East Aurora School District 131

Transcription

1 East Aurora School District 131 Office of Centralized Registration Dear New District 131 Parent/Guardian, Welcome to Aurora East School District 131. Enclosed you will find your child s Registration Packet for the school year. Please complete all enclosed forms and return them to: Centralized Registration 231 E. Indian Trail, Aurora, IL Office hours: Monday Thursday from 8:30 a.m. to 3:30 p.m. No appointment necessary. Requirements for Enrolling a New Student Birth Certificate Original or certified copy (hospital copy will not be accepted) Driver s License or Photo ID Proof of Residency You must provide three (3) documents from the list below Title evidence, Mortgage Papers, or Lease Agreement Utility bill for Current Months: (i.e. Nicor Gas, Com Ed, Comcast, City Water) Medical Card with current address Green Card/Matriculate Card with current address Illinois State Board of Education Transfer Form This document must be provided by the previous school if transferring from a public school within the State of Illinois. Unofficial Transcript (High School Only)- This document must be provided by the previous school. State of Illinois Health Physical/Immunizations Exam, Dental & Vision Exams Health Physical/Immunizations Exam - All Preschool, Kindergarten, 6 th, 9 th grade students before entering their first day of school. Dental Exam - All Kindergarten, 2 nd and 6 th grade students. Visions/Eye Exam All Kindergarten and out of state students. Current IEP or any other Special Education records if student was receiving services at previous school (if applicable) Affidavit If you are not the student s parent or legal guardian and have assumed responsibility for a student for reasons other than access to the educational programs of the school district. Standard School Fees All school fees are collected at the attending school. Kindergarten Half-Day ($20) Elementary Grades 1-5 ($30) Middle School Students ($40 + $15 PE Uniform) High School Students ($50 + $4 for Student ID) Please feel free to contact the Centralized Registration Office with any questions at (630) Thank you, District 131 Centralized Registration SR36-E Rev. Jan 2014 Making Choices for Excellence

2 2014/2015 Student Enrollment Form FOR INTERNAL USE ONLY Registration flag created by : (initials) ID number: School attending: Grade: FOR KINDERGARTEN USE ONLY 1/2 day AM PM Full Day Date & time registration received : Student Information Last name: First name: Middle name: Suffix (Jr., Sr., I, II, III): Birth date: Birth Country: Birth City, State: Date entered U.S. (if applicable): Nickname: Mother's maiden name: Gender: Male Female Student School Enrollment Information Is the student new to District 131? Yes NO (Please indicate information below, regardless if student is new or returning to District 131) Name of the school last attended: Address: City: State: Phone number Last grade attended: Last date of enrollment: Services provided: Bilingual Speech Special Ed 504 plan Gifted Year of last evaluation: Date entered U.S. School: Student resides with: Parent/Guardian (student resides with) Date entered IL school: Parent/Guardian Primary Household Information Please note that all numbers you list for primary and secondary residences will receive an automated phone call from District 131's School Messenger System in the case of an emergency. Both parents Mother only Father only Legal guardian Self (if 18 and over) Mother/Stepfather Father/Stepmother Foster parent Home address: Home number: City: State: Zip: Parent/Guardian (student resides with) Order of contact (circle one): Order of contact (circle one): Name Relationship to student Cell number Daytime work number Name Relationship to student Cell number Daytime work number English Spanish other (specify: ) English Spanish other (specify: )

3 Parent/Guardian Secondary Household Information Parent/Guardian (student DOES NOT reside with) Parent/Guardian (student DOES NOT reside with) Order of contact (circle one): Order of contact (circle one): Name Name Relationship to student Relationship to student Address Address City State Cell number Daytime work number English Spanish other (specify: ) City State Cell number Daytime work number English Spanish other (specify: ) Order of contact (circle one): Order of contact (circle one): Name Name Relationship to student Home number Cell Number Daytime Work Number English Spanish other (specify: ) Emergency Contact(s) The emergency contact should be a local person who can be contacted to assume responsibility for your child if the school is unable to contact a parent/guardian. Relationship to student Home Cell Number Daytime Work Number English Spanish other (specify: ) Siblings (residing in primary household and attending District 131) Siblings (NOT residing in primary household and attending District 131) Military: Part A: Is either parent/guardian in the armed forces: Yes No If yes, answer Part B Part B: Is either parent/guardian currently deployed to active duty or will be in the next 12 months? Yes No SR2-E Rev. 2/14 ALL INFORMATION ON THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE Signature of Parent/Guardian Date KNOWINGLY FALSIFYING ANY INFORMATION ON THIS FORM IS A CLASS C MISDEMEANOR

