way to improve communication between students, faculty members, and administrative staff. The primary purpose of student Google accounts are to support teaching and learning. A henryhudsonreg.k12.nj.us·Google account is housed on a Google server, giving student access to Google Docs (word processor, spreadsheet, and presentation software).
1. Official Google Account Your child has been assigned a HHRS student Google account. This account will be considered the student's official HHRS Google Account until such time as the student is no longer enrolled in HHRS. In using these accounts, students must follow all Rules & Responsibilities set forth in the Henry Hudson Regional Acceptable Use and Internet Safety Policy of Computer Network/Computer and Resources.
2. Prohibited Conduct In addition to any prohibitions set forth in HHRS Computer Acceptable Use Policy, the student Google account may not be used in the following ways:
• Unlawful activities
• Commercial purposes
• Personal financial gain
• False identity in e-mail communications
• Misrepresentation of HHRS
• Interference with HHRS technology operations
3. Access Restriction Access to and use of student Google accounts are considered a privilege accorded at the discretion of HHRS. The HHRS District maintains the right to immediately withdraw the access and use of a student Google account when there is reason to believe that a student has engaged in any of the prohibited conduct set forth above or has otherwise violated the law or the Rules &
Responsibilities set forth in the HHRS Computer Acceptable Use Policy. In such cases, the alleged violation will be referred to the Principal for further investigation and adjudication.
4. Privacy Users of student Google accounts are strictly prohibited from accessing files and information other than their own. The District reserves the right to access the HHRS Google Account system, including current and archival files of user accounts.
If you have any questions or concerns, please feel free to contact Ms. Triplett ([email protected] or 732-872-0900 ext. 2041).
The complete Google Apps Education Edition Agreement and Privacy Policy may be found here: http://www.qooqle.com/apps/intllen/terms/education terms.html
We agree to follow the HHRS Google Account Agreement. Student Name: (print) ______________________________________________________ Student Signature: _________________________________________________________ Parent Name: (print) ________________________________________________________ Parent Signature: __________________________________________________________
Henry Hudson Regional School District Chromebook Agreement Overview:
Henry Hudson Regional School District One-to-One Initiative
Henry Hudson Regional School District is committed to prepare students for an ever-changing world that
sees technological advancements happening at a rapid rate. Technology supports the acquisition of enduring and conceptual understandings that will enable students to build foundational knowledge and make connections that deepen their comprehension.
Herl1y Hudson Regional Public Schools, in an effort to ensure students are equipped with the tools, skills, and knowledge necessary to maximize this potential, has begun to initiate a one to one program-student to computing device-which will provide Chromebooks for individual student use that is integral to curriculum and lead to achievements beyond what can be accomplished with traditional print resources.
The goals of this initiative are to:
provide students with the technology necessary to facilitate optimal learning
opportunities and expand the personal boundaries of what they can accomplish,
increase efficient use of technology in the classroom
assist teachers in individualizing and differentiating instruction as well as shifting the responsibility of learning to students
promote collaboration and increase student engagement while building capacity for students and
teachers to share best practices in their school and around the world, and assist students in
developing the skills and acquiring the knowledge needed for a successful future beyond high school.
Expectations:
Students will abide by the Henry Hudson Regional School District Acceptable Use Policy (available
online)
Students will abide by the Google Account Agreement (available online)
Students will bring the Chromebook to school every day.
The HHRS Chromebooks are being provided to enhance the educational experience at HHRS. lf a student forgets the HHRS Chromebook, he or she will be unable to participate fully in that day's activities in the classroom. We do not have enough Chromebooks to loan them out to students who forget theirs at home. If a student forgets their Chromebook at home, they will not have it for the day. All work assigned and completed on the Chromebook is the responsibility of the student.
Students will charge the Chromebook nightly and will begin each day with a fully charged battery. The HHRS Chromebook needs to be fully charged for each day as there will be limited capability for students to charge it during the school day due to space and electrical constraints. Students should be careful when plugging in the power cord. The Chromebook should be charged in a location which is both secure and safe so no damage will be accidentally done to the Chrome book when it is charging.
