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DAVIS MIDDLE SCHOOL 5TH GRADE
DATE OF ENROLLMENT __ _
Student's Name _______ _ ___ _ ____________ _ _ _ _ (Last) (First) (Middle)
Legal Name ____ _ _________ _ _ ______________ _ (If different) (Last) (First) (Middle)
Home Phone __________ _ Cell Phone _________ __ _
Student's S.S. Number ____________ _ Male__ Female __ _
Student Birth Date ______ Birthplace ___________ Age __ (City) (State)
Parents Email Address ________________________ _
Please specify child's ethnic origin: _ Asian _ White _ Hispanic or Latino _ Not Hispanic or Latino _ African American Native Hawaiian or Other Pacific Islander
_ American Indian or Alaska Native Does Student have C.O.1.B Card __ (Yes or NO)
Are any languages, other than English spoken in the home __ Yes No
Student's Home Address _ _ _ _ ______ _ _ _ _____ _ ____ _ (Street or P.O. Box) (City) (Zip)
Mailing Address (If different) ______________________ _
(Street or P.O. Box) (City) (Zip)
Name of county in which you reside _________ _____ _ __ _
Legal names of student's natural parents: Mother_____ ___ ___ _ _ Father _ ___ _ _ ___ ___ _
Male parent/guardian with whom student resides: Father, Step Father, Guardian
(Name) (Work Place)
(Occupation) (Work Phone)
Female parent/guardian with whom student resides: Mother, Step Mother, Guardian
(Name) (Work Place)
(Occupation) (Work Phone)
Emergency Contacts: (At least two other than parents)
(Name) (Relationship) (Phone)
(Name (Relationship) (Phone)
Does student ride a bus? _ yes _ no Bus #__ Driver ____ ____ _ _
Directions to home ____________________ _ _ ____ _
Does Student have any health problems? _______ _ _ _ _ _ ____ _
Student on IEP/ Special Classes _______ _____________ _
If student's parents are divorced or separated please indicate who has custody _ _ _________ _
Last school attended (Other than Davis) _ _ _________________ _
(Name of school) (Grade)
School's Full Mailing Address _ _ _ _____ ______________ _
I give permission of my child ___ _ ________ _ _ _ _______ _ (child's name)
to participate in field trips within a 60 mile radius of the school.
(Parent Signature)
Davis Public School District Mobile Computing Handbook
Acceptable use for Personal and District Owned Computers and Devices, Mobile Devices, Internet Access, Google Apps for Education
Suite, and Internet Applications
Student Guidelines and Policies for Acceptable Use of Technology Resources for Mobile Computing at Davis Public Schools are provided so that students and parents are aware of the responsibilities students accept when they use Personal or District-owned computer hardware, operating system software, application software, stored text, data files, electronic mail, local databases, digitized information, communication technologies, and Internet access. In general, this requires efficient, ethical, and legal utilization of all technology resources.
1. Expectations are as follows:
a. Student use of Personal or district-owned computers or devices, other technology hardware, software, and computer networks, including the Internet, is only allowed when supervised or granted permission by a staff member, during passing periods or at lunch.
b. All users are expected to follow existing copyright laws.
c. Although the District has an Internet safety plan in place, students are expected to notify a staff member whenever they come across information or messages that are inappropriate, dangerous, threatening, or make them feel uncomfortable.
d. Students who identify or know about a security problem are expected to convey the details to their teacher without discussing it with other students.
e. Students are expected to follow Digital Citizenship guidelines as established by the ISTE National Education Technology Standards (NETS) topics below.
2. Unacceptable conduct includes, but is not limited to the following:
a. Using the network for illegal activities, including copyright, license, or contract violations or downloading inappropriate materials, viruses, and/or software, such as but not limited to hacking and host file-sharing software.
b. Using the network for financial or commercial gain, advertising, or political lobbying.
c. Accessing or exploring online locations or materials that do not support the curriculum and/or are inappropriate for school assignments, such as but not limited to, pornographic sites or threatening behavior.
d. Vandalizing and/or tampering with equipment, programs, files, software, system performance, or other components of the network. Use or possession of hacking software is strictly prohibited.
e. Causing congestion on the network or interfering with the work of others, e.g., chain letters or broadcast messages to lists or individuals.
f. Intentionally wasting finite resources, i.e., online time, real-time music.
g. Gaining unauthorized access anywhere on the network.
h. Revealing the home address or phone number of one’s self or another person.
i. Invading the privacy of other individuals.
j. Using another user’s account, password, or ID card or allowing another user to access your account, password, or ID.
k. Coaching, helping, observing, or joining any unauthorized activity on the network.
l. Posting anonymous messages or unlawful information on the system.
m. Engaging in sexual harassment or using objectionable language in public or private messages, e.g., racist, terroristic, abusive, sexually explicit, threatening, demeaning, stalking, or slanderous.
n. Falsifying permission, authorization, or identification documents.
o. Obtaining copies of or modifying files, data, or passwords belonging to other users on the network.
p. Knowingly placing a computer virus on a computer or network.
3. Acceptable use guidelines for the District’s network computer online services are as follows:
a. General Guidelines:
i. Students will have access to all available forms of electronic media and communication that is in support of education and research, and in support of the educational goals and objectives of the District. Personal devices will be filtered by the District in the same manner as District-owned equipment.
ii. Students are responsible for their ethical and educational use of the computer online services in the District.
iii. All policies and restrictions of the District’s computer online services must be followed.
iv. Access to the District’s computer online services is a privilege and not a right. Each employee, student, and/or parent will be required to sign the Acceptable Use Policy Agreement Sheet and adhere to the Acceptable Use Guidelines in order to be granted access to District computer online services.
v. The use of any District computer online services in the District must be in support of education and research and in support of the educational goals and objectives of the District.
vi. When placing, removing, or restricting access to specific databases or other District computer online services, school officials will apply the same criteria of educational suitability used for other education resources.
