WOODLAND SCHOOL DISTRICT 50

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1 WOODLAND SCHOOL DISTRICT 50 STUDENTS NEW TO DISTRICT 50 Before a child may register and attend our school, the following conditions must be met: You must be a resident of the district and provide two (2) documents verifying residency within district boundaries. At the time a student is registered, parents or guardians will be required to provide at least ONE document from EACH category listed below. Category A: Choose 1 document from the choices below: ( ) Most recent residential property tax statement, Mortgage Statement or Proof of Homeownership ( ) Current signed and dated lease with terms listed and those residing at the residence listed on lease ( ) Notarized Letter of residence from landlord in lieu of lease (Renters) ( ) An agreement of sale of residential property located within the district boundaries between buyer and seller. (New Residents) ( ) Notarized Residency Affidavit (those living with relatives or others) within the district boundaries. (Must attach 1 document from Category A and Category B to the Residency Affidavit) ( ) Housing Letter (Military Personnel) Category B: Choose 1 document from the choices below: ( ) Drivers License, Illinois ID Card, or Matricula Card with current address listed ( ) Current gas, electric, water, cable or telephone bill (cell phone bills NOT accepted) ( ) Current homeowners insurance policy or renters insurance policy ( ) Vehicle Registration ( ) Voter Registration Card If you are unsure of what is needed, please contact the Student Registration Office at A legal (original) birth certificate from the state or country of your child s birth is needed for all students new to the district. We do not accept any type of hospital or baptismal certificate. If your child is entering from another country, we will accept your child s legal passport. 2. Proof of disease immunization or detection as required by State Law and Board Policy. 3. If the child is under a court-approved guardianship, court documents will need to be provided at the time of registration. In addition, a Guardianship Affidavit form will need to be completed. 4. If you are residing with a district resident and all legal forms of residency are in their names, they must complete a Residency Affidavit form, and have it notarized. The parent/guardian must then present to us a copy of a bill or drivers license with their name and address within 30 days of registration. 5. Families who live out of district but anticipate meeting the residency requirements within 45 days of the start of school will be permitted to enroll their children by providing proof of anticipated residency documentation such as a contract or lease, and pay a $ fee associated with our out of district residency affidavit. 6. Kindergarten students must have a birth date between September 2, 2009 and September 1, 2010 for enrollment into the school year. Students with a birth date September 2, 2010 or later must wait until next year to register. 01/14/2015

2 WOODLAND SCHOOL DISTRICT 50 RESIDENCY VERIFICATION FAMILY NAME Student/s Name/s (Last name only if different from family name listed above.) The Board of Education of Woodland School District 50 requires that all students attending District 50 be legal residents of the district. Generally, to be a legal resident, a student must be living with a parent or legal guardian who resides within our district and possesses appropriate custody documents. At the time a student is registered, parents or guardians will be required to provide at least *ONE document from each category listed below. Registration of a student who is not a resident is a fraudulent act. Any student found to have been fraudulently registered will be dropped from the district rolls immediately. Parents or guardians who have been determined to have fraudulently registered will be charged a tuition amount determined annually by the Board of Education. A student must be a district resident on the first day of enrollment each year. Sources of verification required for Proof of Residency are: Category A: Choose 1 document from the choices below: ( ) Most recent residential property tax statement, mortgage statement or proof of homeownership ( ) Current signed and dated lease with terms listed and those persons residing at the address listed (Renters) ( ) Notarized letter of residence from landlord in lieu of lease (Renters) ( ) An agreement of sale of residential property located within the district boundaries between buyer and seller. (New Residents) ( ) Notarized Residency Affidavit (those living with relatives or others) within the district boundaries. *(Must attach 1 document from Category A and Category B to the Residency Affidavit) ( ) Housing Letter (Military Personnel) Category B: Choose 1 document from the choices below: ( ) Drivers License, Illinois ID Card, or Matricula Card WITH CURRENT ADDRESS LISTED ( ) Current gas, electric, water, cable or telephone bill CELL PHONE BILL NOT ACCEPTED ( ) Current homeowners/renters insurance policy ( ) Vehicle Registration ( ) Voter Registration Card After providing proof of residency, please sign below. Signature of Parent or Guardian Home Address Date City, Zip Code Approved by: Date If the parent/s or guardian/s insist they are residents but cannot show the standard form of residency outlines in the above referenced items, the parent or guardian may complete a Student Residency Affidavit, sign it in the presence of a Notary Public and submit it to the District Registrar. The Associate Superintendent of Business Services will assume the responsibility for making the final residency determination. 3/25/14