Students will not leave the Chromebook unattended. When not in the student's possession, the Chromebook should be in a secure, locked environment.
Unattended Chrome books found at school will be collected and stored in the school's office. Do not lend
your Chromebook to another person. Each Chromebook is assigned to an individual and the responsibility
for the care of the Chromebook rests solely with that individual.
Students will keep the Chromebook secure and safe when carrying or transporting. Carefully
transport your Chromebook to school every day in the district provided case. Avoid placing weight on the
Chromebook. Never throw or slide a Chromebook. Never expose a Chromebook to long-term temperature
extremes or direct sunlight. Please do not store a Chromebook in a vehicle. Students will only use the HHRS Chromebook when in a location which is free from food, liquid, and
debris that could damage the device and which provides a flat surface on which to operate. Students should not use the HHRS Chromebook in an area where food and drink are present. Spilling any sort of food or drink on the Chromebook could permanently damage it. The Chromebook should only be used on
a flat surface where it will not fall to the ground or damage the screen. Pets and siblings can also damage the
Chromebook. Care should be taken to always have the Chrome book in an environment where it can be
operated safely. Chromebooks should not be placed on top of soft items like pillows or blankets which could
cause the Chromebook to overheat.
Students should not slam or push on the lid, or set objects/books on top of the Chromebook.
Screen damage is the #1cause of damage for Chromebooks. The Chromebook is an electronic device;
handle it with care. Never throw a book bag that contains a Chromebook. Never place a Chromebook in a
book bag that contains food, liquids, heavy, or sharp objects. Avoid using any sharp object on the
Chromebook. The Chromebook screen is glass and is vulnerable to cracking. Never place heavy objects on
top of the Chromebook and never drop your Chromebook. Careful placement in your backpack is
important. The Chromebook can be cleaned with a soft, slightly water-dampened,lint-free cloth. Avoid
applying liquids to the Chrome book. Avoid getting moisture in the openings. Do not use window cleaners,
household cleaners, aerosol sprays, solvents, alcohol, ammonia, or abrasives to clean the Chromebook.
Students will make the HHRS Chromebook available for inspection by an administrator, teacher, or
staff member upon request. Students understand that the HHRS
Chrome book and its contents can be monitored by HHRS staff when students are signed
on to the HHRS network.
The Chromebook is the property of the Henry Hudson Regional School District and as a result may be
seized and reviewed at any time. The student should have NO expectation of privacy of materials found on
a Chromebook. The HHRS Chromebooks are the property of HHRS and are being loaned to the students
for educational purposes. At any time, an HHRS staff member can inspect a student's Chromebook.
Students will return the Chromebook to HHRS prior to withdrawing or leaving HHRS for summer vacation. Students will use appropriate and respectful language in all communications, and will abide by all
HHRS school policies while using the Chromebook, both at school and at home. Any behavior, materials, or communications involving the Chromebook that are deemed inappropriate by an HHRS staff member may result in disciplinary action.
Students will abide by all copyright laws.
Copyrighted material is protected by law. Any use of copyrighted material should be appropriately noted in
any school work. Please check with a teacher if you have any questions about using copyrighted material
or how to give credit for use of any copyrighted material.
Students will use the HHRS Chromebook for educational purposes.
All HHRS Chromebooks must be used in support of the educational program of HHRS. This access may be
revoked at any time for abusive or inappropriate conduct related to the use of the Chromebook. Failure to
comply with the HHRS policies or the guidelines stated in this document for care and use of the Chromebook
may result in the loss of privilege to take the Chromebook home or use of the Chromebook in general.
Attempting to bypass the filter at school/home or using the Chromebook for non-educational purposes while
at school is prohibited. At home, it is the responsibility of the parents or guardians to ensure that the
Chromebooks are being used in accordance with this policy.
