LYNBROOK PUBLIC SCHOOLS LYNBROOK KINDERGARTEN CENTER

Transcription

1 LYNBROOK PUBLIC SCHOOLS LYNBROOK KINDERGARTEN CENTER 111 ATLANTIC AVENUE LYNBROOK, NEW YORK DR. PHILIP S. CICERO SUPERINTENDENT OF SCHOOLS SANTO J. BARBARINO, PH.D. ELLEN POSTMAN DR. MELISSA BURAK Assistant Superintendent for Interim Principal Assistant Superintendent for Business Curriculum and Personnel (516) Dear Parents, Congratulations and welcome to the Graduating Class of 2020! December, 2006 Our full-day program offers two sessions: 8:30 am-2 pm or 9:30 am-3 pm. Transportation is provided to and from The Center from various bus stops throughout the neighborhood. Registration will take place at Central Administration, 111 Atlantic Avenue. On the first day of class, parents will be invited to accompany their children on the bus. Our experience indicates that this is a very positive way of easing children into the kindergarten routine. The staff and I are confident that our full-day kindergarten program will provide your children with very special experiences and many happy memories in the years to come. Information about your child s classroom teacher will be mailed to you mid-august. In the meantime, please do not hesitate to call me if you have any questions. Sincerely, EP:am Ellen Postman Interim Principal

2 Lynbrook Public Schools 111 Atlantic Avenue Lynbrook, NY (516) Dr. Philip Cicero Superintendent of Schools Elizabeth A. Mueller, District Clerk Jacob S. Feldman, School Attorney Dear Parent or Guardian, Thank you for your inquiry regarding registering a child in the Lynbrook Public School system. Attached please find the registration document packet required by the Lynbrook Public Schools. All forms needed to complete the process are included in the packet. Please read the packet material carefully, gather your required personal documents, have required affidavits notarized if necessary and complete the Registration Form(s) by typing or printing clearly: Page 1: Page 3: Child's Directory Information Parental Workplace Information Gender, Ethnicity, Language Information Emergency Contact Information Parent Affirmantion of Truth Statement Proof of Residency Other Children in School Page 2: Page 4: Guardianship/Parental Information Prior School Attendance Doctor's Report Information Prior/Current Special Education Services Once you have completed the above, please make an appointment to meet with the Central Registrar. At that time, each personal document and item you have entered on the form will be checked for accuracy and reviewed. Please do not make an appointment to complete the registration process if you are not in possession of all of the required documentation listed on the first page of the Registration Form and have completely filled in the form. If you have questions about the process, required documents or Registration Forms, please call the Registrar at during the hours of 9:00 a.m. and 3:00 p.m., Monday through Friday, during days when school is regularly in session. Thank you for your cooperation, and we look forward to seeing you during the registration process. Sincerely, Elizabeth A. Mueller Central Registrar

3 Lynbrook Public Schools 111 Atlantic Avenue Lynbrook, NY (516) REGISTRATION FORM Print Clearly Dr. Philip Cicero Superintendent of Schools Elizabeth A. Mueller, District Clerk Jacob S. Feldman, School Attorney Child s Name: Social Security #: - - Address: Phone #: A bill with proper residence must be Is this your Primary Residence? ( ) Yes ( ) No supplied if this is a cell phone number Gender: ( ) Male ( ) Female Homeless: ( ) Yes ( ) No Ethnicity: You MUST check ONE ( ) American Indian/Alaskan Native ( ) Asian ( ) Black (not Hispanic origin) ( ) Hispanic ( ) White (not Hispanic Origin) ( ) Pacific Islander Date of Birth: / / Place of Birth: mm dd yyyy I certify that all statements made on this form are true and correct. Home Language: Signature of Parent/Guardian Date Any false statement made in this registration form including documentation for residency, is punishable as a Class A misdemeanor pursuant to Section of the penal law. The district will pursue tuition expenses for students deemed non residents. Initials According to New York State Law and Lynbrook Schools Policy, the following records must be presented before a student is enrolled: 1(A) Proof of Student s Birth (One required) Original Birth Certificate or; Passport or; Court Signed Guardianship Papers 1(B) Proof of Parental Relationship (Same as Above) Proof of Recent Physical Exam & Proof of Immunizations Doctor s Report Date of 1 st Polio Vaccination Month/day/year 2 Parent / Guardian Identification Information (One required) Passport or; NYS Drivers License or; Alien Registration Card or; Original Birth Certificate 3(A) Proof of Residency (Required) Home Owner - School Tax Bill Receipt Tenant - Lease Signed by the Landlord indicating section, block, & lot and a Notarized Affidavit from Landlord 3(B) Proof of Residency (Two required) W2 Form Voter Registration Card Bank Statement Utility Bill: Gas; Electric; Water [Telephone Bill unacceptable] Car Registration Proof of Prior School Attendance (One required) Report Card or; Transcript Prior/Current Special Education Services Revised 1/06

