Welcome to Kindergarten in the Alexandria City Public Schools (ACPS)

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1 Welcome to Kindergarten in the Alexandria City Public Schools (ACPS) If your child will be five (5) years old by September 30 this year, s/he is eligible to start kindergarten in ACPS in September We encourage you to complete the registration process as soon as possible. Families must first register their kindergarten child at their neighborhood school. However, if families speak a language other than English in their home or their child was born outside of the United States, please see the registration location below. Registration begins on March 16 and will continue daily from 9 a.m. to 1 p.m. at all schools for walk-ins. After 1 p.m., families should make an appointment to register their child. Schools will also offer extended hours on March 19, from 4 to 7 p.m. Individual schools may offer additional extended hours so please check with your neighborhood school. If you are not sure which school your child will attend, please use our online Attendance Zone Locator: Kindergarten Capacity at Your School ACPS uses a modified open enrollment policy to maintain small class sizes. If kindergarten classes are over-enrolled at a school by June 12 (or June 2 for Samuel Tucker), all students registered up to that date will be put in a lottery to determine which students will need to be transferred to another ACPS school. If all students enrolling by June 12 can be accommodated in the school, they will be enrolled in that school. Students registering after that date will be transferred to another school if classes are filled. (see: If a language other than English spoken in your home, or your child was born outside the United States, register your child for school at the Office of English Language Learner (ELL) Services. All families who may need assistance with English may also register at the ELL Office. The ELL Office is located in the ACPS Central Office at 1340 Braddock Place in Alexandria. Please call for more information. School Bus Transportation Students living more than a mile from their elementary schools will be provided bus transportation. If your kindergartner will be riding the school bus, ACPS requires an authorized adult to meet the child at his or her stop. Please complete the form enclosed as part of the registration process. Bus schedules and stops will be mailed to parents the week before the start of school. For more information on bus transportation, please call School Breakfast and Lunch Schools serve breakfast and lunch daily. Menus are planned by a registered dietitian with a focus on whole grains, fruits and vegetables and foods that are lower in fat. For the school year, elementary school prices are $1.75 for breakfast and $2.65 for lunch. Every child is assigned an account and money may be added to the account in three ways: by cash, check or prepaid online account. Please visit the ACPS School Nutrition website at for more information about these options. If your child has allergies, is on a gluten-free diet, or has other food requirements, we welcome you to review these with your school s cafeteria manager. Please call or Many students can qualify for free or reduced price meals based on their family s income. If you would like to see instantly whether your student qualifies for free meals, please visit after July 15. Then, complete the application in your back-to-school packets that will be sent home in August. Student Transfers The Alexandria City School Board establishes school attendance areas for each school. There are several regulations that define the procedures for administering student transfers. All students must be registered in their home schools before a request for an administrative transfer can be made. For more information on administrative transfers, please call or visit For more information:

