This form is to let St. Pius X know the intentions regarding your SPX student(s) return to campus for the fourth quarter.

This decision is binding for the fourth quarter of the 2020-2021 school year

How Many Students Do You Currently Have at SPX?required

Student 1 First Namerequired

Student 1 Last Namerequired

Student 1 Graderequired

This Student Will:required

Distance Learning Application

I request that the above-named child participate in distance learning for the fourth quarter of the 2020-2021 school year.

I have access to reliable Wi-Fi and/or the means to provide consistent access to internet.*

Yes No

I understand that the expectations for classwork, grading, and attendance will follow the St. Pius X High School Student/Guardian/Parent Handbook. *

Yes No

I understand that if my child fails to make satisfactory progress in the distance learning environment, he/she will need to return to on-campus learning. *

Yes No

I understand that by choosing this distance learning option, my child will not be able to transfer back to an in-person model for the remainder of the 2020-2021 school year.*

Yes No

I understand that by choosing this distance learning option, my child will not be able to participate in co-curricular activities.*

Yes No

Please select the reason(s) why you prefer your student learn in the distance learning model throughout the third quarter. *

Concern of COVID-19 transmission among students Concern of COVID-19 transmission among faculty/staff Concern of having to be quarantined Inability to maintain 6ft of physical distancing Cohabitation with an individual in a high-risk category Feeling that not enough health and safety protocols are in place to keep students safe Other

Please Specify Reason:required

Students participating in distance learning are not permitted to participate in co-curricular activities. If you have special considerations that you would like St. Pius X High School leadership to consider for your student, please include them below.

.

Special Considerations:

Student 2 First Namerequired

Student 2 Last Namerequired

Student 2 Graderequired

This Student Will:required

Distance Learning Application

I request that the above-named child participate in distance learning for the third quarter of the 2020-2021 school year.

I have access to reliable Wi-Fi and/or the means to provide consistent access to internet.*

Yes No

I understand that the expectations for classwork, grading, and attendance will follow the St. Pius X High School Student/Guardian/Parent Handbook. *

Yes No

I understand that if my child fails to make satisfactory progress in the distance learning environment, he/she will need to return to on-campus learning. *

Yes No

I understand that by choosing this distance learning option, my child will not be able to transfer back to an in-person model for the remainder of the 2020-2021 school year.*

Yes No

I understand that by choosing this distance learning option, my child will not be able to participate in co-curricular activities.*

Yes No

Please select the reason(s) why you prefer your student learn in the distance learning model throughout the third quarter. *

Concern of COVID-19 transmission among students Concern of COVID-19 transmission among faculty/staff Concern of having to be quarantined Inability to maintain 6ft of physical distancing Cohabitation with an individual in a high-risk category Feeling that not enough health and safety protocols are in place to keep students safe Other

Please Specify Reason:required

Students participating in distance learning are not permitted to participate in co-curricular activities. If you have special considerations that you would like St. Pius X High School leadership to consider for your student, please include them below.

Special Considerations:

Student 3 First Namerequired

Student 3 Last Namerequired

Student 3 Graderequired

This Student Will:required

Distance Learning Application

I request that the above-named child participate in distance learning for the third quarter of the 2020-2021 school year.

I have access to reliable Wi-Fi and/or the means to provide consistent access to internet.*

Yes No

I understand that the expectations for classwork, grading, and attendance will follow the St. Pius X High School Student/Guardian/Parent Handbook. *

Yes No

I understand that if my child fails to make satisfactory progress in the distance learning environment, he/she will need to return to on-campus learning. *

Yes No

I understand that by choosing this distance learning option, my child will not be able to transfer back to an in-person model for the remainder of the 2020-2021 school year.*

Yes No

I understand that by choosing this distance learning option, my child will not be able to participate in co-curricular activities.*

Yes No

Please select the reason(s) why you prefer your student learn in the distance learning model throughout the third quarter. *

Concern of COVID-19 transmission among students Concern of COVID-19 transmission among faculty/staff Concern of having to be quarantined Inability to maintain 6ft of physical distancing Cohabitation with an individual in a high-risk category Feeling that not enough health and safety protocols are in place to keep students safe Other

Please Specify Reason:required

Students participating in distance learning are not permitted to participate in co-curricular activities. If you have special considerations that you would like St. Pius X High School leadership to consider for your student, please include them below.

Special Considerations:

Parent/Guardian First Namerequired

Parent/Guardian Last Namerequired