Cold Springs School Early Childhood Registration Requirements **All registrations scheduled by appointment only**

Transcription

1 Cold Springs School Early Childhood Registration Requirements **All registrations scheduled by appointment only** Birth certificate (must be age 3 or 4 by September 30, 2014) Four proofs of residency o For ex: Mortgage, lease, certificate of occupancy, utility bill, drivers license, etc Physical examination for all NEW students (must have GCSD physical form) Immunization requirements for PreK Kindergarten o 4 DTP 5 DTP o 3 Polio / IPV / OPV 4 Polio / IPV o 3 Hepatitis B 3 Hep B o 1 MMR(after 1 st birthday) 2 MMR o 1 HIB (after 1 st birthday) 1 HIB o 1Varicella (after 1 st birthday) 1 Varicella o 1 Pneumococcal (after 1 st birthday) 1 Pneumococcal o 1 Influenza (between Sept 1-Dec 31) **Students must have all immunizations completed by the first day of school** *All children welcome (children in diapers or pull ups, special needs children). For more info regarding special needs children, please call * Please call Janice Kenney at ext to schedule an appointment MaryAnn T. Woodruff 1194 Market Street Gloucester, New Jersey Phone: x3279 Fax: Mawoodruff@gcsd.k12.nj.us

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5 New Jersey Department of Education Office of Early Childhood Education Preschool Program Uniform Preschool Enrollment Form English Only Version DIRECTIONS TO DISTRICT: The questions in this form must be administered annually to the parent or guardian of every child registering in the preschool program. Four-year-olds who were previously enrolled in the three-year-old program must have their information updated from the previous year. Districts are encouraged to incorporate the questions into existing registration forms and eliminate any items duplicated in identical form on existing forms, but please do not alter the questions, as the same questions must be asked in every district. Please interview the child s parent or guardian or have him/her complete a form to obtain responses to the following questions. Print legibly. Responding to the questions in this form is not required for a parent to register a child in the preschool program, except that a parent or guardian must provide proof of child age and residency. However, the parent or guardian should understand that his/her responses to these questions will be of great help to the district and the state in planning a program that meets the unique needs of his/her child. If the parent or guardian declines to respond to a question, leave the item blank and proceed to the next question. If the parent or guardian does not know the answer to a question but is willing to seek out the answer, allow him/her additional time to follow up with a correct response. Upon completion of the interview/form, administer or arrange for a time to administer the approved screening tool to the child. ABOUT THE CHILD 1. Last Name of Child *Required Field 2. First Name of Child *Required Field 3. Middle Name of Child If applicable. 4. Generation Code or Suffix If applicable, for example: Jr., Sr., III. 5. Address of Child *Required Field Street Apartment City, State, Zip G L O U C E S T E R N J Abbott Uniform Preschool Enrollment Form Final Draft Page 1 of 3

6 7. Identification Number of Child To be assigned by computer. 8. Birth Date of Child (Month/Day/Year) *Required Field What is the child s sex? Mark one box. Female Male 10. Is the child Spanish, Hispanic or Latino? Mark one or more groups to indicate the child s Spanish/Hispanic/Latino origin. No, not Spanish/Hispanic/Latino. Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, other Spanish/Hispanic/Latino (Print group.) 11. What is the child s race? Mark one or more races to indicate the child s race. White Black or African American American Indian or Alaska Native Asian or Pacific Islander Some other race (Print race.) 12. What language does the child speak most at home? Mark one box. English Spanish Arabic Chinese Creole (Haitian) Gujarati Korean Polish Portuguese Russian Urdu Some other language (Print language.) 13. Does the child have any chronic medical problems, special needs, or handicapping conditions? Mark one box. No Yes (Print problem or condition.) 14. Will the child be enrolling for the entire school day? Mark one box. A six-hour (minimum) program must be offered to every enrolling child. However, once a parent/guardian is made aware of its availability, he/she may opt out of it and choose a half-day program, if available. Yes, enrolling for the entire school day. No, enrolling for half day. Abbott Uniform Preschool Enrollment Form Final Draft Page 2 of 3

7 15. What kind of health insurance does the child have? Mark one box. Private or employment-based health insurance Medicaid New Jersey FamilyCare Some other health insurance Uninsured END OF FORM END OF FORM END OF FORM END OF FORM K:\Data\Needs Assessment\Uniform Preschool Enrollment Form v3 FINAL (English Only).doc Abbott Uniform Preschool Enrollment Form Final Draft Page 3 of 3

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