vii. Transmission of any material that is in violation of any federal or state law is prohibited. This includes, but is not limited to confidential information, copyrighted material, threatening or obscene material, and computer viruses.
viii. Any attempt to alter data, the configuration of a computer, or the files of another user without the consent of the individual, campus administrator, or technology administrator, will be considered an act of vandalism and subject to disciplinary action in accordance with the District’s Student Code of Conduct booklet.
ix. Parents concerned with the District’s computer online services at their child’s school should refer to EFA(LOCAL): Instructional Resources: Instructional Material Selection
and Adoption policy and follow the stated procedure.
x. Any parent wishing to restrict their children’s access to any District computer online services will provide this restriction request in writing. Parents will assume responsibility for imposing restrictions only on their own children.
b. Network Etiquette:
i. Be polite.
ii. Use appropriate language.
iii. Do not reveal personal data (home address, phone number, phone numbers of other people).
iv. Remember that the other users of the District’s computer online services and other networks are human beings whose culture, language, and humor have different points of reference from your own.
v. Users should be polite when forwarding email. The intent of forwarding email should be on a need-to-know basis.
c. E-Mail:
i. All secondary students will be provided with a school affiliated email address which is filtered to meet CIPA requirements.
ii. E-mail should be used for educational or administrative purposes only.
iii. E-mail transmissions, stored data, transmitted data, or any other use of the District’s computer online services by students, employees, or any other user shall not be considered confidential and may be monitored at any time by designated staff to ensure appropriate use.
iv. All email and all email contents are property of the District.
4. Consequences for breach of Acceptable Use Policy
a. The student in whose name a system account and/or computer hardware is issued will be responsible at all times for its appropriate use.
b. Noncompliance with the guidelines published here, in the Student Code of Conduct, may result in suspension or termination of technology privileges and disciplinary actions. Use or possession of hacking software is strictly prohibited and violators will be subject to consequences of the Student Code of Conduct. Violations of applicable state and federal law, including the Oklahoma Penal Code, Computer Crimes, will result in criminal prosecution, as well as disciplinary actions by the District.
c. Electronic mail, network usage, and all stored files will not be considered confidential and may be monitored at any time by designated District staff to ensure appropriate use.
d. The District will cooperate fully with local, state, or federal officials in any investigation concerning or relating to violations of computer crime laws. Contents of e- mail and network communications will be turned over to the proper authorities and proper authorities will be given
access to their content.
Terms of the Computing Device Loan
Terms: You will comply at all times with the Davis School District’s Parent/Student Mobile Computing Handbook and Acceptable Use Policy, incorporated herein by reference and made a part hereof for all purposes. Any failure to comply may terminate your rights of possession effective immediately and the District may repossess the property. Students shall have no reasonable expectation of privacy in the device used, and the District, in its sole discretion, can review the contents of the device at any time.
Title: Legal title to the property is in the District and shall at all times remain in the District. Your right of possession and use is limited to and conditioned upon your full and complete compliance with this Agreement and the Parent/Student Mobile Computing Handbook.
Loss or Damage: If the property is intentionally damaged, you are responsible for the reasonable cost of repair or its fair market value on the date of damage. Loss or theft of the property must be reported to the District by the next school day after the occurrence, or you will be responsible for the fair market value replacement. A table of estimated pricing for a variety of repairs is included in the Parent/Student Mobile Computing Handbook to which reference is hereby made. Seniors must clear all records and pay all fees before participating in graduation ceremonies.
Repossession: If you do not timely and fully comply with all terms of this Agreement and the Parent/Student Mobile Computing Handbook, including the timely return of the property, the District shall be entitled to declare you in default and come to your place of residence, or other location of the property, to take possession of the property. The District, in its sole discretion, shall determine if a violation of this Agreement and the Mobile Computing Handbook has occurred. The District’s determination shall be conclusive.
Term of Agreement: Your right to use and possession of the property terminates not later than the last day of the school year unless earlier terminated by the District or upon withdrawal from the District.
Appropriation: Your failure to timely return the property and the continued use of it for non-school purposes without the District’s consent may be considered unlawful appropriation of the District’s property.
Use & Maintenance Costs
• In case of theft, vandalism, and other criminal acts, a police report MUST be filed by the student or parent within 48 hours of the occurrence. Incidents happening off campus must be reported to the police by the parent and a copy of the report must be brought to the school.
• If device is stolen and student reports the theft (by the next school day) and police filed a report, then the student will not be charged.
• Student will be charged the Fair Market Value of the device if lost, damaged or vandalized.
• There will be an optional $25.00 technology fee. This fee will cover up to 2 accidental damages to the device, upon a 3rd accidental damage it will be at the discretion of the administration if the student is responsible for the damage.
• Seniors must clear all records and pay all fees before participating in graduation.
• Students/Parents are responsible for reasonable cost of repair for deliberately damaged devices.
Device Usage Guidelines and Procedures
Davis Public Schools is committed to provide the necessary tools to effectively utilize computing devices. To
accommodate this process, the District is providing the following:
Check-Out Check-In Procedures
The device check-out/check-in process will mirror textbook management practices established at each individual campus.
Web Filtering Filtering and Security
The industry-leading Web filtering and Web security technology, Lightspeed, will be used to protect device users outside of your organization's network. Remote Filtering protects remote users and frequent travelers from external security threats and prevents access to inappropriate and malicious sites, phishing sites, spyware, and malicious mobile code as well as a tracking system software that will be installed on devices providing the ability to GPS track, locate, disable and recover lost or stolen devices.. A critical component of any organization's endpoint protection strategy, remote filtering ensures secure internet use anytime and anywhere. Davis Public Schools uses the Lightspeed Relay filtering solution to meet federal CIPA requirements. For more information about Internet safety, please visit www.isafe.org.
Data Access
Students can save important files to their Google Drive folder which is cloud based, and backed-up continually by Google. Students can access this data from any computer with Internet access. While working offline, student data will be cached locally and synchronized once network access is established.
