Cresskill Public Schools Registration Packet Kindergarten Only a parent or *guardian may register a student for the Cresskill Public Schools. Children must be 5 years of age on or before October 1 st to enter kindergarten and 6 years of age by October 1 st to enter first grade from a private school. Registration Information: Mrs. Debra Brody (201) 227-7791 Ext. 1038 e-mail: dbrody@cboek12.org Registration Hours: Registration Location: Monday Friday 8:00 am-11:30 am 1:00 pm-3:00 pm Please call for an appointment Cresskill High School Guidance Office One Lincoln Drive, Cresskill, NJ 07626 Elementary Schools Edward H. Bryan School 51 Brookside Avenue Cresskill, NJ 07626 (201) 569-1191 Grades: Pre-K 5 Merritt Memorial School Dogwood Lane Cresskill, NJ 07626 (201) 569-8381 Grades: Pre-K 5 Secondary Schools Cresskill Middle /High Schools One Lincoln Drive Cresskill, NJ 07626 (201) 227-7791 Middle School Grades 6-8 High School Grades 9-12 Middle School/High School Guidance Office: (201) 567-9805 *Guardian An adult who has assumed financial and legal responsibility for a minor child. The Guardian must provide notarized guardianship papers.
Cresskill Public Schools Registration Form School (for office use only): EHB MMS CMS CHS Today s Date: / / Entry Date: / / STUDENT INFORMATION Last Name: First Name: Middle Initial: Nickname (optional): Gender: Male Female Home Address: If renting, date lease expires: / / Home Phone: ( ) Date Of Birth (MM/DD/YYYY): / / Age: Birth City/State/Country: Citizenship: Ethnicity: White African-American Hispanic American Indian/Alaskan Asian Hawaiian Native/Other Pacific Islander US Entry Date (if student was born outside the US): / / First Entry Date US School ((if student was born outside the US): / / Student s Primary Language (first or native language spoken): Home Language (language spoken most frequently at home): Name Of Last School Of Attendance: Entering Grade: State ID # (from previous NJ public school-10 digits) Student s E-Mail Address (CMS/CHS only): Revised 2011 Page 1 of 4 pages
FAMILY INFORMATION Primary Email Address (Parent Portal) Parent/Guardian #1 Relationship to student: Mother Father Legal Guardian Last Name First Name Middle Name Title Mailing Address Primary/Home Telephone Cell Phone Email address Employer Work Telephone Living Deceased Resides with student Separated Divorced Remarried Contact legally not allowed Receives school communication Parent/Guardian #2 Relationship to student: Mother Father Legal Guardian Last Name First Name Middle Name Title Mailing Address Primary/Home Telephone Cell Phone Email address Employer Work Telephone Living Deceased Resides with student Separated Divorced Remarried Contact legally not allowed Receives school communication Step-Parent/Guardian Relationship to student: Mother Father Legal Guardian Last Name First Name Middle Name Title Mailing Address Primary/Home Telephone Cell Phone Email address Employer Work Telephone Living Deceased Resides with student Separated Divorced Remarried Contact legally not allowed Receives school communication Revised 2011 Page 2 of 4 pages
OTHER THAN PARENT EMERGENCY CONTACT INFORMATION Contact Relationship Contact Name Contact Number E-Mail Address Other children in family: Name: Birth Date: Name: Birth Date: Name: Birth Date: Revised 2011 Page 3 of 4 pages
HEALTH INFORMATION Medical alerts or allergies: Yes No Receives daily medication during school hours: Yes No If yes, what medication? Wears glasses or contact lenses: Yes No Health Care Provider Information Contact Contact name Contact phone number Hospital Doctor Dentist Does your child have health care coverage? Yes No If yes, name of provider: Please sign here to indicate that we have your permission to call the above contacts when you are not available or in an emergency. Signature Date I give the school nurse permission to release and exchange pertinent medical information to all appropriate school staff members. I do consent I do not consent Signature Date NJ FamilyCare provides free or low cost health insurance for uninsured children and certain low income parents. For more information call 800-701-0710 or visit www. Njfamilycare.org. Yes, you may release my name and address to NJ FamilyCare program to contact me about health insurance. No, do not release my name and address to NJ FamilyCare to contact me about health insurance. Signature Date Revised 2011 Page 4 of 4 pages
NEW STUDENT ENROLLMENT - STUDENT RECORDS FORM (Please send records to the school checked below) Merritt Memorial School Edward H. Bryan School One Dogwood Lane 51 Brookside Avenue Cresskill, NJ 07626 Cresskill, NJ 07626 Voice: 201-569-8381 Voice: 201-569-1191 Fax: 201-569-3862 Fax: 201-569-3367 Authorization to release Student Records to: Merritt Memorial School Edward H. Bryan School I authorize the school district named below to release the records of the student whose name appears on this release. Name of School Student Last Attended or Currently Attends Address Tele. # ( City State Zip Code ) STUDENT Last Name First Name Address Current Grade Telephone Number Date of Birth Date of Request Forwarding Address Street City State Zip Code Records Authorized for Release: Academic Records Testing Records Health Records Attendance Records All of the above Individual Student Improvement Plan Reports Regarding I.E.P. Remediation Supportive Services Curriculum Guide Signature of Parent/Guardian Signature of Student (if 18 years or older)