4 1. (A) PROOF OF BIRTH & (B) PROOF OF PARENT, LEGAL GUARDIAN OR FOSTER PARENT RELATIONSHIP ONE FORM OF PROOF IS REQUIRED ( )Original Birth Certificate ( )Passport ( )Guardian Papers (Registrar, please answer the questions that pertain to section 1 on the questionnaire) Does the Student reside with both parents? ( )YES ( )NO If YES, proceed to Health Record at the bottom of the page. If NO, please complete the following: Check the item that applies: Student Resides Solely With: ( ) Mother ( ) Father ( ) Guardian Custody: ( ) Joint ( ) One Parent ( ) One Parent Widowed Child lives with: Mother at Name Full Address & Telephone Number Days with Mother Father at Name Full Address & Telephone Number Days with Father Guardian at Name Full Address & Telephone Number One of the following documents is required: 1. A copy of the Judgment of Divorce showing custody or; 2. A notarized letter from the spouse affirming that the child resides with the other parent or; 3. A Court Order indicating guardianship or; 4. A death certificate Which parent claims the child for a dependent on Income Tax? ( ) Mother ( ) Father Which parent claims the child on medical insurance? ( ) Mother ( ) Father HEALTH RECORDS Last Physical Examination / / Doctor Phone mm dd yyyy Immunization Record / / Doctor Phone First Polio Vaccination Revised 1/06

5 2. PARENT IDENTIFICATION Mother s Name: Workplace: Workplace Address Phone Father s Name Workplace: Workplace Address Phone Emergency Contact Name Address Phone ONE FORM OF PROOF IS REQUIRED ( ) Original Birth Certificate ( ) Passport ( ) NYS Drivers License ( ) Alien Registration Card (Registrar, please answer the questions that pertain to section 2 on the questionnaire) 3. (A) PROOF OF RESIDENCY Homeowners must provide a current tax bill indicating taxes paid to School District #20 Renters must provide both a: Lease for a residence located within the district indicating section, block, & lot and a; Rent receipt with a notarized letter from the landlord indicating lot, block & section (Registrar, please answer the questions that pertain to section 3 on the questionnaire) (B) PROOF OF RESIDENCY TWO FORMS OF PROOF ARE REQUIRED ( )W2 Form ( )Automobile registration ( )Bank Statement ( )Voter Registration Card Utility bill: ( )Gas ( ) Electric ( )Water [Telephone bills are not accepted] (Registrar please answer the questions that pertain to section 4 on the questionnaire) OTHER CHILDREN IN SCHOOL Full Name Birth Date Grade School

6 PRIOR SCHOOL ATTENDANCE Last School Attended Address Telephone # Last Grade Completed Date Does child have any special needs or interests? Documentation: ( ) Report Card ( ) Transcript ( ) [Telephone Call] Checked by: Date School Official PRIOR/CURRENT SPECIAL EDUCATION SERVICES Has the child ever been presented to the Committee on Special Education or received any special education services? ( )NO ( )YES If your answer is yes, please answer the following questions: District in which child was presented to the Committee District Name City State Date Please place an x in the box of the disability determined by the CSE or CPSE Autism Emotional Disturbance Learning Disability Mental Retardation Deafness Hearing Impairment Speech Impairment Visual Impairment Deaf & Blind Orthopedic Impairment Multiple Disabilities Traumatic Brain Injury Other Health Impairment: Last Services Received in: School Name City State Date Please place an x in the box indicating the type of service received: Related Services BOCES Special Education Special Home Instruction Resource Room Day School Special Education Hospital Placement Self-Contained Class Residential School Special Education Court Placement Other Services: Comments by Special Education director (required for admission) Registrar: ( ) ADMIT ( ) DO NOT ADMIT Date Sent to Administration: / / mm dd yyyy Authorized Signature School Date