2 KINDERGARTEN REGISTRATION CHECKLIST PLEASE NOTE: ALL registrants who have another language other than English spoken in the home, or were born outside the United States, must register at the Office of English Language Learner Services (ELL Office) located in the ACPS Central Office at 1340 Braddock Place in Alexandria. Registration hours are 8:30 a.m. to 2 p.m., Monday to Friday. For additional information, please call When you come to school to register your child, please bring ALL of the required documents below: rr ORIGINAL BIRTH CERTIFICATE (or a Certified Birth Certificate) rr PROOF OF GUARDIANSHIP (Proof that the adult registering the child is the Parent/Legal Guardian) Name on birth certificate should match the parent/guardian s picture ID or court documents of legal custody. rr COPY OF REPORT CARD FROM PREVIOUS SCHOOL (If applicable) rr PHYSICAL EXAMINATION REPORT (included in this packet) State law (Ref. Code of Virginia ) requires that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary school. Based on the above, students currently participating in an ACPS pre-kindergarten program must provide proof of immunizations and physical examination prior to entering kindergarten, even if these documents were provided prior to entrance into pre-kindergarten. For the purposes of clarification, elementary school above refers to grades one through five. Physical examination must be dated within twelve months prior to date of entry. rr IMMUNIZATION RECORDS (Documenting month, day and year each was administered) PPD Tuberculin Skin Test, negative Tuberculosis Risk Assessment, or negative Chest X-Ray (Administered within 12 months prior to child s first day of school.) Required of all children entering ACPS. HEPATITIS B A complete series of three doses of Hepatitis B vaccine is required for all children. Diphtheria, Tetanus, Pertussis (Dtap, DTP or Tdap) A minimum of four doses, with one dose administered on or after the fourth birthday. POLIO (OPV or IPV) A minimum of four doses, with one dose administered on or after the fourth birthday. Measles, Mumps, & Rubella (MMR) All children must have at least two doses of Measles, two doses of Mumps and one dose of Rubella prior to kindergarten. The first dose must be administered at 12 months of age or older. VARICELLA (Chicken Pox) All susceptible children must have one dose of Varicella administered at 12 months of age or older. All children entering kindergarten must have a second dose of Varicella. IMPORTANT IF SHOTS ARE DEFICIENT: If new vaccines have just been administered, a physician must advise in writing the date of the next scheduled visit for additional vaccines. Also, proper spacing of doses should be followed. When additional vaccines are received, written documentation needs to be provided to the school nurse. rr PROOF OF RESIDENCY You MUST submit any ONE of the following documents for verification of current residency; they must be dated within the past 60 days, and only originals are accepted (no copies): Lease agreement or rent receipt Mortgage contract or payment receipt and ONE of the following documents: Utility bill (water, gas, electric, cable, or landline phone) Personal property tax bill or receipt NOTES: A driver s license or state-issued ID does NOT serve as valid proof of residency. If you reside with someone else, you will be required to complete the ACPS Residency Affidavit and submit a copy of the householder s lease agreement and a utility bill. Revised 3/8/2015 Communications Office dnb

3 Home Language Survey Office of English Language Learner Services 1340 Braddock Place Alexandria, VA Telephone: Federal regulations require school systems to survey all enrolling students regarding the students home language and any other languages the students may speak. Based on the results of the survey, a student may be assessed, as required by federal regulations, for English proficiency. Based on the results of the assessment, the student may be eligible for supplemental instruction through the English Language Learner (ELL) program. Parents/guardians will be informed about the assessment results and if the student is eligible for supplemental services, the parents will have the opportunity to accept or refuse the supplemental ELL services. Regulaciones Federales requieren que los sistemas escolares encuesten a todos los estudiantes sobre el lenguaje materno y cualquier otro lenguaje que el estudiante hable. Basado en los resultados de la encuesta, el estudiante podría ser evaluado para determinar su competencia en el inglés. De acuerdo con los resultados de la evaluación, el estudiante puede ser elegible para recibir instrucción suplementaria a través del programa de aprendizaje de inglés. Los padres/guardianes serán informados sobre los resultados de la evaluación y si el estudiante es elegible para recibir instrucción suplementaria los padres tendrán la oportunidad de aceptar o rehusar los servicios suplementarios de ELL. Instructions: Please complete the following information. Print neatly using a pen. Favor de completar la siguiente información. Escriba claramente con un lapicero እባክዎት የሚቀጥለውን መረጃ ይሙሉ በእስኪብርቶ በግልፅ ያስፍሩ يیرجى ااستكمالل االمعلوماتت االتاليیة مستخدما قلم حبر ووبخط ووااضح ووددقيیق Student s Name: Nombre del estudiante የተማሪው ሥም Date of Birth: Country of Birth: Home Telephone: Fecha de nacimiento País de nacimiento Teléfono de casa የትውልድ ቀን تارريیخ االميیلادد : የትውልድ አገር مكانن االولاددةة የቤት ሥልክ Parent/Guardian Name: Nombre del padre/madre o apoderado የወላጅ/አሳዳጊ ሥም : ااسم االطالب : ررقم هھھھاتف االمنزلل: ااسم االواالديین / وولي االا مر : 1. What is the native language of each parent/guardian? ما هھھھي االلغة االا صليیة لكل من االواالديین padre/apoderado? Cuál es el idioma materno de cada የወላጆች/ የአሳዳጊ የመጀመሪያ ቋንቋ? 2. What languages are spoken in your home? Qué idiomas se hablan en el hogar? ቤት ውስጥ የሚነገሩ ቋንቋዎች? 3. What language did your child learn first? Qué idioma aprendió primero su hijo/a? ልጅዎት መጀመሪያ የተማረው ቋንቋ? ما هھھھي لغة االتحدثث في االمنزلل : ما هھھھي االلغة االتي تعلمهھا ططفلك ااوولا : 4. What language(s) does your child use most frequently at home? ما هھھھي االغة ا أوو االلغاتت االتي يیستخدمهھا ططفلك في ا أغلب االا ووقاتت في االمنزلل : hogar? Qué idioma(s) usa su hijo/a con más frecuencia en el በአብዛኛው ልጅዎት ቤት ውስጥ የሚጠቀመው ቋንቋ? 5. What language does each parent/guardian most frequently use in speaking to the child? ما هھھھي االلغة ا أوو االلغاتت االتي يیستخدمهھا االواالديین في ااغلب االا ووقاتت في االمنزلل : hijo/a? Qué idioma usa cada padre con más frecuencia al hablar a su ወላጆች ከልጁ ጋር ለመነጋገር በአብዛኛው የሚጠቀሙበት ቋንቋ? Signature of individual completing survey: Firma de la persona que completa esta encuesta ይኸንን ቅኝት የሚሞላው ሰው ፊርማ Date: ووقيیع االشخص االذيي عبا هھھھذاا االا ستبيیانن : ACPS Revised 3/2015 Communications dnb