Students will not use or harm another student's Chromebook Students will not Joan the HHRS
Chromebook assigned to them to others. Students will not use or attempt to use another student's
or a HHRS staff member's subscriptions, logins, files, or personal information. The HHRS Chromebook is assigned to one student for educational purposes and should not be loaned to others. Passwords and logins should also remain confidential with the individual students. Any material on the HHRS Chromebook obtained with their login or password is the responsibility of the student. Students will not give out personal information, such as name, address, photo, or other identifying
information on the Internet, nor will students misidentify themselves during online communication
in an attempt to avoid detection for any misbehavior or rules violation. Giving out personal information on the Internet can be dangerous. Students should never mis-identif'y
themselves or reveal their age on the HHRS Chromebooks. Students should not share files except for
school related projects or assignments.
Students will not change the configuration of the HHRS Chromebook, including the network and
security settings. Policy settings are preconfigured on all HHRS Chromebooks and are managed by the HHRS Administration. Any attempt to bypass these preconfigured settings is prohibited. Students will log into the HHRS Chromebook ONLY with their school assigned Google Apps for Education user account. Students may not log into the HHRS Chromebook using a non-HHRS assigned account. Students will not deface or otherwise decorate the HHRS Chromebook
Students are expected to treat the HHRS Chromebooks with care and respect. The Chromebooks are the
property of HHRS and are not to be defaced by any student. This includes pen marks, stickers, marring
the surface, picking at the keys, glitter, etc...
Students must abide by parental guidelines when traveling with or using the
HHRS Chromebook at locations other than HHRS.
We are relying on parents/guardians to be the best judges of where and how their child may use the HHRS
Chromebook. It is the parents who bear the financial responsibility for any damage or loss of the
Chromebook.
Students will not attempt to repair, alter, or make additions to the HHRS Chrome book
If any repairs need to be made, the student should return the HHRS Chromebook to a designated location
within their school. Depending on the condition of the Chromebook and the repair needed, there may be a
loaner Chromebook given until the assigned Chromebook is repaired. No attempts should be made to fix
the Chromebook except as supervised by an HHRS staff member.
Students agree to bring the Chromebook back and forth between school and home on a daily basis. The school does not have the space to store and charge all of the Chromebooks each night. Furthermore,
there may be people using the facility after school hours and the Chromebooks cannot be guaranteed
secure at HHRS each night. If a student must leave the Chrome book in school, it must be placed in their
locker using a school issued lock.
Students will report all problems and damage immediately to a HHRS staff member. Students will not attempt to remove asset or identification names on the Chromebook. Students will report loss/theft of the HHRS Chromebook to their parents/guardians, HHRS Administration, and proper authorities within 24 hours. Each Chromebook has a unique identification number and at no time should the numbers or labels be modified or removed. Do not attempt to gain access to the internal electronics or repair your Chromebook.lf your Chromebook fails to work or is damaged, report the problem to an HHRS staff member as soon as possible. Chromebook repair/replacement options will be determined by the School Administration. You may be issued a temporary Chromebook until your Chromebook is working properly or replaced. If the Chromebook is experiencing technical difficulties outside of school hours, you will need to wait until you return to school to fix it. Henry Hudson uses two different Chromebook vendors. Depending on the type issued to your student, the
following fee’s apply. All Chromebooks must be returned at the end of each School Year. Students who
leave HHRS during the school year must return the Chromebook to their building's main office, along with
any other accessories, at the time they leave.
For Samsung Chromebooks:
If the Chromebook and/or Cover is lost or stolen, a replacement fee of $265 will be assessed.
Estimated Costs (subject to change)
Chrome book: $250.00 Chrome book Cover: $ 15.00
Screen: $100.00 Keyboard/touchpad: $ 60.00 Power Adapter: $ 35.00
For Dell Chromebooks:
If the Chromebook and/or Cover is lost or stolen, a replacement fee of $290 will be assessed.
