Millstone Township Primary School Schoolhouse Road, Millstone Township, NJ 08510

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1 Millstone Township Primary School Schoolhouse Road, Millstone Township, NJ Trish Bogusz Scott Hobson Principal Assistant Principal x x40002 Fax: Fax: Dear Parents and Guardians, January 2015 The Millstone Township Public School district offers a kindergarten program for residents of Millstone Township. Children must be five years of age on or before October 1 of that school year. Kindergarten registration for September 2015 begins in February Registration will be held at the Primary School on Wednesday, February 25, 2015 from 5:00-7:00 pm and on Thursday, February 26, 2015 from 9:30-11:30 am. Prior to registration, parents or guardians must complete all forms in the registration packet and compile all the necessary registration information. At the time of registration, parents or guardians must bring the completed registration packet, original documents of the items listed below, and one copy of each original document: 1. Birth certificate with raised seal 2. Four proofs of residency 3. Immunization report 4. Child custody or guardianship papers, if applicable Millstone Township School District offers morning and afternoon kindergarten sessions (enrollment is based upon transportation) as well as a full day Kindergarten Enrichment Program. If you have any questions about the kindergarten program or registration process, please call the Main Office at x Sincerely, Trish Bogusz Principal

2 Millstone Township School District Millstone Township, NJ Kindergarten Registration Welcome to Millstone Township School District. The following will assist you with the registration process. 1. Read the attached student registration information. 2. Complete all forms. 3. Bring the completed forms and the following items to register: immunizations records, original birth certificate, and four proofs of residency. Please bring copies of all documentation listed above. 4. If any of the situations listed below apply to the child you are registering, the registrar will provide additional information or forms, as needed. The child is living with a person, other than the parent or guardian, who lives in Millstone Township. The child is living with a parent or guardian who is temporarily residing in Millstone. You have a signed contract to purchase a home in Millstone Township but the closing has not been completed. We will be happy to assist you in completing the registration process.

3 Millstone Township School District Millstone Township, NJ Student Registration Information The following information is provided to assist with the registration of your child. Please read this information carefully. New Jersey law requires that Millstone Township provide a free public education to any student between the ages of 5 and 20 who is: Living with a parent or guardian whose permanent home is located within the district or who is temporarily living in the district. Living with a person, other than a parent or guardian, who resides in the district and who is supporting the student without compensation, as if the student were his or her own child because the parent cannot support the child due to family or economic hardship. Living with a person, other than a parent or guardian, who resides in the district when the parent is a member of the New Jersey National Guard or the reserve component of the United States Armed Forces and has been ordered to active military service in time of war or national emergency. The child of a parent or guardian who is homeless. Placed in the district by court order. A child of a parent or guardian who resided in the district prior to being called to active military duty in time of war or national emergency. Residing on federal property within the district. The following may be used as proof of eligibility for enrollment in the district: Property tax bills, deeds, contracts of sale, leases, mortgages, signed letters from landlords and other evidence of property ownership, or residency. Voter registration, licenses, permits, financial account information, utility bills, delivery receipts, and other evidence of personal attachment to a particular location. Court orders or state agency agreements. Receipts, bills, cancelled checks or other evidence of expenditures showing support of the student. Medical reports, social worker assessments, or employment documents showing family or economic hardship. Affidavits, certificates or sworn statements pertaining to statutory criteria for school attendance. Documents pertaining to military status. Any record by a government agency. The information and documentation offered will be considered in evaluating an application, and, unless required by law, the student will not be denied enrollment based on inability to provide certain documentation where other acceptable evidence is provided. Please be aware that any initial determination of the student s eligibility to attend school in this district is subject to a more thorough review and subsequent re-evaluation, and that tuition my be assessed in the event that an initial admitted student is later found ineligible. If a student is found ineligible, reasons for the decision will be provided as well as instructions on how to appeal. If you are experiencing difficulties with the enrollment process, please contact the building principal s office for assistance.

4 Millstone Township School District Millstone Township, NJ Registration Form Form A Date: School: Student: Last Name First Name Middle Initial Age: Sex: Date of Birth: Student s Place of Birth: City State Country Name of Parent(s) or Guardian(s): Birthplace of Parent(s) or Guardian(s): Person Enrolling Student: Relationship to Student if other than Parent: Student s Physical Address: Mailing Address (if different than above): Home Telephone (including area code): Other Phone or Fax (if any): Parent s or Guardian s Physical Address: Mailing Address (if different than above): Home Telephone (including area code): Other Phone or Fax (if any): Please indicate native language of parent, guardian, or person enrolling student (if other than English): - Please check here if English is spoken and understood by the parent, guardian, or person enrolling student. Last School Attended: Address: Names and Ages of Siblings:

5 FORM B DOMICILE SECTION A (DOMICILE): Complete this section if the student is living with a parent or guardian whose permanent home is the address given on page one (1) of this application and is located in the district. If you are the student s guardian, or will be the guardian of a student from out of state following expiration of the 6-month waiting period, you will be asked to provide official papers proving guardianship. You will not be asked to produce affidavit student proofs of the types requested in Section B. How long have you lived in this house? Do you have any present intention of moving from this home? If yes, when and to where? Do you have residence(s) elsewhere, and, if so, where are they and when do you live there? Please list four forms of proof (see attached list) you will provide to demonstrate that the information given on page one (1) of this application is your permanent home If the student s parents are domiciled in different districts, regardless of which parent has legal custody, please answer the following questions: Is there a court order or written agreement between the parents designating the district for school attendance, and if so, where does it require the student to attend school? (You will be asked to provide a copy of this document.) Does the student reside with one parent for the entire year? If so, which parent and at what address? If not, for what portion of time does the student reside with each parent and at what addresses? If the student lives with both parents on an equal-time, alternating week, month, or other similar basis, with which parent did the student reside on the last school day prior to October 16 preceding the date of this application?