4 U.S. Department of Education Race and Ethnicity Data Standards Student s Name: SIS ID: 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? 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 the student s race to be. Part B. What is the student s race? Choose one or more American Indian/Alaska Native A person having family origins from: o Mexico o Puerto Rico o South America o Central America o North America o Tribal Affiliation Asian A person having family origins from: o Far East o Asia/India o Cambodia, Philippines, Pakistan o China, Japan, Korea, Thailand, Vietnam Black/African-American A person having family origins from: o Black racial groups of Africa Hawaii Native/Pacific Islander A person having family origins from: o Hawaii o Guam o Samoa o Pacific Islands White A person having family origins from: o Europe o Middle East/North Africa SR8-E, Rev. Feb 2014

5 AURORA EAST SCHOOL DISTRICT Student s Name School/Grade Authorization for Field Trips Today s classrooms extend beyond the physical limits of a room or even a building. Teachers recognize the values of taking school children on field trips or excursions. Among other educational benefits, children get to see and hear things which cannot be brought into the classroom On some field trips, children take school buses. On others, they walk or use other means of transportation. If you sign in the space below, your child will be allowed to join in these field trips during the current school year. However, he/she will still be given information to take home before each field trip by note, by a school s monthly calendar, or by some other means to let you know the place to be visited and the date of the field trip. At that time, you may refuse to give your permission for your child to go on this specific field trip. You should know that the School District is not necessarily responsible for every injury sustained by a pupil. I have read the foregoing information and consent to my child s being taken on field trips during the school year and give my permission for my child to receive emergency medical treatment in the event I cannot be reached. Signature of Parent/Guardian X Date Authorization for Emergency Medical Treatment I, as parent or legal guardian of Student whose name is listed on this page hereby authorize and consent to emergency medical treatment for my child. Specifically, I authorize the School District s employees and agents to administer any emergency medical treatment that is necessary for the health and welfare of my child, and/or to arrange for emergency medical treatment by a health care provider. In addition, I authorize the health care provider to provide emergency treatment that he/she deems appropriate to treat any injury sustained by my child. I agree to hold harmless and indemnify East Aurora School District No. 131, its Board of Education, and the Board s members, employees and agents, from and against any and all claims, demands, injuries, damages or causes of action, including reasonable attorneys fees and costs in the defense thereof, resulting from or arising out of the provision of emergency medical treatment by school personnel or a health care provider. Signature of Parent/Guardian X Date Authorization to Release Health Records to District I hereby authorize my child s health care provider and previous school to release my child s most recent physical and immunization information to Aurora East School District 131 for completion of student health records. This authorization is valid while the student is enrolled in Aurora East School District 131. Signature of Parent/Guardian X Date Pesticide Notification Request The Aurora East School 131 practices Integrated Pest Management, a program that combines preventive techniques, non-chemical pest control methods, and the appropriate use of pesticides with a preference for products that are the least harmful to human health and the environment. The term pesticide includes insecticides, herbicides, rodenticides, and fungicides. If you have any questions or comments, please contact, Director of Buildings and Grounds, at The school district is establishing a registry of people who wish to be notified PRIOR to pesticide applications. To be included in the registry, please check the box, YES. No, I do NOT need to be notified before the use of pesticides at the school. Yes, I would like to be notified two days before the use of pesticides at the school. I understand that if there is an immediate threat to health or property that requires treatment before notification can be sent out, I will receive notification as soon as practical. Signature of Parent/Guardian Date SR16-E. Rev. Mar. 2013

6 East Aurora School District 131 Centralized Registration Office 231 E. Indian Trail Aurora, IL Phone: (630) Website: MEDIA PERMISSION FORM Student name (Print): Student ID #: East Aurora School District 131 draws its strength from the citizens who live and work in the District. The quality of school programs depends on the public understanding what is happening in their schools. East Aurora School District 131 is proud to highlight the accomplishments, daily work and extracurricular achievements of our students in various internal and external publications. Sharing school news benefits the students, staff, school, the District and our community. Accordingly, from time to time, your student s name or picture may appear in various publications, including: newsletters, newspapers, Web sites, communications to parents, textbooks or videos. The District also issues positive news releases and distributes photos to outside media outlets, which may want to interview, photograph or videotape students under the supervision of District personnel. YES, my student s name or photo may be published. NO, my student s name or photo may not be published. (Requesting to be excluded from any of the above will NOT exclude the publishing of your students name and picture in a yearbook or class photo.) Parent signature Date Failure to complete this form could require a District employee to contact you each time your student s name or photo might be published. The District does not control the publication of students names or photos in public areas, including outside of schools, Board of Education meetings, extracurricular activities or other areas populated by the general public. SR17-Eng Rev February 2014 Making Choices for Excellence