Estimated Costs (subject to change)
Chrome book: $260.00 Chrome book Cover: $ 30.00
Screen: $100.00 Keyboard/touchpad: $ 60.00 Power Adapter: $ 35.00
The Student will use the Chromebook Camera & Microphone for approved use only.
The Chromebook comes equipped with audio and video recording capabilities through a built-in
microphone and camera. All electronic recordings created with the device must comply with school
policies and State and Federal laws. Users of the Chromebook device are required to use the device in a
manner that complies with these and other HHRS policies. Use of the Chromebook in a manner that violates
HHRS policy may result in revocation of the device and may result in further disciplinary consequence.
Use of the Chromebook and any other devices with audio and video recording capabilities during
instructional time is at the discretion of the teacher and the student must obtain prior approval to use the
device for such purposes. Any electronic recordings obtained with the recording device are for
institutional purposes. Therefore, electronic recordings obtained with the Chromebook may not be
shared, published or rebroadcasted for any reason by the student without permission. Furthermore, users
of the Chrome book should be aware that State and Federal laws in many instances prohibit secret or
surreptitious recording undertaken without the knowledge and consent of the person or persons being
recorded. Violations of State and Federal recording laws may be reported to the proper authorities and
may result in criminal prosecution.
HENRY HUDSON REGIONAL SCHOOL DISTRICT
Our school district is participating in a system where the federal government's Medicaid will pay state and local
school districts for a portion of the costs of health-related special education services provided to Medicaid
eligible children. Your child will continue to receive services at no cost to you under this new system. This
initiative simply helps us maximize federal funds in support of local education. The information you
voluntarily provide by completing this consent form will only be used for the purposes identified.
Please fill in the information below, sign the form and return it to the address indicated.
Child’s Name: __________________________ ___________ __________________________
First Mid. Initial Last
Child’s Date of Birth: ____________________
As parent/guardian of the child named above, I give permission to disclose information from
my child's educational records to local, state, and federal agency representatives for the sole purpose
of claiming Medicaid reimbursement for health related support services in my child's Individualized
Education Program (IEP).
Signature: ______________________________________ Date: ________________________
Parent or person in parental relationship (Month/Day/Year)
Please return this form to:
Henry Hudson Regional School
Holly Akers
1 Grand Tour
Highlands, NJ 07732
CONSENT FOR RELASE OF INFORMATION TO ACCESS MEDICAID
REIMBURSEMENT FOR HEALTH RELATED SUPPORT SERVICES
HENRY HUDSON REGIONAL SCHOOL DISTRICT
SERVING THE BOROUGHS OF ATLANTIC HIGHLANDS AND HIGHLANDS
One Grand Tour Highlands,New Jersey 07732-2039
Phone: 732-872-1517 Fax: 732-872-1315
Dr. Susan Compton
Superintendent
Sarah Kroon-Chiles
Board President
Janet Sherlock
Business Administrator/Board Secretary
Dear Parent/Guardian:
Children need healthy meals to learn. Henry Hudson Regional School offers healthy meals every school day at
the prices listed below. Your children may qualify for free meals or for reduced price meals. Applications
for the free/reduced lunch are available under the Guidance Tab.
FULL PRICE
. REDUCED PRICE
Elementary
Middle
High
Elementary
Middle
High
National School
Lunch
NIA
$2.75
$2.75
NIA
$0.40
$0.40
School
Breakfast
NIA
$1.50
$1.50
NIA
$0.30
$0.30
After School
Snack
NIA
NIA
NIA
NIA
NIA
NIA
·special Milk
Program
NIA
NIA
NIA
Not Applicable
Not Applicable
Not Applicable
Split Session Milk
Program
NIA
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
NIA - Not Applicable
This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions.
Below are some common questions and answers to help you with the application process.
1. Who can get free OR REDUCED PRICE meals?
All children in households receiving benefits from NJ SNAP or NJ TANF are eligible for free meals.
Foster children that are under the legal responsibility of a foster care agency or court are eligible for
free meals.
Children participating in their school's Head Start program are eligible for free meals.
Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.