4 STUDENT REGISTRATION FORM Alexandria City Public Schools STUDENT INFORMATION Student s Last Name: First Name: Middle Name: Student Address: Street Apt # City State Zip r Male r Female Date of Birth: Mo: Day: Year: Country of Birth: Grade: Birth Certificate: r Yes r No Birth Certificate #: *Is this student Hispanic or Latino? (choose only one) r No, not Hispanic or Latino r Yes, Hispanic or Latino (person of Cuban, Mexican, Puerto Rican, South American, Central American, or other Spanish culture or origin, regardless of race) *What is the student s race? (choose one or more) r American Indian/Alaskan r Asian r Black or African American r Native Hawaiian or Other Pacific Islander If a language other than English is spoken in the student s home, what is that language? r Spanish r Amharic r Arabic r Other (please specify) Last School Attended: r Public r Private Address: City State Zip If not an Alexandria City school, has student EVER attended Alexandria City Public Schools? r Yes r No r White (a person having origins in any of the original peoples of Europe, the Middle East or North Africa) If Yes, please provide the following: School: Year: Grade: PARENT/GUARDIAN INFORMATION Parent/Guardian: Is the City of Alexandria your legal residence? r Yes r No If No, has an exception to policy been approved? r Yes r No Parent/Guardian #1: Last Name: First Name: r Male r Female r Father r Stepfather r Legal Guardian r Mother r Stepmother r Foster Parent Other (please indicate relationship): Employer: Work Address: Address: r Address is the same as student s address above Street Apt # City State Zip Work Phone: ( ) - Ext: Home Phone: ( ) - Cell Phone: ( ) - Address: Parent/Guardian s preferred language of communication? r English r Spanish r Amharic r Arabic r Other (please specify) Parent/Guardian #2: Last Name: First Name: r Male r Female r Father r Stepfather r Legal Guardian r Mother r Stepmother r Foster Parent Other (please indicate relationship): Employer: Work Address: Address: r Address is the same as student s address above Street Apt # City State Zip Work Phone: ( ) - Ext: Home Phone: ( ) - Cell Phone: ( ) - Address: Parent/Guardian s preferred language of communication? r English r Spanish r Amharic r Arabic r Other (please specify) Revised 3/2015 Communications Office dnb