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4 Woodland Bus Information Student ID# PLEASE NOTE: When a PERMANENT change needs to be made, a REVISED bus information sheet must be completed and returned to the school office. THE CHANGE TAKES A MINIMUM OF 3 WORKING DAYS TO PROCESS. CIRCLE: PRIMARY ELEMENTARY INTERMEDIATE MIDDLE STUDENT INFORMATION (PLEASE PRINT NEATLY) (PLEASE FILL OUT COMPLETELY) LAST NAME FIRST MI ADDRESS APT # CITY ZIP CODE HOME PHONE AGE GRADE BIRTH DATE SEX CHILD LIVES WITH (CIRCLE): PARENTS MOTHER ONLY FATHER ONLY STEP/GUARDIAN OTHER FATHER/GUARDIAN NAME MOTHER/GUARDIAN NAME FATHER/GUARDIAN WK # ALTERNATE # MOTHER/GUARDIAN WORK # ALTERNATE # FATHER/GUARDIAN MOTHER/GUARDIAN PLEASE PROVIDE INFO FOR SOMEONE OTHER THAN YOURSELF EMERGENCY PHONE #: NAME & RELATIONSHIP: YOUR CHILD WILL BE ASSIGNED ONE STOP FOR PICK UP AND ONE FOR DROP OFF LEAVE THIS SECTION BLANK IF YOUR CHILD WILL RIDE TO/FROM THE STOP CLOSEST TO HOME!! ALTERNATE LOCATION BEFORE SCHOOL: NAME: ADDRESS: PHONE #: AFTER SCHOOL: NAME: ADDRESS: DOES YOUR CHILD HAVE ANY MEDICAL CONDITIONS THAT THE BUS DRIVER SHOULD KNOW? (THESE WILL BE KEPT STRICTLY CONFIDENTIAL.) PHONE #: X PARENT/GUARDIAN SIGNATURE DATE TRANSPORTATION OFFICE USE ONLY DISTRICT USE ONLY NEW REVISED A.M. RT #: BUS STOP SCHOOL RECEIVED DATE: TRANSPORTATION START DATE: P.M. RT #: DATE PARENT NOTIFIED: BUS STOP REVISED: 1/14/2015

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6 F O R Returning Student: Yes No O F F I C E Student's Last Name Building Level/Entity First Name (Student's Name As Shown on Legal Birth Certificate or Passport) Building Division Middle Name Grade Level Entry Date Entry From Grad Year U S E O N L Y Student Language Ethnicity/Race Immigrant/Country Custody - Sole/Joint Military (Yes or No) Other legal paper Birth Certificate Copy on File Order of Protection/ Dated: Passport Copy on File Immunization Records Rec'd Physical Exam Dental Vision HS PATH: WTHS GRY FOR OFFICE USE ONLY Student ID # Children's Names List all children in Household Nombre de los niños. Lista de niños en el hogar Date of Birth Fecha de nacimiento Sex M/F Sexo Grade Grado Special Services? Y/N IEP? Y/N 504? Y/N PLEASE TURN OVER CARD TO COMPLETE EMERGENCY AND FAMILY INFORMATION Por favor siga a la siguiente hoja para completar la informacion de la familia, y de emergencia