Children may receive free or reduced price meals if your household's Income is within the limits on
the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if
your household income falls at or below the limits on this chart.
FEDERAL INCOME CHART
For school Year 2015-2016
Household Size
Yearly
Monthly
Weekly
1 21,775
1,815 419
2
29,471
2,456 567
3
37,167
3,098
715
4
44,863
3,739
863
5
52,559
4,380
1,011
6
60,255
5,022
1,159
7
67,951
5,663
1,307
8
75,647 6,304 1,455
For each additional
person, add:
+7,696
+642
+148
2. HOW DO I KNOW IF MY CHILDREN QUALIFY AS homeless, MIGRANT, OR RUNAWAY? Do the members of
your household lack a permanent address? Are you staying together in a shelter, hotel, or other
temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living
with you who have chosen to leave their prior family or household? If you believe children in your
household meet these descriptions and haven't been told your children will get free meals, please call or
e-mail your school, homeless liaison or migrant coordinator.
3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School
Meals Application for all students in your household. We cannot approve an application that is not
complete, so be sure to fill out all required information. Return the completed application to one of your
children's schools.
4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN
ARE ALREADY APPROVED FOR FREE MEALS? No, but please read the letter you got carefully and follow the
Instructions. If any children in your household were missing from your eligibility notification, contact your
school immediately.
5. CAN I APPLY ONLINE? If available, you are encouraged to complete an online application instead of a
paper application. The online application has the same requirements and will ask you for the same
information as the paper application. Contact your school if you have any questions about the online
application.
6. MY CHILD'S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your
child's application is only good for that school year and for the first few days of this school year. You must
send in a new application unless the school told you that your child is eligible for the new school year.
7. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children In households participating in WIC may be
eligible for free or reduced price meals. Please send in an application,
8. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the
household Income you report.
9, IF I DON'T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year.
For example, children with a parent or guardian who becomes unemployed may become eligible for free
and reduced price meals if the household income drops below the income limit.
10. WHAT IF I DISAGREE WITH THE SCHOOL'S DECISION ABOUT MY APPLICATION? You should talk to school
officials. You also may ask for a hearing by calling or writing to:
Hearing Officer Name: Janet Sherlock Address: One Grand Tour. Highlands, NJ 07732
Phone Number: (732)872-0900 Ext: 2005
11. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other
household members do not have to be u.s. citizens to apply for free or reduced price meals.
12. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For
example, if you normally make $1000 each month, but you missed some work last month and only made
$900, put down that you made $1000 per month. If you normally get overtime, include it but do not
include It If you only work overtime sometimes. If you have lost a job or had your hours or wages
reduced, use your current Income.
13. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not
receive some types of income we ask you to report on the application, or may not receive Income at
all. Whenever this happens, please write a 0 in the field. However, If any income fields are left empty or
blank, those will also be counted as zeroes. Please be careful when leaving Income fields blank, as we
will assume you meant to do so.
14. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash
bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or
clothing, or receive Family Subsistence Supplemental Allowance payments, it must also be Included as
income. However, if your housing Is part of the Military Housing Privatization Initiative, do not
Include your housing allowance as Income. Any additional combat pay resulting from deployment is also
excluded from income.
15. WHAT IF THERE ISN'T ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional
household members on a separate piece of paper, and attach it to your application.
16. MY FAMILY NEEDS HELP. ARE THERE ANY PROGRAMS WE MIGHT APPLY FOR? To find out how to apply
for NJ SNAP or other assistance benefits, contact your local assistance office, call 1-800-687-9512 or
go to https:l/oneapp.dhs.state.ni.us/default.aspx. You can also contact NJ Family Care or Medicaid at
1-800-701-0710 or www.njfamilycare.org for information regarding health Insurance for your family.
For the WIC Program, call 1-866-446-5942 or go to www.nj.gov/health/fhs/wic.
If you have other questions or need help,
call (732)872-0900 Ext: 2005
Sincerely,
Signature:
Title: Business Administrator
Rev. 6/22/16