Students may also save files to a flash drive or other external device.
Profiles and Policies
Student policies are pushed from Active Directory Services for all student logins giving sufficient access to complete tasks. While allowing for windows security updates, students will not have install capabilities for other software. Requests for additional software packages can be made through their campus “Help Desk”. A district approved default software package will be installed on all devices prior to checkout. Google apps may be pushed out at any time by teacher request.
Help Desk Requests
The Davis Public Schools Information Technology Department will strive to provide “same day” turn around on all student/teacher device problems. All Help Desk requests will be submitted to the campus technology office and prioritized accordingly.
Summer Storage
Devices will be returned during the textbook check-in process at each campus and stored appropriately. All devices will be thoroughly inspected and re-imaged during the summer months by the IT Dept client services staff.
Parental Involvement
In addition to the Student Mobile Computing Handbook, informative presentations will be provided for parents regarding the One-to-One initiative. A parental permission form must be signed and on file before device receipt.
Classroom Computers
The District currently has multiple computer labs on campus. These computers can be used by students if they do not have their device. They will be able to access their work saved in the Google Drive folder from any computer with Internet access.
No Loaning or Borrowing Devices
• Do NOT loan devices or other equipment to anyone.
• Do NOT borrow a device from another student.
• Do NOT share passwords or usernames with others.
General Device Rules Inappropriate Content & Graffiti
• Inappropriate content will not be allowed on devices.
• Physical appearance of the device may not be modified by any means, including skins, stickers, markers, etc.
• Presence of weapons, pornographic materials, inappropriate language, alcohol, drug, gang-related symbols or pictures on the device will result in disciplinary actions.
• In the case of intentional damage, students will be charged for replacement parts.
Sound
• Sound will be muted at all times unless permission is obtained from the teacher for instructional purposes. Headphones, provided by the student, may be used when approved by the teacher.
Deleting Files
• Do not delete any folders, files, or apps that you did not create or that you do not recognize. Deletion of certain files will result in a computer failure and will interfere with your ability to complete class work and may affect your grades.
Music, Games, or Programs
• Music and games may not be downloaded or streamed over the Internet. This may be a violation of copyright laws.
• All software loaded on the system must be District approved.
Unauthorized Access
• Access to another person’s account or computer without their consent or knowledge is considered hacking and is unacceptable.
DAVIS PUBLIC SCHOOLS
STUDENT/PARENT DEVICE USE AGREEMENT PLEASE PRINT ALL INFORMATION
_____________________________________________________________________________
Student Name __________________________ __________________________ __________________________
Last Name First Name Student ID#
Parent Name __________________________ __________________________
Last Name First Name
Parent Email Address ______________________________________________________ Student Current Grade ______________
Address ____________________________________________________________________________________________________
Home Phone ____________________________________ Work Phone ____________________________________
_____________________________________________________________________________
In this agreement, “we”, “us”, and “our” means the District. “You” and “your” means the parent/guardian and student enrolled in Davis Public Schools.. The “property” is a device owned by Davis Public School District.
_____________________________________________________________________________
Terms: You will comply at all times with the Davis Public School District’s Mobile Computing Handbook and Acceptable Use Policy, incorporated herein by reference and made a part hereof for all purposes. Any failure to comply may terminate your rights of possession effective immediately and the District may repossess the property. Students shall have no reasonable expectation of privacy in the device and the District, in its sole discretion, can review the contents of the device at any time.
Title: Legal title to the property is in the District and shall at all times remain in the District. Your right of possession and use is limited to and conditioned upon your full and complete compliance with this Agreement and the Mobile Computing Handbook.
Loss or Damage: If the property is intentionally damaged, you are responsible for the reasonable cost of repair or its fair market value on the date of damage. Loss or theft of the property must be reported to the District by the next school day after the occurrence and a police report must be filed, or you will be responsible for the fair market value replacement.
Seniors must clear all records and pay all fees before participating in graduation ceremonies.
Repossession: If you do not timely and fully comply with all terms of this Agreement and the Mobile Computing Handbook, including the timely return of the property, the District shall be entitled to declare you in default and come to your place of residence, or other location of the property, to take possession of the property. The District in its sole discretion, shall determine if a violation of this Agreement and the Mobile Computing Handbook has occurred. The District’s determination shall be conclusive.
Terms of Agreement: Your right to use and possession of the property terminates no later than the last day of the school year unless earlier terminated by the District or upon withdrawal from the District.
Appropriation: Your failure to timely return the property and the continued use of it for non-school purposes without the District’s consent may be considered unlawful appropriation of the District’s property.
Optional Technology Fee: Please select one of the following.
_____ I accept and will pay the $25 fee. Accidental damage to any device will be covered up to two incidents by this fee. A 3rd incident will be at the discretion of the administration.
_____ I decline the fee and will be accepting all responsibility for damages to any devices.
_____________________________________________________________________________ Users’ Signatures:
_____________________________ _____________________________ ________________
Parent or Guardian Signature Student Signature Date
20J.!/_-20.2.i) HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS
STUDENT INFORMATION
Name of Student: _____________ ___________ _ Last Name First Name Middle Name
Date of Birth: _____ _ School: ____ _ Student ID# ______ _ MM/DD/YYYY
Is the student of Hispanic or Latino culture or origin? Yes. __ _ No. ___ _
Select one or more of the following races: African American/Black Native Hawaiian/Pacific Islander
American Indian/Alaskan Native Caucasian/White
1. What is the dominant language most often spoken by the student?
Grade:. ____ _
Gender: Male ___ Female. __ _
Asian
2. What is the language routinely spoken in the home, regardless of the language spoken by the student? __________ _
3. What language was first learned by the student?
4. Does the parent/guardian need interpretation services? Yes__ No If so, what language? __________ _
5. Does the parent/guardian need translated materials? Yes__ No__ If so, what language?
6. What was the date the student first enrolled in a school in the United States? ________ _ MM/YYYY
Date (MM/DD/YYYY) Parent I Guardian Signature -
SCHOOL USE ONLY
D Other language than English Indicated TWO OR MORE times on questions 1 - 3 above. The student is classified as ·more often· and automatically qualifies as bilingual on the accreditation report.
