RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9 Accord, New York SPRING 2014

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1 RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9 Accord, New York Mr. Rosario Agostaro Dr. Timothy Wade Superintendent of Schools Deputy Superintendent Ext Ext Mrs. Michelle M. Donlon Mrs. Debra Kosinski Assistant Superintendent for Curriculum & Instruction School Business Administrator Ext Ext Dear Parent/Guardian, SPRING 2014 Attached you will find a lottery application for anticipated Universal Pre-Kindergarten seats for the academic year. Seats will be offered based on a public lottery to be held on May 20 at 6:00 p.m. at the Middle School Lecture Hall. You must be a resident of the Rondout School District Your child must be 4 years old on/before December 1, Complete the enclosed Lottery Application and UPK Registration Forms. Return both forms to the Rondout Valley Central School District Office by 4:00 p.m. on May 19, Please review the enclosed information carefully. All required documents (see page 2) must be received no later than July 2, 2014 in order for your child to attend school in September. (We must have a Physical form and Updated Immunizations before they can attend UPK) You may bring your required documents to the District Office and we will copy them for you, or they may be faxed to: Atten: UPK or mailed to: Rondout Valley CSD DO-PPS-UPK PO Box 9 Accord, NY All are welcome to attend the lottery on May 20 although your presence is not required. Please Note: The New York State budget has not been adopted as of March 28, Providing Universal Pre-Kindergarten for residents of the Rondout Valley School District is dependent upon the State grant. Parents will be contacted in July with results of lottery. Patricia Robbins CSE/CPSE Chairperson Pupil Personnel Services Ext. 4863

2 Please keep this page for your information Due to NYS Immunization requirements we must ask for documentation. All Preschoolers must be up to date on immunizations and Well Child exam before attending school. *PLEASE TE: DOCUMENTS REQUIRED BY JULY 1st 1)Proof of Residency- copy of bill/receipt with name and physical address 2)Copy of Birth Certificate 3)Copy of Shot Records 4)Copy of Physical Exam -physical must be done between 9/13-9/14 (please take enclosed Health Assessment Form to your Doctor) NY State Immunization Requirements for School Entrance/Attendance Vaccines Pre-kindergarten (Day Care, Nursery, Head Start, or Pre-K) Diphtheria and Tetanus Toxoid-Containing Vaccine and Pertussis Vaccine (DTaP, DTP) 4 doses 4-5 doses (See footnote 2b) Kindergarten Polio (IVP or OPV) 3 doses 3-4 doses (See footnote 4b-d) Measles, Mumps and Rubella(MMR) 1 dose 1 dose Hepatitis B 3 doses 3 doses Haemophilus influenzae type b conjugated 1-4 doses (See footnote 8a-g) Not applicable vaccine (Hib) Pneumococcal Conjugate Vaccine (PCV) 1-4 doses (See footnote 9a-f) Not applicable Varicella(Chickenpox) 1 dose 2 dose 2b. If the fourth dose of DTaP was administered at age 4 years or older, the fifth (booster) dose of DTaP vaccine is not necessary. 4b. If 4 or more doses were administered before age 4 years, an additional dose should be received at age 4through 6 years. c. If both OPV and IPV were administered as part of a series, a total of 4 doses should be received, regardless of the child s current age. d. For children 4 years of age or older who have previously received less than 3 doses, a total of 3 doses are required. 8. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks) a. Children who start the series on time should receive a Hib vaccine primary series and a booster dose to all infants. The primary series doses should be received at 2, 4, and 6 months of age. One booster dose should be received at age 12 through 15 months. b. If the first dose was administered at ages 7 through 11 months, a second dose should be received at least 4 weeks later and a final dose at 12 through 15 months of age. c. If 2 doses of vaccine were administered at 11 months of age or younger, a third and final dose should be received at 12 through 15 months of age and at least 8 weeks after the second dose. d. If dose 1 was administered at ages 12 through 14 months, a final dose should be received at least 8 weeks after dose 1. e. For children who received 1 dose of vaccine at 15 months of age or older, no further doses are necessary. f. For unvaccinated children 15 months of age or older, 1 dose of vaccine is required. g. Hib vaccine is not routinely required for children 5 years of age or older. 9. Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks) a. Children starting the series on time should receive a series of PCV13 vaccine at ages 2, 4, 6 months with a booster at age 12 through 15 months. b. Unvaccinated children 7 through 11 months of age should receive 2 doses, at least 4 weeks apart, followed by a 3rd dose at age 12 through 15 months. c. Unvaccinated children 12 through 23 months of age should receive 2 doses of vaccine at least 8 weeks apart. d. Previously unvaccinated children 24 through 59 months of age should receive only 1 dose. e. PCV13 is the preferred vaccine for use in healthy unvaccinated/partially vaccinated children 2 through 59 months of age. A single supplemental dose of PCV13 is recommended for children 14 through 59 months who have already completed the age appropriate series of PCV7. (Note: PCV13 has been licensed and recommended for children in the U.S. since 2/2010. PCV13 replaced the previous version of Prevnar, known as PCV7, which included 7 pneumococcal serotypes.) f. For further information, refer to the PCV chart available at

