RCS Virtual School Opt-In Form

Application for Raleigh County Virtual Program

2025 - 26 School Year
Raleigh County Virtual Consent Form- 2025-2026

I hereby consent to the West Virginia Virtual (Raleigh County) collection, use, and/or disclosure of information about my child through the course registration process and other manual and/or electronic procedures of the Virtual Program or associated course providers. I understand that my child is registering for a virtual course and that the information collected is needed for both course registration and grade/progress reporting to my child’s school. This consent form covers all forms of distance learning courses, included but not limited to satellite courses, video courses, and web-based courses. Your child’s image may be transmitted during video portions of distance learning and online courses. The information supplied to the course provider and/or the Virtual Program may include, but not be limited to student name, address, phone number, age, gender, school name, student grade in school, student email address, student progress and grade in the course(s).
A separate form must be completed by the parent/guardian for each child enrolling in the Raleigh County Virtual Program.

You must complete a separate Opt-In form for each student. This is an application only and DOES NOT guarantee acceptance into the program. First semester classes will begin on September 2, 2025. Application for students who are receiving special services will be considered through the IEP process. All other student applications will be reviewed by the virtual school team. Parents will be notified regarding the acceptance of their application.
What is the intent for your child?*

Yes, I want my child to attend Virtual School, and I understand that my child will remain in Virtual School until the end of the first semester.
Is your child a Raleigh County resident?*

YesNo, if no, your child is not eligible for RCS Virtual School.
Does your child currently have an IEP?*

Yes, I understand an IEP team meeting must be held at the school level to determine if my child can successfully be served in the virtual setting, and I understand this will delay acceptance and possible transfer into RCS Virtual School.No
Do you/will you have reliable internet services in your home?*

YesNo, if no, your child is not eligible for RCS Virtual School.
Yes, I want my child to attend Virtual School, and I understand that my child will remain in VS until the end of the first semester. (You can sign with your finger, mouse or a stylus)*

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I have read and understand Raleigh County Policy E. 18 Virtual School. (You can sign with your finger, mouse or a stylus)*

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My student and I have reviewed and understand our responsibilities regarding Cyber Safety. (You can sign with your finger, mouse or a stylus)*

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I understand my child and a guardian must attend the required Virtual School orientation as stated in Policy E.18. (You can sign with your finger, mouse or a stylus)

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I understand the RCS Virtual Platform REQUIRES attendance in two live sessions per course per week. (You can sign with your finger, mouse or a stylus)

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Date*

MonthDayYear
Date
I understand my child must attend in-person required state testing for students in grades 6, 7, 8, and 11. I acknowledge I must provide transportation for state testing. (You can sign with your finger, mouse or a stylus)

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School your child currently attends*
Grade:*
Child's Last Name*
Child's First Name*
Parent/Guardian's Name*
Parent/Guardian's Email. (Please use a working email for receipt of completed forms)*
example@example.com
Mailing Address: (Street/PO Box)*
City*
State*
Zipcode*
Parent/Guardian's Home Phone*
Raleigh County has taken this step in order to be in compliance with federal legislation for child protection, including The Family Educational Rights and Privacy Act (FERPA -http://www.ed.gov/offices/OM/ferpa.html) and the Children’s Online Privacy Protection Act (COPPA http://www.ftc.gov/os/1999/9910/64fr59888.htm). All students using computers from school locations must agree to abide by school, county, and/or West Virginia Board of Education Policy 2460 (Educational Purpose and Acceptable Use of Electronic Resources, Technologies and the Internet). It may be viewed online at http://wvde.state.wv.us/policies/, or you may request a copy from your child’s school. It is the intention of the West Virginia Department of Education to filter and restrict access to controversial materials from school computers. However, since the online courses are web-based, content accessed from home or elsewhere outside the school could put the student in contact with objectionable materials via the World Wide Web. It is the responsibility of the parent/guardian of the student to restrict any access to materials deemed inappropriate by the parent/guardian.
I understand that the application process can take several days or weeks and my student must attend face-to-face until after the transfer process is complete. (You can sign with your finger, mouse or a stylus)

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This agreement, agreements ancillary to this agreement, and related documents entered into in connection with this agreement are signed when a party’s signature is delivered by email or other electronic medium. These signatures must be treated in all respects as having the same force and effect as original signatures.
Signature- To sign, use your finger, mouse, or stylus in the box.*

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Application for Raleigh County Virtual Program

Raleigh County Virtual Consent Form- 2025-2026

A separate form must be completed by the parent/guardian for each child enrolling in the Raleigh County Virtual Program.