D Other language than English Indicated ONLY ONCE on questions 1 - 3 above. The student is dassified as 'less often• and only qualifies as blHngual on the accreditation report 
CHILD NUTRITION PROGRAM 2 019- 2020
PARENT NOTIFICATION
Tne Chi l d Nu~ri - ~on Progra~ (CNP ) is dedica:ect to servir.g goac, nutritious meals to tr.e students in :he :>a·1 .:.. s P•.,bli::: S:::r.oo ls . It is our goal to ser ve meals that all the students will enjoy . If your :::hild has a rood allergy , it is irnportan: we know, s o that a:-i alterr.ati•."= may be pre?a r ed .
~eal prices f or z c :9- 2O2 0 sc~oo: ter~ :
Paid stJdents ?re-k i ~d~r;a=te~ ~~rou1h grad~ 4 Paid scudents grad~ 5 thrcu~h 12 IMSi ~s : ~ed J:::ed meal prices all grades All adults anc all visito rs
3:-:e::tk fast 1.25 1 . 50
. 30 ~. 00
Lt.:nC:'l 2 . 0 ) 2 . 25
. 40 3 . 65
r~e CN? has a new reea l cou:-i:i ng syste~ that can reccr d c r edits ar.d deoits in each student a::::::ount . Pr epayments are encouraged for the convenience of parents/guardians. Elementa r y students wil: recei ve s'.:ateme:-its d i stribu:ed through tt:eir teacr.er . Mi ddle Sc:1001 and Hig;i School sta tements ~,i ll be mailed . Account s t atus reports may be requested at any time fr om the C~? office .
The ?ol! c y c f the Davis Pi.:bl!c Schoo ls is to a l low only ten (10 1 emer;ency cha!ges . Students will ~o: be allow to charge aft er ten1:0 1 c har;es have been accumulated ~:-1:il a:l charges have been paid . T~i s ~eal policy will be str i c~ly e~ f crced ci.:ring this sc~col term .
Appl t ca:ions for Free and Reci.:ced ~ea_s are available witt t he er.ro~l~en t packet er car. be comple: ed a: anyc i ~e during t he school year . Yo u ~ay obtain a f c!n ! r cn the o f f i ce or :he cafeteria . f orms can a l so be sent. home 1~icr. yet.:::- child o r ma:.led by r equest: . Studer.ts enr olled ir-, Davis Public Sc~ools can be e nce r ed on one ~ami l y ho~Se;'\Old application.
It is not necessa:y t o complete more :han one application .
Other school- programs in add~tion co the Child Nut r i t ion Pr ogra~ recei ve fundi ng based o~ the total nun.be! of approved app~ica~ i ons ; t he refore ~1 1 pa r ents a r e urged to complete this a ppl i cation a t enr ollme nt bec ause these B?p licacions have a fi~ancia: impact on the total school bt.:dget .
?lease con::a ct Chi ld Nutri t ion offL::e a :: (580) 369- 2458 or Superin:endent O:fice if there are any questions .
Page 2 o f 2 , ns100 Ca f eter ia
- - - - L
Approved: July 7, 2005; Revised: August 9, 2007
8015 - DA VIS PUBLIC SCHOOLS ACTIVITY STUDENT DRUG TESTING POLICY
The Davis Board of Education in an effort to protect the health and safety of its extracurricular activities students from illegal and/or performance-enhancing drug use and abuse, thereby setting an example for all other students of the Davis Public School District, proposes to adopt the following policy for drug testing of activity students.
STATEMENT OF PURPOSE AND INTENT
Although the board of Education, administration, and staff desire that every student in the Davis Public School District refrain from using or possessing illegal drugs, district officials realize that their power to restrict the possession or use of illegal and performance-enhancing drugs is limited. Therefore, this policy governs only perfonnance-enhancing and illegal drug use by students participating in certain extra-curricular activities. The sanctions imposed for violations of this policy will be limitations solely upon limiting the opportunity of any student determined to be in violation of this policy to a student's privilege to participate in extracurricular activities. No suspensions from school or academic sanctions will be imposed for violations of this policy. This policy supplements and complements all other policies, rules, and regulations of the Davis Public School District regarding possession or use of illegal drugs.
Participation in school-sponsored interscholastic extra-curricular activities at the Davis Public School District is a privilege. Students who participate in these activities are respected by the student body and are representing the school district and the community. Accordingly, students in extra-curricular activities carry a responsibility to themselves, their fellow students, their parents and their school to set the highest possible examples of conduct, sportsmanship, and training, which includes avoiding the use or possession of illegal drugs. In addition the opportunity for students to drive or park a vehicle on campus is a privilege, and not a right; and those students receiving a parking permit from Davis School will be included in this policy. The safety of students of the Davis Public School District is paramount, and driving on campus while using or possessing illegal drugs would be a serious threat to student health and safety.
The purposes of this policy are five-fold:
1. To educate students of the serious physical, mental and emotional harm Caused by illegal drug use.
2. To alert students with possible substance abuse problems to the potential harms that drug use poses for their physical, mental, and emotional well-being and offer them the privilege of competition as an incentive to stop using such substances.
3. Ensure that students adhere to a training program that bars the intake of illegal and performance-enhancing drugs.
4. To prevent injury, illness, and harm for students that may arise as a result from illegal and performance-enhancing drug use.
5. To offer students practices, competition and school activities free of the effects of illegal and performance-enhancing drug use.