3 Fax Physical & Immunizations to: Mail to: Rondout Valley CSD-PPS-UPK PO Box 9 Accord, NY RONDOUT VALLEY CENTRAL SCHOOL DISTRICT HEALTH SERVICES P.O. BOX 9, ACCORD, N.Y NYSED requires an annual physical exam for UPK, new entrants, students in Grades K, 2, 4, 7 and 10, sports, working permits and triennially for the Committee on Special Education (CSE) HEALTH ASSESSMENT FORM Name: Date of Birth: School: Gender: M F Grade: IMMUNIZATIONS/ HEALTH HISTORY Immunization on record attached Sickle Cell Screen: Positive Negative Not Done Date: No immunizations given today PPD: Positive Negative Not Done Date: Immunizations given since last Health Appraisal: Elevated Lead: Yes No Not Done Date: Dental Referral Yes No Not Done Date: Significant Medical/Surgical History: see attached Specify current diseases: Asthma Diabetes: Type 1 Type 2 Hyperlipidemia Hypertension Other: Allergies: LIFE THREATENING Food: Insect: Other: Seasonal Medication: PHYSICAL EXAMS Height: Weight: Blood Pressure: Date of Exam: Body Mass Index: - Weight Status Category (BMI Percentile): Less than 5 th 5 th through 49 th 50 th through 84 th 85 th through 94 th 95 th through 98 th 99 th and higher Vision - without glasses/contact lenses R L Vision with glasses/ contact lenses R L Vision Near Point R L Hearing Pass 20 db sc both ears or: R L EXAM ENTIRELY RMAL Tanner: l. ll. IIl. lv. V. Scoliosis: Negative Positive: Specify any abnormality (use reverse of form if needed): MEDICATIONS Medications (list all): None Additional medications listed on physician letter head stationary Name: Dosage/ Time: Name: Dosage/Time: If AM dose is missed at home: I assess this student to be self directed Yes No Student may self carry and self administer medication Yes No Note: Nurse will also assess self-direction for the school setting. Please advise parent to send in additional medication in the event that emergency sheltering is necessary at school or if morning medication has not been given. PHYSICAL EDUCATION / SPORTS / PLAYGROUND / WORK QUALIFICATION / CSE CONSIDERATION Free from contagions & physically qualified for all physical education, sports, playground, work & school activities OR only as checked: Limited contact: cheerlead, gymnastics, ski, volleyball, cross-country, handball, fence, baseball, floor hockey, softball. Non-contact: badminton, bowl, golf, swim, table tennis, archery, riflery, weight train, crew, dance, track, run, walk, rope jump. Specify medical accommodations needed for school: Known or suspected disability: Restrictions: None Please monitor Please monitor Protective equipment required: Athletic Cup Support goggles/impact resistant eyewear Other: Provider s Signature: Phone: Provider s Name/ address: Fax: Parent Signature: Date: This exam complies with NYSED requirements above and is valid for twelve months, with the exception of any illness or injury lasting more that five days that will require review by private healthcare and the school medical director. DH #6new 1/08

4 Pre Kindergarten Lottery Application Rondout Valley Central School District Office of Pupil Personnel P.O. Box 9 Accord, New York Name of Student: Male/Female (Please Circle one ) Date of Birth: Must be 4 years old on December 1, 2014 Father/Legal Guardian: Mother/Legal Guardian: We have 4 schools participating is our Universal Prekindergarten program: The Brookside School in Cottekill on Lucas Ave. RMCC Preschool at the Rondout Methodist Church on Schoonmaker Lane Ulster County Community College ChildCare Lederman Children s Center on Rt 213 Please indicate below your preference in rank order with: 1- being your first choice 2- second choice 3- third choice 4-Fourth Choice Morning Afternoon Brookside School Afternoon sessions are available Wrap around available* RMC Cooperative PreSchool No afternoon session UCC Childcare Center No afternoon session/wrap around available* Lederman Children s Center No afternoon session/wrap around available* *Wrap around-parent pays for afternoon session This Lottery Application and the following UPK Registration Form must be delivered to the Office of Pupil Personnel at the Rondout Valley Central School District Office by 4:00 p.m., May 19, Pre-Kindergarten Lottery will take place on May 20, 2014 at 6:00 p.m. in the Middle School Lecture Hall