7 Aurora East School District #131 STUDENT/PARENT AGREEMENT AND PERMISSION FOR INTERNET ACCESS STUDENT AND PARENT SIGNATURE FORM We have read this Agreement and Permission for Internet Access. All use of the Internet must be consistent with the District's goal of promoting educational excellence by facilitating resource sharing, innovation, and communication. This Agreement/Permission does not attempt to state all required or proscribed behavior by users. However, some specific examples are provided. Students will be subject to loss of privileges, disciplinary action, and/or appropriate legal action for any violation of this Agreement or Board Policy 645/645-R, or for any inappropriate use of the Internet or network. The signatures below are legally binding and indicate that the student and the student's parent/guardian have read this Agreement carefully and understand its significance. We understand and will abide by the Agreement and Permission for Internet Access. We further understand that if the student commits any violation, the student's access privileges may be revoked, and the student will be subject to disciplinary action and/or appropriate legal action. In consideration for using the District's Internet connection and having access to public networks, we hereby release the School District and its Board members, employees, and agents from any claims and damages arising from use of, or inability to use, the Internet. We understand that access is designed for educational purposes. Even though the School District provides and operates a technology protection measure (filtering) with respect to any of its computers with Internet access, we recognize that it is impossible to fully eliminate or restrict access to all controversial or inappropriate material. We also understand that the District cannot guarantee that "filtering" software will be totally effective or that a student will not have access to materials that may be defamatory, inaccurate, offensive, or otherwise inappropriate in the school setting. We will hold harmless the District, its employees, agents, and Board members, for any harm caused by materials or software obtained via the network. I accept full responsibility for supervision if and when my child's use is not in a school setting. The undersigned have discussed the terms of this Agreement/Permission. Please check only one choice. STUDENT ID # We hereby request that the student be allowed access to the District's Internet. We do not wish the student to have access to the District s Internet DATE: PARENT/GUARDIAN NAME (Please Print): PARENT/GUARDIAN SIGNATURE: STUDENT NAME (Please Print): STUDENT SIGNATURE: Students will not be allowed to use the District's internet until a signed permission form is given to school. SR20-E, Revised Jan, 2012

8 Aurora East Schools District 131 School Service Center 417 Fifth Street Aurora, Illinois Telephone (630) Fax (630) OFFICE USE ONLY School Language Code Data Secretaries Initials Home Language Survey The Illinois School Code requires that each school district administers a Home Language Survey to every student entering the district s schools. This information is used to report to the state the number of students whose families speak a language other than English. It also helps to identify the need for English Language Learning services in the schools. Your cooperation in helping us meet this important legal requirement is appreciated. Student Name Country of Birth Grade Birthdate 1. Does anyone living in your home speak a language other than English? Yes No If yes, what language? 2. Does your child speak a language other than English? Yes No If yes, what language? 3. Has your child ever been in a Bilingual or ELL/ESL program? Yes No If yes, what grade(s)? Where (school/city)? Parent/Guardian Signature Phone Number Date Encuesta sobre idioma en casa El código escolar de Illinois requiere que cada distrito escolar administre una encuesta sobre idiomas en casa a cada estudiante que ingrese a las escuelas del distrito. Esta información se utiliza para reportar al estado el número de estudiantes cuyas familias hablan otro idioma además del inglés. También ayuda a identificar la necesidad para los servicios de aprendizaje del idioma inglés en las escuelas. Se agradece su cooperación en ayudarnos a cumplir con este importante requisito legal. Nombre del estudiante: País de nacimiento: Grado: Fecha de nacimiento: 1. Alguien en su casa habla otro idioma que no sea el inglés? Sí No Si es así, qué idioma? 2. Su hijo(a) puede hablar otro idioma que no sea el inglés? Sí No Si es así, qué idioma? 3. Ha estado su hijo(a) en algún programa bilingüe o ELL/ESL? Sí No Si es así, qué grado(s)? Dónde (escuela/ciudad)? Firma del padre/tutor Número de teléfono Fecha SR33 Eng/Span 3/2013 BIL