Illegal and performance-enhancing drug use of any kind is incompatible with the physical, mental, and emotional demands placed upon participants in extra-curricular activities
Page 1 of 8, #8015 Activity Student Drug Testing Policy
and upon the positive image these students project to other students and to the community on behalf of the Davis Public School District For the safety, health and well being of students in extra-curricular activities the Davis Public School District has adopted this policy for use by all participants in interscholastic extra-curricular activities in grades 7-12.
The administration may adopt regulations to implement this policy.
I. Definitions
"Activity Student" means a member of any middle school or high school Davis Public School District sponsored extra-curricular organization which participates in interscholastic competition. This includes any student that represents Davis Schools in any extra-curricular activity in interscholastic competition, such as BP A, FF A, Academic Team, Band, Vocal, Cheerleading and Athletics
"Drug use test" means a scientifically substantiated method to test for the presence of illegal or performance-enhancing drugs or the metabolites thereof in a person's urine.
"Random Selection Basis" means a mechanism for selecting activity students for drug testing that:
A results in an equal probability that any activity student from a group of activity students subject to the selection mechanism will be selected, and
B. does not give the School District discretion to waive the selection of any student selected under the mechanism.
"Illegal drugs"means any substance which an individual may not sell, possess, use, distribute or purchase under either Federal or Oklahoma law. "Illegal drugs" includes, but is not limited to, all scheduled drugs as defined by the Oklahoma Uniform Controlled Dangerous Substance Act, all prescription drugs obtained without authorization, and all prescribed and overthe-counter drugs being used for an abusive purpose. "Illegal drugs" shall also include alcohol.
"Performance-enhancing drugs" include anabolic steroids and any other natural or synthetic substance used to increase muscle mass, strength, endurance, speed or other athletic ability. The term "performance-enhancing drugs" does not include dietary or nutritional supplements such as vitamins, minerals and proteins which can be lawfully purchased in overthe-counter transactions.
"Positive" when referring to a drug use test administered under this policy means a toxicological test result which is considered to demonstrate the presence of an illegal or a performance-enhancing drug or the metabolites thereof using the standards customarily established by the testing laboratory administering the drug use test.
"Reasonable suspicion" means a suspicion of illegal or performance-enhancing drug use based on specific observations made by coaches/administrators/sponsors/teachers of subtle changes in the appearance, speech, or behavior of the student: the reasonable inferences that are drawn from those observations; and/or information of illegal or performance-enhancing drug use by a student supplied to school officials by credible sources. In order for a student to be referred for testing on "reasonable suspicion," his or her activity sponsor, or ( one of his/her teachers) and at least two building administrators must agree to the reasonable suspicion. The name and identity of students referred on "reasonable suspicion" will be kept confidential.
Page 2 of 8, #8015 Activity Student Drug Testing Policy
"Reasonable suspicion" would not include overtly recognizable signs of present illegal drug use, such as a perceptible odor of drugs, erratic behavior reasonable attributable to illegal drug or alcohol use, or perceptible odor of alcohol. Instances such as these would subject the student to ordinary disciplinary action apart from this policy.
II. Procedures
Each activity student shal1 be provided with a copy of the "Student Drug Testing Consent Form" which shall be read, signed and dated by the student, parent or custodial guardian and coach/sponsor before such student shall be eligible to practice or participate in any extracurricular activities. The consent requires the activity student to provide a urine sample: (a) as part of the student's annual physical or for eligibility for participations: (b) when the activity student is selected by the random selection basis to provide a urine sample; and ( c) at any time when there is reasonable suspicion to test for illegal or performance-enhancing drugs. No student shall be allowed to practice or participate in any extra-curricular activities involving interscholastic competition unless the student has returned the properly signed "Student Drug Testing Consent Form".
Prior to the commencement of drug testing each year an orientation session will be held with each Activity Student to educate them of the sample collection process, privacy arrangements, drug testing procedures and other areas which may help to reassure the activity student and help avoid embarrassment or uncomfortable feelings about the drug testing process.
Each Activity Student shall receive a copy of the Activity Student Drug Testing Policy. The head coach or sponsor shall be responsible for explaining the Policy to all prospective students, and for preparing an educational presentation to acquaint the student with the harmful consequences of drug and alcohol use and abuse.
All Activity Students will be required to provide a urine sample before the student may participate in an extra-curricular activity covered under this policy. A student who moves into the district after the school year begins will have to undergo a drug test before they will be a eligible for participation.
Drug use testing for Activity Students will also be chosen on a random selection basis monthly from a list of all Activity Students who are involved in off-season or in-season activities. The Davis Public School District will determine a monthly number of student names to be drawn at random to provide a urine sample for drug use testing for illegal drugs or performance-enhancing drugs. Also included in the random testing process are all students with a prior positive result.
In addition to the drug tests required above, any Activity Student may be required at any time to submit to a test for illegal or performance-enhancing drugs, or the metabolites thereof when an administrator, coach, or sponsor has reasonable suspicion of illegal or performanceenhancing drug use by that particular student.
Any drug use test will be administered by or at the direction of a professional laboratory chosen by the Davis Public School District. The professional laboratory shall be required to use scientifically validated toxicological testing methods, have detailed written specifications to assure chain of custody of the specimens, and proper laboratory control and scientific testing.
Page 3 of 8, #8015 Activity Student Drug Testing Policy
All aspects of the drug use testing program, including the taking of specimens, will be conducted so as to safeguard the personal and privacy rights of the student to the maximum degree possible. The test specimen shall be obtained in a manner designed to minimize intrusiveness of the procedure. In particular, the specimen must be collected in a restroom or other private facility behind a closed stall. The principal/athletic director shall designate a coach, sponsor, or school employee of the same sex as the student to accompany the student to a restroom or other private facility behind a closed stall. The monitor shall not observe the student while the specimen is being produced, but the monitor shall be present outside the stall to listen for the normal sounds of urination in order to guard against tampered specimens and to insure and accurate chain of custody. The monitor shall verify the normal warmth and appearance of the specimen. If at any time during the testing procedure the monitor has reason to believe or suspect that a student is tampering with the specimen, the monitor may stop the procedure and inform the principal/athletic director who will then determine if a new sample should be obtained. The monitor shall give each student a form on which the student may list any medications legally prescribed for the student he or she has taken in the preceding thirty (30) days. The parent of legal guardian shall be able to confirm the medication list submitted by their child during the twenty-four (24) hours following any drug test. The medication list shall be submitted to the lab in a sealed and confidential envelope and shall not be viewed by district employees.