7 Primary Guardian LAST NAME - Guardián Primario Apellido Spouse LAST NAME - Conyuge Apellido Primary Guardian FIRST NAME - Guardián Primer Nombre Spouse FIRST NAME - Conyuge Primer Nombre Cell Phone Num.- Número del Celular Cell Phone Number.- Número del Celular Work Phone Num.- Número del Trabajo Work Phone Num.- Número del Trabajo Home Address- Domicilio Apt. No- Apto. City- Ciudad Zip Code- Zona Postal Address- Correo eléctronico Primary Phone Number Telefono Primario Please circle whom the child(ren) live with: Por favor circule con quien viven los niños: Parents Father & Stepmother Mother & Stepfather Mother Only Father Only Padres Padre y Madrastra Madre y Padrastro Madre Solamente Padre Solamente None of the above: Ninguno- Explique Is either parent an active member of the Armed Forces? Uno de los padres es miembro activo de las Fuerza Armadas? Currrently Deployed? Actualmente Desplegado? Will they be deployed for active duty during the school year? Seran desplegados para servico activo durante el año escolar? Second Family/Joint Custody Information - Información de Familia Secundaria/Custodia Mutua Last Name/ First Name- Apellido/Nombre Spouse Name (If Applicable)- Nombre del cónyuge (Si aplica) Head of Household (Last, First Name): Home Address- Domicilio Home Phone Num.- Número del Teléfono Address- Correo eléctronico City- Ciudad Alternate.- Otro Teléfono Zip- Zona Postal Relationship to Student- Parentesco con el estudiante EMERGENCY CONTACT INFORMATION - IFORMACION EN CASO DE EMERGENCIA (If parents are not available, please list a person we may contact. ONLY those listed will be pemritted to sign the student out.) (Liste a las personas que podemos llamar en caso de NO localizar a los padres. SOLAMENTE agrege personas cuyo nombre este en esta lista son las autorizadas para llevares al niño de la escuela) Name Nombre Relationship to student Parentesco con el estudiante Phone Number Número de Teléfono Alternate Phone Number Otro Teléfono 1-2- PLEASE TURN OVER CARD TO COMPLETE HOUSEHOLD INFORMATION Por favor siga a la siguiente hoja para completar la informacion de casa

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10 Illinois State Board of Education New U.S. Department of Education Race and Ethnicity Data Standards Note: The student s parents or guardians should respond to both questions (Part A and Part B). If the parents or guardians decline to respond to either question (Part A or Part B), school district staff are required to provide the missing information by observer identification. Student s Name: INSTRUCTIONS: This form is to be filled out by the student s parents or guardians, and both questions must be answered. Part A asks about the student s ethnicity and Part B asks about the student s race. If you decline to respond to either question, the school district is required to provide the missing information by observer identification. Part A. Is this student Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Choose only one. No, not Hispanic/Latino Yes, Hispanic/Latino The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to the question below by marking one or more boxes to indicate what you consider this student s race to be. Part B. What is the student s race? Choose one or more. American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.) Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.) Black or African American (A person having origins in any of the black racial groups of Africa.) Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.) White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) Parent (signed): Date: Note: Data collected on this form must be maintained by the school district for three years. However, when there is litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the completion of the action. Illinois State Board of Education, Division of Data Analysis and Progress Reporting December 2009

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12 WOODLAND SCHOOL HEALTH AND EMERGENCY INFORMATION Date-Fecha: (Please Print- Por favor imprima) Student Name - Nombre del estudiante: Gender-Sexo: Grade(o): Address-Domicilio: Daate of Birth - Fecha de nacimiento: Family Information (family who child lives with) Información De Familia (Familia Que Vive Con El Niño/a) Father/Guardian-Padre/Guardían: 1st Phone Num.-1er Num. Teléfono 2nd Phone Num.2do Num. de Teléfono Mother/Guardian-Madre/Guardían: 3rd Phone Num.-3er Num. de Teléfono 1st Phone Num.-1er Num. Teléfono 2nd Phone Num.2do Num. de Teléfono 3rd Phone Num.-3er Num. de Teléfono Second Famly/ Joint Custody Information Información De Segunda Familia/Custodia Mutua Name/Nombre: 1st Phone Num.-1er Num. Teléfono Address-Domicilio: 2nd Phone Num.2do Num. de Teléfono 3rd Phone Num.-3er Num. de Teléfono 1st Emergency Contact: 1er Contact de emergencia: Emergency Contacts (Other than parents living with child) Contactos de Emergencia (Otros que no sean los padres) Relationship: Parentesco: 1st Phone: 1er Num. 2nd Emergency Contact: 2do Contact de emergencia: 1st Phone: 1er Num. 2nd Phone: 2do Num. 2nd Phone: 2do Num. 3rd Phone: 3ro Num. Relationship: Parentesco: 3rd Phone: 3ro Num. Health Problems - Problemas de Salud Health Problems - Problemas de Salud: Seizures - Convulsiones: Surgeries/Hospitalizations- Operaciones/Hospitalizaciones: Medications Medicinas: Diabetes - Diabetes: Allergies - Alergias: Asthmas -Asma Vision Problems - Problemas Visuales: Hearing Problems - ProblemasAditivos: Wears Glasses/Contacts - Usa Antejojos/Contactos Wears Hearing Aids - Usa Aparato Auditivo Other Health Concerns - Otras inquietudes de Salud: Docotos Name - Nombre del doctor: Doctors Phone - Núm. de Teléfono de Doctor:

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14 WOODLAND SCHOOL DISTRICT 50 Kindergarten Health Forms Guidelines Physical examination: Due October 8 th,2015. Must be on standard Illinois physical examination form and dated no more than one year earlier than 1 st day of attendance of current school year. Physical Exam MUST INCLUDE: a. Health History: Located on back of the physical form- Answer all questions, sign and date by parent or guardian. b. Diabetes Screening: All questions must be answered by a physician c. Lead Risk Questionnaire: All questions must be answered by a physician. d. Physician must sign and date physical e. Immunization Records: Must be signed by physician or nurse. Turn physical and immunization records into Primary School as soon as they are completed. If your physical and immunizations records are NOT received by October 14 th, your child will NOT be allowed in class the following day according to the Illinois School Code. Due to the high volume of students, do not wait until the Oct. 14 th deadline. This will give us adequate time to resolve any issues with the physical and immunization records. Vision Exam: Must be on a standard Illinois vision form, which is: a. Completed, signed and dated by an Ophthalmologist or Optometrist. b. Due by October 15 th. Please turn in as soon as it is completed. Dental Exam: Must be on a standard Illinois dental form. a. Completed, signed and dated by dentist b. Due by May 15 th, Please turn in as soon as it is completed.

15 WOODLAND SCHOOL DISTRICT 50 ********** PROOF OF RESIDENCY EVENT ********** WHERE: Woodland Middle School, 7000 Washington St., Gurnee IL WHEN: Tuesday, August 11, 2015 Wednesday, August 12, 2015 WALK IN: 10:00a.m. - 8:00p.m. Residency Documents Accepted for Proof of Residency: HOMEOWNERS: Please bring any two (2) of the following documents: Current property tax bill Current mortgage statement Current gas, electric, water, cable or home telephone bill (NOT CELL PHONE BILLS) Voter registration card or vehicle registration (WITH CURRENT ADDRESS LISTED) Homeowner s insurance policy Driver s license, Illinois State ID card or Matricula card LEASEHOLDERS/RENTERS: Please bring the following: Current signed and dated lease agreement with terms listed and those residing at the residence listed on lease. AND one (1) of the following documents: Current gas, electric, water, cable or home phone bill (NOT CELL PHONE BILLS) Voter registration card or vehicle registration (WITH CURRENT ADDRESS LISTED) Renter s Insurance Policy Driver s license, Illinois State ID card or Matricula card *RESIDENCY AFFIDAVIT REQUIREMENTS: *Families MUST PROVIDE a Notarized Affidavit and the district resident s homeowner documents from the list above or leaseholder s documents from the list above. New for School Year All Day Kindergarten program in Fall of 2015! Meal program: Breakfast program will be available for the upcoming school year. Meal Low Balance alerts notifications will be sent out for low balances Save time/delays at POR and complete the Online Re-Registration before July 15 th Please visit for updated information Incoming 6th grade students, plan on coming to POR and have your ID picture taken in Gym A. You'll be all set when you start 6th grade! Families will be able to submit health forms to the nurse, pay registration fees, add money to their lunch accounts, purchase spirit wear, PE uniforms for Middle School children, and *PTA school supply packs (limited supply). *Pre-ordered packs will be delivered to your child s classroom. ALL families with children enrolled in Woodland District 50 for the 2015/2016 school year will be required to prove residency in August. Questions should be directed to the registration department at