5 STUDENT BACKGROUND Does your child have a current IEP for Special Education services or 504 Plan? r Yes If Yes, has documentation been provided to the school? r Yes r No r No Please check if your child has any medical conditions: r Allergy r Asthma r Autism r Diabetes r Heart Disease r Hearing Impaired r Seizure Disorder r Visual Impairment (including wears glasses or contacts) r Other mental or physical impairment (please specify) Physician s Name: Phone: ( ) - If we are not able to contact you or the physician listed above, do we have your permission to take your child to the emergency room of the nearest hospital, at your expense, and do we further have your authorization for the hospital and its medical staff to provide such treatment as a physician deems necessary for the well-being of your child? r Yes r No Parent/Guardian Signature: Date: OTHER CHILDREN IN THE FAMILY Name Birth Date Sex School EMERGENCY CONTACTS Emergency Contact #1 (Other than Parent/Guardian): Name: Address: Street Apt # City State Zip Home Phone: ( ) - Cell Phone: ( ) - Work Phone: ( ) - Relationship to student: Emergency Contact #2 (Other than Parent/Guardian): Name: Address: Street Apt # City State Zip Home Phone: ( ) - Cell Phone: ( ) - Work Phone: ( ) - Relationship to student: PRE-KINDERGARTEN EXPERIENCE During the year before kindergarten, my child attended (choose one): Home-Based Child Care r Child care provider in my home r Child care provider in their home r Parent/Relative Alexandria City Public Schools r Virginia Preschool Initiative (VPI) 4-year-old program r Early Childhood Special Education r Preschoolers Learning Together Other Program r Head Start r Child and Family Network Center r Child Care Center (full day, full year) Name: r Half-Day Program (preschool) Name: By signing this form I am verifying that the information contained herein is correct. Parent/Guardian Signature: Date: FOR OFFICE USE ONLY Student ID School ID Sch/Res Att/Permit Code Address/Transfer Permit Verified Grade Entry Code Entry Date Office Verification/Signature Revised 3/2015 Communications Office dnb

6 EMERGENCY CARE INFORMATION In case of emergency, school staff will call 911. Every attempt will be made to contact a parent, guardian or emergency contact. School Year: STUDENT INFORMATION Last Name: First Name: Middle: Date of Birth: Gender: Grade: r Male r Female School: Teacher: Bus # After School Care: PARENT/GUARDIAN CONTACT INFORMATION This form is to be completed by a parent or legal guardian with whom the student lives during most of the week. Parent Last Name: First: Middle: Telephone Home: Address: Work: Relationship: r Mother r Father r Legal Guardian r Foster Parent r Self Student lives with this parent/guardian r yes r no Language: Other Parent Last Name: First: Middle: Telephone Home: Address: Work: Cell: Relationship: r Mother r Father r Legal Guardian r Foster Parent r Self Student lives with this parent/guardian r yes r no Language: OTHER CONTACT INFORMATION Please list at least two people we may call to make emergency decisions and/or pickup your child from school if the parent(s) or guardian(s) cannot be reached in the event of an emergency: Name of Person Relationship Language Telephone(s) Cell: CURRENT HEALTH CONDITIONS If there are medical and/or health conditions that affect your child s school day, please complete the following information: r ADD/ADHD: r medications r Allergies: r food r bees/insects r other allergy (please list) r has Epi-Pen r other allergy medications r Asthma: r uses inhaler r other asthma medications r Blood disorder r Cancer: type r Physical disability r Diabetes r Seizures: r medications r Hearing problems r Hearing aids r Vision problems: r glasses r contacts r Heart problems r Other health concerns: Please list any medications your child receives on a continual basis: If your child needs medication at school, please obtain the required Medication Authorization forms from the school. HEALTH CARE My child has health insurance r Yes r No Name of health insurance company: My child has dental insurance r Yes r No Name of dental insurance company: My child s Primary Care Provider is: Phone: I, (do ) (do not ) authorize my child s health care provider and designated provider of health care in the school setting to discuss my child s health concerns and/or exchange information pertaining to this form. This authorization will be in place until or unless you withdraw it. You may withdraw your authorization at any time by contacting your child s school. When information is released from your child s record, documentation of the disclosure is maintained in your child s health or scholastic record. Signature of Parent/Legal Guardian: Date: Revised 3/2015 Communications Office dnb