An initial positive test result will be subject to confirmation by a second and different test of the same specimen. The second test will use the gas chromatography/mass spectrometry technique. A specimen shall not be reported positive unless the second test utilizing the gas chromatography/mass spectrometry procedure is positive for the presence of an illegal drug or the metabolites thereof. The unused portion of a specimen that tested positive shall be preserved by the laboratory for a period of six (6) months or the end of the school year, whichever is shorter. Student records will be retained until the end of the school year.
m. Confidentiality
The laboratory will notify the principal/athletic director or designee of any positive test. To keep the positive test results confidential, the principal/athletic director or designee will only notify the student, the head coach/sponsor, and the parent or custodial guardian of the student of the results. The principal/athletic director or designee will schedule a conference with the student and parent or guardian and explain the student's opportunity to submit additional information to the principal/athletic director or to the lab. The Davis Public School District will rely on the opinion of the laboratory which performed the test in determining whether the positive test result was produced by something other than consumption of an illegal or performance-enhancing drug.
Test results will be kept in files separate from the student's other educational records, shall be disclosed only to those school personnel who have a need to know, and will not be turned over to any law enforcement authorities.
IV. Appeal
An Activity Student who has been determined by the principal/athletic director to be in violation of this policy shall have the right to appeal the decision to the Superintendent or his/her designee(s). Such request for a review must be submitted to the Superintendent in writing within five (5) calendar days of notice of the positive test. A student requesting a review will remain eligible to participate in any extra-curricular activities until the review is completed. The
Page 4 of 8, #8015 Activity Student Drug Testing Policy
Superintendent or his/her designee (s) shall then determine whether the original finding was justified. No further review of the Superintendent's decision will be provided and his/her decision shall be conclusive in all respects. Any necessary interpretation or application of this policy shall be in the sole and exclusive judgment and discretion of the Superintendent which shall be final and nonappealable.
V. Consequences
Any Activity Student who tests positive in a drug test under this policy shall be subject to the following restrictions:
First Offense:
Parent/guardian will be contacted immediately and a private conference will be scheduled to present the test results to the parent/guardian. A meeting will then be set up with the student, parent/guardian, athletic director, and principal concerning the positive drug test.
The student will be suspended from participation in all activities covered under this policy for (21) calendar days, and successful completion of four ( 4) hours of substance abuse education/counseling from a qualified drug treatment program or counseling entity. Any fees that arise from treatment or counseling will be the responsibility of the parent/guardian. The student may not participate in any meetings practices, scrimmages or competitions during this period. Additionally, the student will be randomly tested for the remainder of the school year. The time and date will be unknown to the student and determined by the principal/athletic director or designee.
These restrictions and requirements shall begin immediately, consecutive in nature, unless a review appeal is filed following receipt of a positive test. Should the parent/student not agree to these provisions the consequences listed in this policy for the second offense will be imposed.
Second Offense (in the same school year):
Complete suspension from participation in all extra-curricular activities including all meetings, practices, performances, and competition for the remainder of the school year, or eighty-eight school days (1 semester) whichever is the longer and successful completion of eight (8) hours of substance abuse education/counseling from a qualified drug treatment program or counseling entity. This may carry over to the next school year if necessary.
VI. Steroid Testing will be Conducted on a Random Basis
VII. Refusal to Submit to Drug Use Test
A participating student, who refuses to submit to a drug test authorized under this policy, shall not be eligible to participate in any activities covered under this policy including all meetings, practices, performance and competitions for the remainder of the school year. Additionally, such student shall not be considered for any interscholastic activity honors or awards given by the school.
VIII. Voluntary Participation
If the student is not a member of an extracurricular activity involving competition but the parent/guardian wants them to be subject to the random drug testing, the parent/guardian may do so by contacting the building principal or athletic director and completing a "Voluntary Participation Fonn". In
Page 5 of 8, #8015 Activity Student Drug Testing Policy
the event of such a request, the cost of the test and any counseling which may arise will be the responsibility of the parent/guardian.
Davis Public Schools is committed to cooperating with parents/guardians in an effort to help students avoid illegal drug use. The Davis Public School District believes accountability is a powerful tool to help some students avoid using drugs and that early detection and intervention can save lives.
Page 6 of 8, #8015 Activity Student Drug Testing Policy
Davis Public School District Student Drug Testing Consent Form
Statement of Purpose and Intent
Participation in school sponsored extra-curricular activities at the Davis School District is a privilege. Activity Students carry a responsibility to themselves, their fellow students, their parents, and their school to set the highest possible examples of conduct, which includes avoiding the use or possession of illegal drugs.
Drug use of any kind in incompatible with participation in extra-curricular activities on behalf of the Davis Public School District. For the safety, health, and well being of the student of the Davis Public School District, the Davis Public School District has adopted the attached Activity Student Drug Testing Policy and the Student Drug Testing Consent for use by all participating students at the middle school and high school levels.
Participation in Extra-Curricular Activities
Each Activity Student shall be provided with a copy of the Activity Student Drug Testing Policy and Student Drug Testing Consent which shall be read, signed and dated by the student, parent or custodial guardian, and coach/sponsor before such student shall be eligible to practice or participate in any interscholastic activities. The consent shall be to provide a urine sample: a) as part of their annual physical or for eligibility for participation; b) as chosen by the random selection basis; and c) at any time requested based on reasonable suspicion to be tested for illegal or performance-enhancing drugs. No student shall be allowed to practice or participate in any activity governed by the policy unless the student has returned the properly signed Student Drug Testing Consent.