5 RONDOUT VALLEY CENTRAL SCHOOL DISTRICT UPK REGISTRATION FORM Student First Name Middle Name Student Last Name Physical Address (Street Address) (City) (State) (Zip) Mailing Address (if different) (PO Box/address) (City) (State) (Zip) Town/Village of Residence Address: Mother Father (Please circle one) Father/Legal Guardian s Name: Mother/Legal Guardian s Name: Student s Sex M F Student s Place of Birth Student s Date of Birth: Special Programs/IEP: Date of Entry (if not born in US) Country of Origin (City) (State) (Zip) Number of years in US Schools: What languages does the student understand? Home Language What language does student: Read Write Race (circle one) Hispanic Non-Hispanic International Adoption? Date of Adoption Ethnicity (circle one): I American Indian or Native America A Asian B- Black or African American H Hispanic or Latino P Native American or other Pacific Islander W - White RESIDENCY INFORMATION ( please circle one) Citizenship Status (check one) Dual Nation: Non-resident alien: US Citizen: Other: Student lives with: Both Parents Father Mother Legal Guardian Stepparent Relative Relationship: Foster Home PLEASE TE PLACEMENT AGENCY & ADDRESS: Date of 1 st Polio Immunization: STUDENT LIVING ARRANGEMENTS Is the student homeless?.. Is the student living in a shelter: Is the student living with relatives due to lack of housing?... Is the student living in an abandoned apartment/building?... Is the student living in a motel/hotel?... Is the student living in a campground, car, train/bus station or other similar situation due to lack of alternative, adequate housing?... Is the student temporarily housed in a shelter awaiting OCF S permanent foster care placement?...

6 TELEPHONE NUMBERS (Fill out employer information only for parent(s), Legal Guardian or Relative that student lives with) HOME# WORK# CELL# Father Father s Employer Mother Mother s Employer Guardian Guardian s Employer Relative Relative s Employer Name ****EMERGENCY NUMBERS**** Relationship Address Permission to pick up student: Phone # Cell # OTHER CHILDREN Sex Date of Birth Attending Rondout? Brother s Names Yes No Sister s Names

7 RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9 Accord, New York Mr. Rosario Agostaro Dr. Timothy Wade Superintendent of Schools Deputy Superintendent Ext Ext Mrs. Michelle M. Donlon Mrs. Debra Kosinski Assistant Superintendent for Curriculum & Instruction School Business Administrator Ext Ext PARENTAL PERMISSION FOR USE OF STUDENT NAMES, PHOTOGRAPHS & VIDEO Dear Parent/Guardian, The Rondout Valley Central School District is changing its practice of publishing student names, photographs and videos. From here forward, the district will publish names, photographs and videos of students unless parents/guardians have completed and returned the following form expressing that they do not give consent to publish his or her child s name, photograph or video. Student names, photographs and videos will be used only for educational and/or public relations purposes, in newsletters, on the district website, etc. and student names will not be used together with their photo or video. OPT OUT FORM I,, the parent/legal guardian of student (Please print parent/guardian s name), DO T give my permission to the Rondout Valley (Please print student s name) Central School District to use my child s name, photograph or video. Full Parent/Guardian Signature Date /rc

8 RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9 Accord, New York Mr. Rosario Agostaro Dr. Timothy Wade Superintendent of Schools Deputy Superintendent Ext Ext Mrs. Michelle M. Donlon Mrs. Debra Kosinski Assistant Superintendent for Curriculum & Instruction School Business Administrator Ext Ext Dear Pre-Kindergarten Parent/Guardian, We have the capability of sending phone calls, s, and/or text messages to inform you of school delays, emergency closings, and upcoming events in the district. This is accomplished through an automated system which we use to contact parents, students, and staff. If you would like the district to register you for this service, please fill in this form and return it with your Universal Pre-Kindergarten application. Thank you, Superintendent Rosario Agostaro Parent/Guardian Name Student Name I would like the Rondout Valley Central School District to send me notifications about: Emergency Closings/Delays Upcoming Community Events Please check all that apply below regarding how you would like to receive the reminders. I prefer to receive notifications through a(n): Phone E Text Should you have any questions, please contact Ms. Randi Chase in the Technology Office at the following phone number: extension 4851.