7 COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE HEALTH FORM Health Information Form/Comprehensive Physical Examination Report/Certification of Immunization Part I HEALTH INFORMATION FORM State law (Ref. Code of Virginia ) requires that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary school. The parent or guardian completes this page (Part I) of the form. The Medical Provider completes Part II and Part III of the form. This form must be completed no longer than one year before your child s entry into school. Name of School: Current Grade: Student s Name: Last First Middle Student s Date of Birth: / / Sex: State or Country of Birth: Main Language Spoken: Student s Address: City: State: Zip: Name of Parent or Legal Guardian 1: Phone: - - Work or Cell: - - Name of Parent or Legal Guardian 2: Phone: - - Work or Cell: - - Emergency Contact: Phone: - - Work or Cell: - - Condition Yes Comments Condition Yes Comments Allergies (food, insects, drugs, latex) Diabetes Allergies (seasonal) Head injury, concussions Asthma or breathing problems Hearing problems or deafness Attention-Deficit/Hyperactivity Disorder Heart problems Behavioral problems Lead poisoning Developmental problems Muscle problems Bladder problem Seizures Bleeding problem Sickle Cell Disease (not trait) Bowel problem Speech problems Cerebral Palsy Spinal injury Cystic fibrosis Surgery Dental problems Vision problems Describe any other important health-related information about your child (for example; feeding tube, hospitalizations, oxygen support, hearing aid, dental appliance, etc.): List all prescription, over-the-counter, and herbal medications your child takes regularly: Check here if you want to discuss confidential information with the school nurse or other school authority. Yes No Please provide the following information: Name Phone Date of Last Appointment Pediatrician/primary care provider Specialist Dentist Case Worker (if applicable) Child s Health Insurance: None FAMIS Plus (Medicaid) FAMIS Private/Commercial/Employer sponsored I, (do ) (do not ) authorize my child s health care provider and designated provider of health care in the school setting to discuss my child s health concerns and/or exchange information pertaining to this form. This authorization will be in place until or unless you withdraw it. You may withdraw your authorization at any time by contacting your child s school. When information is released from your child s record, documentation of the disclosure is maintained in your child s health or scholastic record. Signature of Parent or Legal Guardian: Date: / / Signature of person completing this form: Date: / / Signature of Interpreter: Date: / / MCH 213G reviewed 03/2014 1

8 COMMONWEALTH OF VIRGINIA SCHOOL ENTRANCE HEALTH FORM Part II - Certification of Immunization Section I To be completed by a physician or his designee, registered nurse, or health department official. See Section II for conditional enrollment and exemptions. A copy of the immunization record signed or stamped by a physician or designee, registered nurse, or health department official indicating the dates of administration including month, day, and year of the required vaccines shall be acceptable in lieu of recording these dates on this form as long as the record is attached to this form. Only vaccines marked with an asterisk are currently required for school entry. Form must be signed and dated by the Medical Provider or Health Department Official in the appropriate box. Student s Name: Date of Birth: Last First Middle Mo. Day Yr. IMMUNIZATION RECORD COMPLETE DATES (month, day, year) OF VACCINE DOSES GIVEN *Diphtheria, Tetanus, Pertussis (DTP, DTaP) *Diphtheria, Tetanus (DT) or Td (given after 7 years of age) *Tdap booster (6 th grade entry) 1 *Poliomyelitis (IPV, OPV) *Haemophilus influenzae Type b (Hib conjugate) *only for children <60 months of age *Pneumococcal (PCV conjugate) *only for children <60 months of age Measles, Mumps, Rubella (MMR vaccine) *Measles (Rubeola) 1 2 Serological Confirmation of Measles Immunity: *Rubella 1 Serological Confirmation of Rubella Immunity: *Mumps 1 2 *Hepatitis B Vaccine (HBV) Merck adult formulation used *Varicella Vaccine 1 2 Date of Varicella Disease OR Serological Confirmation of Varicella Immunity: Hepatitis A Vaccine 1 2 Meningococcal Vaccine 1 Human Papillomavirus Vaccine Other Other Other I certify that this child is ADEQUATELY OR AGE APPROPRIATELY IMMUNIZED in accordance with the MINIMUM requirements for attending school, child * care Required or preschool vaccine prescribed by the State Board of Health s Regulations for the Immunization of School Children (Reference Section III). Signature of Medical Provider or Health Department Official: Certification of Immunization 11/06 Date (Mo., Day, Yr.): / / MCH 213G reviewed 03/2014 2