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10 Dear Parents or Guardians: AURORA EAST SCHOOL DISTRICT 131 ANNUAL STUDENT HEALTH INFORMATION SURVEY To help meet your child s health needs in school, we are asking that you complete the information requested below and return this form to the school. Please call the School Health Office if you have any questions. This form must be completed each school year. Thank you for your cooperation. Name Male Female Date of birth Attending School Grade Student ID Please answer all health/medical questions to the best of your knowledge. (Please circle yes or no) 1. Does / should your child wear glasses? YES NO 2. Have a history of hearing problems? YES NO 3. Does your child wear contact lenses? YES NO 4. Hearing aids YES NO 5. Does your child have any of the following conditions? (Please circle yes or no) Asthma YES or NO Heart Problems YES or NO Diabetes YES or NO Urinary YES or NO Stomach YES or NO Seizure Disorder YES or NO ADHD/ADD YES or NO Migraine YES or NO Orthopedic YES or NO 6. Does your child have any allergies? *If NO proceed to question 7 *If YES refer to the list below and circle all that apply Bee sting breathing problems rash itching swelling - all over the body or sting site only Peanut breathing problems rash itching swelling - all over the body or only the face Latex breathing problems rash itching swelling - all over the body or only the face Foods (List food) breathing problems rash itching swelling - all over the body or only the face Medicines (List meds.) breathing problems rash itching swelling - all over the body or only the face Environmental (List) breathing problems rash itching swelling - all over the body or only the face Animals (List) breathing problems rash itching swelling - all over the body or only the face *How do you treat your child s allergy symptoms? Epi Pen YES or NO Oral medications 7. Is your child currently under medical treatment/care for a long term or chronic issue? YES or NO *If yes please explain 8. Doctor s Name Phone number 9. Does your child have any special needs or necessary precautions while in school? YES or NO *If yes please explain 10. Does your child take any medications? YES or NO *If Yes how often are they given? Daily or as needed Reason for medication(s) Name of medication(s) Dosage Time(s) of day Will medications be needed at school? YES or NO *If yes, please see the school Nurse to get the appropriate school form. HEALTH INFORMATION MAY BE SHARED WITH APPROPRIATE SCHOOL PERSONNEL. Parent / Guardian Signature Relationship to Student Date Home address Primary phone number SR12-E, Feb 2014

11 DISTRITO ESCOLAR 131 DEL ESTE DE AURORA ENCUESTA ANUAL INFORMATIVA SOBRE LA SALUD DEL ESTUDIANTE Estimados padres o tutores: Para ayudar a cumplir las necesidades sobre salud de su hijo(a) en la escuela, le pedimos que complete la información solicitada a continuación y regrese este formulario a la escuela. Si tiene cualesquier preguntas, por favor comuníquese a la oficina escolar de salud. Nombre Masculino Femenino Fecha de nacimiento Escuela Grado Numero del estudiante Este formulario debe completarse cada año escolar. Muchas gracias por su cooperación. 1. Su hijo(a) usa/debe usar lentes? SÍ NO 2. Tiene antecedente de problemas auditivos? SÍ NO 3 Su hijo(a) usa lentes de contacto? SÍ NO 4. Audífonos SÍ NO 5. Su hijo(a) tiene alguna de las siguientes condiciones: (Por favor, indique sí o no). Asma SÍ NO Problemas cardíacos SÍ NO Diabetes SÍ NO Urinaria SÍ NO Estómago SÍ NO Trastorno de convulsiones SÍ NO TDAH ó TDA* SÍ NO Migraña SÍ NO Ortopédico SÍ NO *Trastorno por déficit de atención con hiperactividad (ADHD)/Trastorno por déficit de atención (ADD). 6. Su hijo(a) tiene alergias? *Si NO proceder a la pregunta 7 *Si (Consulte la siguiente lista. Por favor, indique todas las que apliquen). Picadura de abeja problemas respiratorios erupción comezón hinchazón -en todo el cuerpo/lugar del piquete Cacahuate problemas respiratorios erupción comezón hinchazón -en todo el cuerpo/lugar del piquete Látex problemas respiratorios erupción comezón hinchazón -en todo el cuerpo/lugar del piquete Alimentos (mencione el alimento) problemas respiratorios erupción comezón hinchazón-en todo el cuerpo/lugar del Medicamentos (mencione medicamentos) problemas respiratorios erupción comezón hinchazón-en todo el cuerpo/lugar Ambiente (mencione)_ problemas respiratorios erupción comezón hinchazón-en todo el cuerpo/lugar del piquete Animales (mencione) problemas respiratorios erupción comezón hinchazón -en todo el cuerpo/lugar del piquete * Qué medidas toma para tratar los síntomas de alergia de su hijo(a)? Auto inyector de epinefrina SÍ NO medicamentos orales 7. Su hijo(a) actualmente está bajo tratamiento/cuidado médico por un problema a largo plazo o crónico? SÍ NO Si es así, cuál es la razón? 8. Nombre del médico Número telefónico 9. Su hijo(a) tiene necesidades especiales o precauciones necesarias durante su estancia en la escuela? SÍ NO Describa 10. Su hijo(a) toma cualquier medicamento? SÍ NO Frecuencia de administrar diario o según sea necesario Razón del medicamento(s) Nombre del medicamento(s) Dosis Veces al día Los medicamentos serán necesarios en la escuela? Si es así, por favor visite a la enfermera de la escuela para completar el formulario escolar adecuado. LA INFORMACIÓNN SOBRE SALUD PUEDE SER COMPARTIDA CON EL PEROSNAL ESCOLAR ADECUADO Firma del padre/tutor Parentesco Fecha Domicilio Número telefónico SR12-S Feb 2014