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20 WOODLAND SCHOOL DISTRICT 50 SCHOOL ADDRESS & PHONE # S Woodland School District 50 Educational Support Center 1105 N. Hunt Club Road Gurnee, IL Phone Fax Woodland Primary School Grades Kindergarten, WELE, EC W. Gages Lake Road Gages Lake, IL :20am - 3:30pm Phone Attendance Fax Woodland Elementary East School (Even Addresses) Grades 1 st, 2 nd, 3 rd W. Gages Lake Road Gages Lake, IL :50am 3:25pm Phone Attendance Fax Woodland Elementary West School (Odd Addresses) Grades 1 st, 2 nd, 3 rd W. Gages Lake Road Gages Lake, IL :50am 3:25pm Phone Attendance Fax Woodland Intermediate School Grades 4 th, 5 th 1115 N. Hunt Club Road Gurnee, IL :10am 2:45pm Phone Attendance Fax Woodland Middle School Grades 6 th, 7 th, 8 th 7000 W. Washington Street Gurnee, IL :30am 2:10pm Phone Attendance Fax Woodland Transportation Office W. Gages Lake Road Gages Lake, IL Phone Fax

21 NEW STUDENT REGISTRATION KINDERGARTEN 8TH GRADE Please fill out and complete all the enclosed forms and submit at the time of your registration appointment. Registration will not be complete with out the following items listed below. CHECKLIST! BIRTH CERTIFICATE Original with seal required for Kindergarten. A copy is acceptable for 1 st 8 th! RESIDENCY DOCUMENTATION required at time of registration. (CATEGORY A) please refer to Students new to Woodland page included in packet! RESIDENCY DOCUMENTATION (CATEGORY B) required 30 days from start date of school if not submitted at time of registration! RESIDENCY AFFIDAVIT (if it applies to you) must include documentation from Category A and Category B and signed in front of a Notary Public to be valid. This form is to be used only if you are not the district resident.! ADOPTION PAPERS (only if it applies to you)! PARENTAL AGREEMENT (only if it applies to you)! HEALTH FORMS Medical, Dental, & Vision. Please check guidelines included in this packet to confirm which applies to your child s grade level.! STUDENT TRANSFER FORM Public school districts in Illinois are to provide this form to any student who is moving out of the school district to verify whether or not the student is in good standing. Questions may be directed to the Student Registration office at or REGISTRATION IS BY APPOINTMENT ONLY AT THE EDUCATIONAL SUPPORT CENTER 1105 N. HUNT CLUB ROAD GURNEE, IL

22 WOODLAND SCHOOL DISTRICT 50 The school health offices are required by the State of Illinois to maintain health records for every student. Below is a summary of the requirements for each grade level. ILLINOIS STATE HEALTH REQUIREMENTS K Physical Exam with Immunizations & Dental Exam & Vision Exam 1st No additional requirement 2nd Dental Exam 3rd No additional requirement 4th No additional requirement 5th No additional requirement 6th Physical Exam with Immunizations & Dental Exam (Sports Physical, see below*) New Vaccines required are: Tdap and Meningococcal (MCV4) 7th Sports Physical if participating in interscholastic sports 8th Sports Physical if participating in interscholastic sports New to Illinois (transfer students) Physical Exam with Immunizations & Vision Exam Physical Exams with Immunizations are due by October 8 th. Student exclusion begins on October 15 th if not turned in according to Illinois School Code. Dental Exams are due by May (end of the school year). If not able to get a dental exam, please fill out the waiver form. Eye Exams are due by August (beginning of the school year). If not able to get an eye exam, please fill out the waiver form. Sports Physicals are due 1-2 weeks before the tryout/sport begins. Physicals are valid for 395 days. Applies to students joining interscholastic sports. Students will not be permitted to tryout if they do not have a current sports physical. *The 6th grade physical exam covers sports participation for one year. All forms are available on the Woodland District 50 web site: Section/Student Forms. Please Note: Reminder for all medical forms: The entire form needs to be filled out. The form will be returned for completion if signatures, dates, health history or any other information is missing. WE WILL ONLY ACCEPT DOCUMENTED APPOINTMENTS FOR OUT OF STATE TRANSFERS. Please keep a copy for your records. The Lake County Health Department offers physical exams, immunizations, and dental services at /15

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