9 Student s Name: Date of Birth: Section II Conditional Enrollment and Exemptions Complete the medical exemption or conditional enrollment section as appropriate to include signature and date. MEDICAL EXEMPTION: As specified in the Code of Virginia , C (ii), I certify that administration of the vaccine(s) designated below would be detrimental to this student s health. The vaccine(s) is (are) specifically contraindicated because (please specify):. DTP/DTaP/Tdap:[ ]; DT/Td:[ ]; OPV/IPV:[ ]; Hib:[ ]; Pneum:[ ]; Measles:[ ]; Rubella:[ ]; Mumps:[ ]; HBV:[ ]; Varicella:[ ] This contraindication is permanent: [ ], or temporary [ ] and expected to preclude immunizations until: Date (Mo., Day, Yr.):. Signature of Medical Provider or Health Department Official: Date (Mo., Day, Yr.): RELIGIOUS EXEMPTION: The Code of Virginia allows a child an exemption from receiving immunizations required for school attendance if the student or the student s parent/guardian submits an affidavit to the school s admitting official stating that the administration of immunizing agents conflicts with the student s religious tenets or practices. Any student entering school must submit this affidavit on a CERTIFICATE OF RELIGIOUS EXEMPTION (Form CRE-1), which may be obtained at any local health department, school division superintendent s office or local department of social services. Ref. Code of Virginia , C (i). CONDITIONAL ENROLLMENT: As specified in the Code of Virginia , B, I certify that this child has received at least one dose of each of the vaccines required by the State Board of Health for attending school and that this child has a plan for the completion of his/her requirements within the next 90 calendar days. Next immunization due on. Signature of Medical Provider or Health Department Official: Date (Mo., Day, Yr.): Section III Requirements For Minimum Immunization Requirements for Entry into School and Day Care, consult the Division of Immunization web site at Children shall be immunized in accordance with the Immunization Schedule developed and published by the Centers for Disease Control (CDC), Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), otherwise known as ACIP recommendations (Ref. Code of Virginia (a)). (Requirements are subject to change.) Certification of Immunization 03/2014 MCH 213G reviewed 03/2014 3