6 Health Office - Student Emergency Reference Card 20 /20 School Year Student Grade Teacher Birth Date Bus # Home Phone Allergies Mailing Address Medications (Street) (Town) (Zip Code) Mother s Name Cell Phone # Mother s Workplace Work Phone # Father s Name Cell Phone # Father s Workplace Work Phone # List any operations, illnesses, and inoculations that your child has had this year Please contact the school if your child is absent. Each absence requires a note from you stating the reason why your child was absent. Thank you. In the event that I (the parent or guardian) cannot be reached, I have arranged for the following people to assume temporary care of my child in the event of an emergency. The people should reside locally. 1. Name Relationship Phone # Cell # 2. Name Relationship Phone # Cell # 3. Name Relationship Phone # Cell # 4. Name Relationship Phone # Cell # Local Physician s Name: Phone # ( ) Please be advised that the information in your child s health folder is confidential. Your permission is required to share ONLY information pertinent to your child s health with his or her teachers (for example, allergies, diabetes, asthma). By signing this card, you are granting your permission to have this information shared with the appropriate people. In case of accident or serious illness, I request the school to contact me. If the school is unable to contact me, I authorize the school to call the physician named above and follow his or her instructions. If it is impossible to contact this physician, the school may take whatever actions necessary. Signature of Parent or Guardian Date

7 Millstone Township School District Student Health History and Record Status Student Date of Birth Address Town Zip Date of Entry Parent(s) or Guardian(s) Name Grade Phone Name and Address of Previous School Prenatal/Development History List any significant problems during pregnancy or newborn period List any significant developmental delays Family History This child is # of children. Recent changes in family life List any custody problems or visitation limitations (court papers must be supplied, if applicable) List chronic diseases in family (include grandparents) Habits and Personality Please describe this child in terms of temperament and attitudes List any specific information about this child which you would like the school to know Medical History Allergies Diabetes Heart Disease Drug Sensitivities Lyme Disease Otitis Media Hepatitis Rheumatic Fever Strep Mononucleosis Chickenpox Asthma Hearing Problems Convulsive Disorders Vision Problems Neuromuscular Problems Operations Special Conditions or Problems Medication taken regularly and reason Signature of Parent or Guardian Date For School Nurse: Immunizations Complete Needs Physical Needs Mantoux Original Health Record Received Yes No Yes No Yes No Yes No

8 MILLSTONE TOWNSHIP SCHOOL DISTRICT SCHOOL ENTRANCE PHYSICAL EXAMINATION Student Grade Entering Date of Examination (must be within 1 year of entry) Birth Date Sex Height Weight Vision Hearing Blood Pressure Disease History (please specify type and age at onset): Allergies Convulsive Disorders Congenital Defects Diabetes Drug Sensitivities Heart Disease Hepatitis Otitis Media Neuromuscular Disorders Rheumatic Fever Asthma Strep Infections Chickenpox Mononucleosis Lyme Disease Other Illnesses Operations or Injuries Physical Examination Ears Eyes Skin Lymph Glands Thyroid Throat Nose Teeth and Mouth Speech Heart Lungs Abdomen Hernia Nutrition Nervous System General Appearance Other Orthopedic Immunization Record (exact dates including month, day, and year are required by law) #1 #2 #3 booster1 booster2 DPT POLIO *One booster of DPT & POLIO must be given on or after the 4 th birthday. MMR #1 #2 Hepatitis B #1 #2 #3 Hib #1 #2 #3 _ #4 Varicella #1 (required for school, unless child had disease) #2 Prevnar #1 #2 #3 #4 Hepatitis A #1 #2 (not required) Recommendations or restrictions (if any): I have examined this child and find him or her physically fit to participate in all school activities. Signature of Physician (stamps or counter-signatures are NOT acceptable) Print Physician s Name Date Telephone

9 Millstone Township School District 5 Dawson Court, Millstone Township, NJ Karen Barry Director of Curriculum & Instruction x fax barryk@millstone.k12.nj.us Dear Parents/Guardians: As part of the federal accountability requirements of the No Child Left Behind Act (NCLB), districts must report student standardized test scores as a whole group (grade level and school) and in specified subgroups. One of the subgroups required is Ethnic Groups. Please complete the following for your child. Thank you for your cooperation. Karen Barry Director of Curriculum and Instruction ******************************************************************************************************* Please check the ONE that applies. DO NOT add to this listing, as these are the only ethnic subgroups allowed by the NCLB Act. Student s Name (Please print): Grade: ( ) Asian ( ) Black or African American ( ) American Indian or Alaskan ( ) Native Hawaiian or other Pacific Islander ( ) White ( ) Hispanic or Latino ( ) Two or more races (only if non-hispanic)

10 Millstone Township Primary School Health Office x40006 Dear Parent/Guardian: Below is a permission slip that will allow the health office to discuss your child s health concern with the appropriate school staff. Please note that if your child has a food allergy, a letter may also go home with your child s classmates informing their parents of the condition so that a safe environment can be provided for your child. Your child s name will not be disclosed. Please complete and return this form to the health office. If you have any questions, please contact the health office. Please note that if your child has a food allergy, it is the parents responsibility to provide to the health office a list of safe snacks that your child is allowed to have. This list will then be distributed to your child s class. Thank you, Eleanor Sico, RN I hereby give permission for the health office to discuss any health concerns regarding my child s allergies with the appropriate personnel. I do not wish my child s health concern to be discussed. Child s Name Teacher/Grade Specific allergy/food allergy/medical condition For peanut allergies: My child does/does not need to sit at the peanut free table (circle one) Parent/Guardian signature Date