7 Lynbrook Public Schools 111 Atlantic Avenue Lynbrook, NY (516) LANDLORD AFFIDAVIT Print Clearly Dr. Philip Cicero Superintendent of Schools Elizabeth A. Mueller, District Clerk Jacob S. Feldman, School Attorney State of New York County of Nassau I acknowledge that I am the Printed Name of the Landlord or Record Owner record owner or landlord of the property located at: Address,, recorded on the tax bill with Unit # City Section # Block # Lot # I affirm that rents said property Printed Name of Tenant ( )monthly ( )annually from to and resides at said property with adults and children. The landlord agrees to call the Lynbrook UFSD at (516) within seven (7) days of said tenant vacating the property. If in agreement, please initial. [Signature of Landlord] (Typed Name of Landlord] [Address of Landlord, line 1] [Address of Landlord, line 2] (Telephone # of Landlord] (Fax # of Landlord] Subscribed and sworn to before me, this day of 20. [Notary Seal:] [Signature of Notary] (Typed or Printed Name of Notary] I understand that any false statements made herein are punishable as a Class A misdemeanor pursuant to Section of the penal law of the State of New York. The Lynbrook School District reserves the right to commence legal action to recover tuition costs against any person who submits false or fraudulent documents for the purpose of enabling one to attend school in the Lynbrook School District who does not legitimately reside within the Lynbrook School District

8 Lynbrook Public Schools PHYSICAL EXAMINATION FORM Must Be Filled In By Physician! Last Name/First Name Date of Birth Teacher Grade Address Date of Examination Parents /Guardians Name & Telephone #: Physician s Name & Telephone #: Height Lungs Nervous System Speech Weight Abdomen Thyroid Nutrition Blood Pressure Hernia Heart Teeth/Gums Eyes Genitalia Epilepsy Posture Ears Skin Orthopedic Feet Nose Tonsils/Throat Structural Defect Other Does this child have any defect or disability? (specify) Is this child physically able to participate in athletics? If NO list restrictions: Are there any problems relating to growth, development or nutrition with which teacher and parents should be acquainted? Health History Please fill in month & year Allergy Epilepsy Operations Serious Injury Asthma German Measles Pneumonia Tonsillectomy Chicken Pox Heart Condition Polio Tuberculosis Diabetes Measles Rheumatic Fever T.B. Contacts Ear Condition Mumps Scarlet Fever Whooping Cough Immunizations and Preventive Measures and Tests: Please fill in month & year 1 st 2 nd 3 rd 4 th Comments DPT Polio MMR Hib/HBCV Hepatitis B Varicella PPD Physician s Signature: HIPPA The information provided on the physical examination may be shared ( ) or may not ( ) be shared with appropriate personnel. Parent s Signature: Date: NYS State Department of Education requires Physical Examinations for all students in Grades K, 2, 4, 7, 10 and all new students to the District. NYS Depart of Education recommends Dental Examinations for all students annually.

9 Lynbrook Public Schools 111 Atlantic Avenue Lynbrook, NY Dr. Philip Cicero Superintendent of Schools LYNBROOK PUBLIC SCHOOLS Immunization Requirements New York State Public Health Law 2164 requires students to be immunized in order to attend public school. The immunizing physician must provide an immunization certificate to the person in parental relation to the child. No child may be admitted to school or allowed to attend school for more than 14 days without proper immunization. This period may be extended to 30 days on a case by case basis if a student has transferred from another state or country and can show a good faith effort to get the necessary evidence of immunization. Attached please find the New York State Immunization Requirements for School Entrance. Thank you for your cooperation in this matter. If you need assistance in fulfilling this requirement, feel free to contact your child s school of attendance or the Nassau County Department of Health. Sincerely, PSC:jd Philip S. Cicero, Ed.D. 9/06 Superintendent of Schools

10 LYNBROOK PUBLIC SCHOOLS Lynbrook, New York Dear Parents, You will soon be registering your child for kindergarten. New York State Law mandates that all children entering kindergarten in September, 2007 have a physical examination and that they be properly immunized. The following vaccines are required for your child to attend school in September doses of Diptheria--containing Toxoid (usually given as DPT, DT or TD) doses of Oral Polio Virus vaccine (OPV) or enhanced inactivated Polio Virus vaccine (EIPV) dose of Mumps vaccine given after 12 months of age dose of Rubella vaccine given after 12 months of age doses of Measles vaccine, the first given after 12 months of age and the second after 15 months of age doses Hepatitis B vaccine dose Varicella vaccine. All immunizations must be dated with month, day and year and signed by a physician. Since we prefer that you have your child examined by your own doctor prior to registration, please have the attached medical form completed at that time. Please bring this completed form, along with the additional completed health forms, when you come to register your child. We look forward to meeting you at that time. School Nurse am