10 Part III -- COMPREHENSIVE PHYSICAL EXAMINATION REPORT A qualified licensed physician, nurse practitioner, or physician assistant must complete Part III. The exam must be done no longer than one year before entry into kindergarten or elementary school (Ref. Code of Virginia ). Instructions for completing this form can be found at Student s Name: Date of Birth: / / Sex: M F Physical Examination Date of Assessment: / / 1 = Within normal 2 = Abnormal finding 3 = Referred for evaluation or treatment Weight: lbs. Height: ft. in Body Mass Index (BMI): BP HEENT Neurological Skin Age / gender appropriate history completed Lungs Abdomen Genital Anticipatory guidance provided Heart Extremities Urinary Health Assessment TB Screening: No risk for TB infection identified No symptoms compatible with active TB disease Risk for TB infection or symptoms identified Test for TB Infection: TST IGRA Date: TST Reading mm TST/IGRA Result: Positive Negative CXR required if positive test for TB infection or TB symptoms. CXR Date: Normal Abnormal EPSDT Screens Required for Head Start include specific results and date: Blood Lead: Hct/Hgb Developmental Screen Assessed for: Assessment Method: Within normal Concern identified: Referred for Evaluation Emotional/Social Problem Solving Language/Communication Fine Motor Skills Gross Motor Skills Hearing Screen Screened at 20dB: Indicate Pass (P) or Refer (R) in each box R L Screened by OAE (Otoacoustic Emissions): Pass Refer Referred to Audiologist/ENT Unable to test needs rescreen Permanent Hearing Loss Previously identified: Left Right Hearing aid or other assistive device Vision Screen With Corrective Lenses (check if yes) Stereopsis Pass Fail Not tested Distance Both R L Test used: 20/ 20/ 20/ Pass Referred to eye doctor Unable to test needs rescreen Dental Screen Problem Identified: Referred for treatment No Problem: Referred for prevention No Referral: Already receiving dental care Recommendations to (Pre) School, Child Care, or Early Intervention Personnel Summary of Findings (check one): Well child; no conditions identified of concern to school program activities Conditions identified that are important to schooling or physical activity (complete sections below and/or explain here): Allergy food: insect: medicine: other: Type of allergic reaction: anaphylaxis local reaction Response required: none epinephrine auto-injector other: Individualized Health Care Plan needed (e.g., asthma, diabetes, seizure disorder, severe allergy, etc) Restricted Activity Specify: Developmental Evaluation Has IEP Further evaluation needed for: Medication. Child takes medicine for specific health condition(s). Medication must be given and/or available at school. Special Diet Specify: Special Needs Specify: Other Comments: Health Care Professional s Certification (Write legibly or stamp) By checking this box, I certify with an electronic signature that all of the information entered above is accurate (enter name and date on signature and date lines below). Name: Signature: Date: / / Practice/Clinic Name: Address: Phone: - - Fax: MCH 213G reviewed 03/2014 4

11 Alternate Authorized Persons for Kindergarten / Special Education Release Transportation Department Information must be submitted to your child s school by 12 noon on the day of use, to be effective immediately. If submitted after 12 noon, the change will go into effect the following school day. Principals MUST approve prior to being able to process. Request Date: Student Information Student ID Number: First Name: Home Address: Last Name: City, State, Zip: Parent / Guardian Information First Name: Last Name: Preferred Language: Home Phone Number: Cellphone Number: Work Phone Number: First Name: Last Name: Preferred Language: Home Phone Number: Cellphone Number: Work Phone Number: School Information School Name: Up to 3 Authorized Persons for Pick-up (other than Legal Guardians) Name: Relationship: Phone Number: Name: Relationship: Phone Number: Name: Relationship: Phone Number: Signatures Parent Signature: Principal Signature: Date: Date: FOR OFFICE USE ONLY Received by: Date: Time: Revised 3/8/2015 Communications Office dnb

12 Kindergarten Prep August 17-21, 2015 What is K-Prep? The ACPS Kindergarten Preparatory Program (K-Prep) is a free half-day program that helps prepare your child for the first day of school. It will run from 9 a.m. to 1 p.m. on August at each ACPS elementary school except Samuel W. Tucker. Register E a rly! K-Prep offers: Academic Instruction Transportation Free Breakfast and Lunch School Readiness Activities Opportunities to Meet New Friends How to register: To participate in K-Prep, you must first complete kindergarten registration at your neighborhood school or at the Office of English Language Learner Services at the ACPS Central Office, 1340 Braddock Place. Let your school office know you would like your child to attend K-Prep. For more information: facebook.com/acpsk12

13 Family and Community Engagement Center (FACE) WHAT IS THE FACE CENTER? The Family and Community Engagement Center Provides: Opportunities for ACPS parents/guardians to get involved in the educational experience of their children. Free information, resources, workshops and fun activities. Families with the tools necessary to support their children s academic success. Why is family engagement so important? Because your child wants to please you! It is part of your child s natural development to seek the approval of his/her parents. So if you make education a priority and establish high expectations for your child, he/she will naturally strive to do his/her best. With your involvement, we can be sure your child will come to school prepared to learn each day, behave appropriately and participate, earn good grades and test scores, aspire to take advance-level classes, graduate from high school and go on to a successful adult life. To learn more about how to support your child s learning, participate in a family workshop or volunteer in your child s school, contact the FACE Center today at or visit twitter.com/acpsk12 facebook.com/acpsk12

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