Student's Last Name First Name
I understand after having read the "Student Activity Drug Testing Policy" and "Student Drug Testing Consent," that, out of care for my safety and health, the Davis Public School District enforces the rules applying to the consumption or possession of illegal and performance-enhancing drugs. As a member of a Davis extra-curricular interscholastic activity, I realize that the personal decision that I make daily in regard to the consumption or possession of illegal or performance-enhancing drugs may affect my health and well-being as well as the possible endangerment of those around me and reflect upon any organization with which I am associated. Ifl choose to violate school policy regarding the use or possession of illegal or performance-enhancing drugs any time while I am involved in in-season or off-season activities, I understand upon determination of that violation I will be subject to the restrictions on my participation as outlined in the Policy.
Signature of Student Date
We have read and understood the Davis Public School District "Activity Student Drug Testing Policy" and "Student Drug Testing consent" We desire that the student named above participate in the extra-curricular interscholastic programs of the Davis Public School District and we hereby voluntarily agree to be subject to its tenns. We accept the method of obtaining urine samples, testing and analysis of such specimens, and all other aspects of the program. We further agree and consent to the disclosure of the sampling, testing and results as provide in this program.
Signature of Parent or Custodial Guardian Date
Signature of Coach Team
Page 7 of 8, #8015 Activity Student Drug Testing Policy
Medication List
I, _____________ , am currently taking or have taken the following drugs, substances, or medications in the last thirty (30) days: (Medications must be legally prescribed for the Activity Student.)
Additional Information: -------------------------
Page 8 of 8, #8015 Activity Student Drug Testing Policy
This fonn is provided by Valley View Regional Hospital as a service to the parents of our community .
•
VALLEY VIEW
Rtglom!Hospial 4)0 Notd, W-VllU ·A4&.0ll&acai 7-»
AUTHORIZATION FOR MEDICAL CARE OF A MINOR
The undersigned parent or guardian has legal custody of the child named below. As such, he/she grants to the listed custodian - into whose care the child has been entrusted - permission to authorize the following: x-ray examination, anesthetic, medical/surgical/dental diagno:,is or treatment and hospital care for the child. All procedures must be recommended by a physician, surgeon or dentist licensed by the state of Oklahoma.
This consent- given in advance of a specific event - encourages the custodian to seek needed treatment for the child in the absence of a parent or guardian. It is effective until withdrawn in writing.
Dated: -------------------------- ---------
Name and birthdate of child: _________________________ _
Name of custodian (s): Davis Middle School
Signature of parent or legal guardian: _______________________ _
Signature of witness: _____________________________ _
Special medical information regarding child (allergies, current medication, medical condition: i.e. asthma,
epilepsy, diabetes, etc.): _ __________________________ _
Minor children must have parent or legal guardian consent for medical treatment. Except in a life-threatening situation, treatment could not be administered without it. Persons entrusted with the care of your child cannot give consent for treatment unless legally authorized by a parent or guardian. 1bis consent form is legal authorization for rredical and/or dental treatment and insures that your child will receive treatment without delay.
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Updated April 20 I 7
OSSAA PHYSICAL EXAMINATION AND PARENTAL CONSENT FORM
PLEASE PRINT DATE OF EXAM
Name Sex ____ Age Date of Birth
Grade School Sport(s)
Address Phone
Penmnal physician Phone
In case of emergency, contact: Name
Relationship Phone (H) (W)
Ex.Q1ain "Yes" answers below. Circle guestions ;r:ou don't know the answers to. YES NO YES NO
Have you had a medical illness or injury since your last check 24. Have you ever had numbness or tingling in your anns, hands, up or sports physical? □ □ legs, or feet? □ □ Do you have an ongoing or chronic illness? □ □ 2S. Have you ever become ill from exercising in the heat? □ □ Have you ever been hospitalized overnight? □ □ 26. Do you cough, wheeze, or have trouble breathing during or
Have you ever had surgery? □ □ after activity? □ □
Are you currently taking any prescription or nonprescription 27. Do you have asthma? □ □
( over-the-counter) medications or pills or using an inhaler? □ □ 28. Do you have seasonal allergies that require medical treatment? □ □ Have you ever taken any supplements or vitamins to help you 29. Do you or does someone in your family have sickle cell trait or □ □ gain or lose weight or improve your performance? □ □ disease?
Do you have any allergies (for example, to pollen, medicine, 30. Do you use any special protective or corrective equipment or
food, or stinging insects)? □ □ devices that aren't usually used for your sport or position (for example, knee brace, special neck roll, foot orthotics, retainer
Have you ever had a rash or hives develop during or after on your teeth, hearing aid)? □ □ exercise? □ □ 31. Have you had any problems with your eyes or vision? □ □ Have you ever passed out during or after exercise? □ □ 32. Do you wear glasses, contacts, or protective eyewear? □ □ Have you ever been dizzy during or after exercise? □ □ 33. Have you ever had a sprain, strain, or swelling after injury? □ □ Have you ever had chest pain during or after exercise? □ □ 34. Have you broken or fractured any bones or dislocated any
Do you get tired more quickly than your friends do during joints? □ □ exercise? □ □ 3S. Have you had any other problems with pain or swelling in
Have you ever had racing of your heart or skipped heartbeats? □ □ muscles, tendons, bones, or joints? □ □ Have you had high blood pressure or high cholesterol? □ □ 36. If yes, check appropriate box and explain below .