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12 Lynbrook Public Schools SCHOOL EMERGENCY INFORMATION FORM (Please Print) Student Name (Last, First, Middle) Grade School/Teacher Home Address City State Zip Telephone # Homeless ( ) Yes ( ) No Country of Origin Original Date of Entry into US (if applicable) Names of Parents/Guardians with Whom Student Resides If Immigrant, Number of Years in US Schools Date of Original Entry into Grade 9 (if applicable) Father s Name Mother s Name Guardian s Name Father s Place of Business Mother s Place of Business Guardian s Place of Business Business Telephone # Business Telephone # Business Telephone # Cell Phone / Beeper # Cell Phone / Beeper # Cell Phone / Beeper # Address Address Address Emergency Contact Name (1) Emergency Contact Name (2) Telephone # Telephone # Cell Phone # Cell Phone # Name of Physician Telephone # During the past year has your child had any serious illness, injury or operation? If yes, please describe and include dates ( ) Yes ( ) No List any medications taken on a regular basis NYS Department of Education requires Physical Examinations for all students in grades K, 2, 4, 7, 10 & all students new to the district I wish to have this examination performed by the student s physician ( ) Yes ( ) No I wish to have this examination performed by the school physician ( ) Yes ( ) No Signature of Parent or Guardian Date

13 Lynbrook Public Schools 111 Atlantic Avenue Lynbrook, NY Dr. Philip Cicero Superintendent of Schools Dear Parents, As part of our school district s Emergency Preparedness Plan, we would like your permission to release your home telephone number, your emergency and or cell telephone number and your address to members of the PTA for telephone chain purposes during an emergency. Recent events have displayed the need for emergency telephone numbers since attempts to contact families through home telephone numbers were not always successful. I am asking you to allow the school district, via each respective school, to release emergency contact information to the PTA grade representative or telephone parents who are primarily responsible for the execution of the telephone chain. The emergency phone numbers will only be used in the event of an emergency. Please complete the form below and return the completed copy with your registration packet. Thank you for your anticipated cooperation. Sincerely, PSC:jd Philip S. Cicero, Ed.D. 1/07 Superintendent of Schools I, grant do not grant permission for my emergency contact (print name) information to be released for phone chain purposes. (Child s name and grade) (Teacher) (Parent signature and date)

14 The University of the State of New York The State Education Department Office of Bilingual Education Albany, New York Home Language Questionnaire (HLQ) Dear Parent or Guardian: DISTRICT SCHOOL TO BE COMPLETED BY SCHOOL PERSONNEL Please print or type clearly GRADE In order to provide your child with the best possible education, we need to determine how well he or she understands, speaks, reads and writes English. Your assistance in answering these questions is greatly appreciated. Thank You STUDENT NAME DATE OF BIRTH Month: Day: Year: STUDENT IDENTIFICATION NUMBER COUNTRY OF BIRTH / ANCESTRY NUMBER OF YEARS ENROLLED IN SCHOOL OUTSIDE THE U.S. NAME/POSITION OF SCHOOL PERSONNEL COMPLETING THIS SECTION DETERMINATION: Possible LEP English Proficient ( boxes that apply) 1. What language(s) is spoken in the student s English Other home or residence? specify 2. What language(s) are spoken most of the time English Other to the student, in the home or residence? specify 3. What language(s) does the student understand? English Other specify 4. What language(s) does the student speak? English Other specify 5. What language(s) does the student read? English Other Does Not Read specify 6. What language(s) does the student write? English Other Does Not Write specify 7. In your opinion, how well does the student understand, speak, read and write English? Very well Only a little Not at all Understands English Speaks English Reads English Writes English Month: Day: Year: Signature of Parent/Guardian/Other Date HLQ (2/00) PM

15 Lynbrook Public Schools Agreement of Responsibilities for Safety over the Internet Please read, sign and return this Internet agreement to your teacher. I promise to my parents, my teacher, and myself that: I will not give out personal information such as my address, telephone number, parent s work address/telephone number and/or the name of my school without my parent s permission. I will tell my teacher and/or parent right away if I come across any information that makes me feel uncomfortable. I will not respond to any messages that are mean or in any way make me feel uncomfortable. I will only send messages in school as part of a class project. I will not sign-in at guest books I see on the Internet. I will talk with my parents so that we can set up rules for going online at home. We will decide upon what time of day that I can be online, the length of time I can be online, and the appropriate areas for me to visit. If a student fails to comply with the District s goals when using the Internet in the classroom, he/she will be subject to the appropriate disciplinary action as decided by the building principal. Student s Name (print) Student s Signature Date (Except for Kindergarten) Parent/Guardian s Name (print) Parent/Guardian s Signature Date Teacher s Name Student s Grade