□ Head 0 Elbow □ Hip Have you ever been told you have a heart murmur? □ □ □ Neck 0 Forearm □ Thigh
Has any family member or relative died of heart problems or □ Back 0Wrbt □ Knee
of sudden death before age 50? □ □ 0 Chest 0Hand □Shin/calf
Have you had a severe viral infection (for example, 0 Shoulder 0 Finger □ Ankle
myocarditis or mononucleosis) within the last month? □ □ 0 Upper arm □ Foot
37. Do you want to weigh more or less than you do now? □ □ Has a physician ever denied or restricted your participation in sports for any heart problems? □ □ 38. Do you lose weight regularly to meet weight requirements for
your sport? □ □ Do you have any current skin problems (for example, itching, rashes, acne, warts, fungus, or blisters)? □ □ 39. Do you feel stressed out? □ □ Have you ever had a head injury or concussion? □ □ 40. Record the dates of your most recent immunizations (shots) for:
Tetanus Measles Have you ever been knocked out, become unconscious, or lost your memory? □ □
Hepatitis Chickenpox
Have you ever had a seizure? □ □ Explain "Yes" answers on a separate sheet.
Do you have frequent or severe headaches? □ □
The above information is correct to the best of my knowledge. I hereby give my informed consent for the above-mentioned student to participate in activities. I understand the risk of injury in athletic participation. If my son/daughter becomes ill or is injured, necessary medical care can be instituted by physicians, coaches, athletic trainers or other personnel properly trained. I further acknowledge and consent that, as a condition for participating in activities, identifying information about the above-mentioned student may be disclosed to OSSAA in connection with any investigation or inquiry concerning the student's eligibility to participate an/or any possible violation of OSSAA rules. OSSAA will undertake reasonable measure to maintain the confidentiality of such identifying information, provided that such information has not otherwise been publicly disclosed in some manner.
Signature ofparent/guardian. _____________ ___ Signature of Athlete. _ ____________ ____ Date _ _____ _ _
Updated April 2017
PREPARTICIPATION PHYSICAL EVALUATION
PLEASE PRINT DATEOFEXAM __________ _
Name ____________________ ____ .DateofBirth __________ _ _ _ _ _
Height ___ Weight _ __ Body fat (optional) _ _ % Pulse _ _ _ BP ___ / ___ Color Blind Yes No ( circle one)
Vision: R 20/ ___ L 20/ __ _ Corrected Y / N Pupils: Equal___ Unequal __
MEDICAL Aooearance Eyes/Ears/Throat Lymph Nodes Heart Pulses Lungs Abdomen Genitalia (male only) Skin MUSCULOSKELET AL Neck Back Shoulder/Arm Elbow/Forearm Wrist/Hand Hio/Thiizh Knee Lel!!Ankle Foot
CLEARANCE
) Cleared
Nonna b 1 . d. A norma Fm mgs
) Cleared after completing evaluation/rehabilitation for: __________________________ _
( ) Not cleared for: ________ Reason: __________ ______________ _
Recommendations:
Name & Title of Examiner (Print/Type) _________________ Date
Address _ _________ ____________ _____ Phone ___________ _
Signature of Examiner ___ ___ _______________ __ _
20.J.2_-20..2.£ HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS
Name of Student: ___________________ _____ _ Last Name First Name Middle Name
Date of Birth: _____ _ School: ____ _ Student ID# ____ __ _ MM/DD/YYYY
Is the student of Hispanic or Latino culture or origin? Yes. __ _ No ___ _
Select one or more of the following races: African American/Black Native Hawaiian/Pacific Islander
American Indian/Alaskan Native Caucasian/White
1. What is the dominant language most often spoken by the student?
Grade :. _ ___ _
Gender: Male ___ Female _ _ _
Asian
2. What is the language routinely spoken in the home, regardless of the language spoken by the student? __________ _
3. What language was first learned by the student?
4. Does the parenUguardian need interpretation services? Yes__ No If so, what language? _ __________ _
5. Does the parenUguardian need translated materials? Yes__ No__ If so, what language?
6. What was the date the student first enrolled in a school in the United States? ________ _ MM/YYYY
Date (MM/DD/YYYY) Parent / Guardian Signature :":,,_._,,, __ "'"·~w :·~-- , -- -r·----= ..... ·:~~~,:-nr-,sctroot.:use: oNtv"·-,....,. ···-~,-r-----· • ~ T ... c( ,o. ":: ~ .. . . ..
;_. ~ -. : -; r , , . ' _, .... ►,- - -· ... .. . ... ~· . .>., ca.. - ~ 4
D Other language than English Indicated TWO OR MORE times on questions 1 - 3 above. The student is classified as "more often• and automatically qualifies as bilingual on the accreditatioo report.
D Other language than English Indicated ONLY ONCE on questions 1 - 3 above. The student is classified as 'less often• and only qualifies as bilingual on the accreditatioo report 
Student Name:
Davis Public Schools McKinney-Vento Enrollment Questionnaire
Today's Date:
Date of Birth: I Grade:(Circle One) 5 6 7 8 School: DAVIS MIDDLE SCHOOL
Your child may be eligible for additional educational services through Title X, Part C McKinney-Vento Assistance Act. Eligibility can be determined by completing this questionnaire.
Where are you and your family currentlv Iivin1!? Please check one of the boxes below. Section A 0 Rent/own my own home or apartment STOP: If you checked the box that you rent/own your own home or apartment skip to the bottom of the page, sign the form, and then submit to school personnel. If you do not rent/own your own home or apartment, please continue to the next section. Section B 0 Temporarily with another family member or friend until we can locate affordable housing O In an emergency or transitional shelter O In a vehicle, park, campground, or on the streets 0 In a house, building, or trailer WITHOUT running water or electricity 0 In a hotel or motel 0 With an adult that is not a parent or legal guardian O Alone or in different locations, without an adult serving as a caregiver 0 Wherever I can find a place to stay at night 0 Other Please Explain:
If you checked a box in section B, in the space below please list all children currently living with you who attend Davis Public Schools.
First and Last Name of Male or Date of Birth Grade School Name "
Student Female ,a
The undersigned certifies that the information provided is correct and accurate.
(Print) Parent/Guardian or Adult Caring for the Student: ___________________ _
Relationship to the Student: ___________ Signature: _______________ _
Street Address City State Zip
Phone Number: ______________ Email Address: _ _____________ _
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