CRESSKILL PUBLIC SCHOOLS One Lincoln Drive Cresskill, NJ 07626 (201) 227-7791, Fax: (201) 567-7976 CERTIFICATE OF RESIDENCY This form must be notarized by a Notary Public This Registration Form is submitted for the purpose of inducing the Cresskill Board of Education to accept my/our child/children as a student in the Cresskill Public Schools on a tuition-free basis. I/We state that the information contained in this Form is true and accurate and acknowledge the Cresskill Board of Education s reliance upon the truthfulness and accuracy of this information. If any of the statements contained in this Registration Form are willfully false, I/we are aware that I/we are subject to the criminal penalties provided by law for perjury and/or false swearing, and I/we will be personally liable for the payment of tuition for the child retroactive for the period of ineligible attendance of said child/children in the Cresskill Public Schools as well as any related costs and/or fees, including attorneys fees, incurred as a result of such ineligible attendance. Signature of Applicant(s): Date: Signature of Applicant(s): Date: SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF NAME OF OFFICIAL ADMINISTERING OATH TITLE OF OFFICIAL The Cresskill Schools will utilize the core curriculum content standards to promote academic excellence and foster self-esteem in a dynamic, caring environment and will prepare students to be life-long learners and contributors in an evolving and ever-changing world.
REGISTRATION PROCEDURES 1. Only a parent or guardian* may register a student in the Cresskill Pubic Schools. Children must be five (5) years of age on or before October 1 st to enter kindergarten, and six (6) years of age by October 1 st to enter first grade from a private school. Guardianship papers must be submitted to the Cresskill School District, Superintendent s Office. 2. The District shall accept a combination of documentation from a parent or guardian* attempting to demonstrate a student s eligibility for enrollment in the District. Your child will be enrolled only if, at the time of registration, the totality of information and documentation offered demonstrates the student s eligibility to attend school in the District. The District requires the following list of documents as documentation. The District will not require disclosure of any of these documents as a condition of enrollment, and all eligible students will be admitted into the District provided that the documentation submitted is sufficient to demonstrate residency. Proof of residency is required to enroll in the Cresskill Schools Deed or original lease Photo identification, such as driver s license with Cresskill address on it or passport Two (2) utility bills (example: Orange and Rockland Electric, PSE&G, Cablevision) Proof of Child s Date of Birth (1 document is required) Original or certified copy of Birth Certificate Passport 3. Certificate of Residency Form 4. Original Immunization Records. Students entering Cresskill from outside the U.S. must submit data using the district s immunization form, complete and signed by a physician. 5. Most Recent Physical Exam 6. Transfer Card from the student s school of last attendance (excluding kindergarten) 7. Recent report cards and grades (excluding kindergarten). 8. For child(ren) of future residents, parent/guardian must provide: Deed, certificate of occupancy, closing date from attorney, or rental contract indicating approximate date of occupancy for primary residence. Copy of divorce or custodial papers, if applicable, to indicate which parent has primary or residential custody. Tuition rates may apply. Please refer to Non-Resident Tuition Contract attached. Note: Tuition rates may be subject to change. * A child may only be enrolled in the District by an individual who is not his/her parent or legal guardian if that child is an affidavit student and he/she is seeking to attend school in the District pursuant to N.J.S.A. 18A:38-1(b) and N.J.A.C. 6A:22-3.1(a)2.
Cresskill Public Schools One Lincoln Drive, Cresskill, NJ 07626 Phone: (201-227-7791) Fax: (201) 567-7976 REGISTRATION MATERIALS PRELIMINARY INFORMATION: PLEASE READ BEFORE PROCEEDING The questions asked in the following pages will enable us to determine your student s eligibility to attend school in this district in accordance with New Jersey law. Please be aware that N.J.S.A. 18A:38-1 and N.J.A.C. 6A:22 specify that a free public education will be provided to any student between the ages of 5 and 20, and to certain students under 5 and over 20 as specified in other applicable law, who are: Domiciled in the district, i.e., living with a parent or guardian whose permanent home is located within the district. A home is permanent when the parent or guardian intends to return to it when absent and has no present intent of moving from it, notwithstanding the existence of homes or residences elsewhere. Living with a person, other than the parent or guardian, who is domiciled in the district and 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 domiciled in the district, other than the parent or guardian, where the parent/guardian is a member of the New Jersey National Guard or the reserve component of the U.S. armed forces and has been ordered into active military service in the U.S. armed forces in time of war or national emergency. Living with a parent or guardian who is temporarily residing in the district. The child of a parent or guardian who moves to another district as the result of being homeless. Placed in the home of a district resident by court order pursuant to N.J.S.A. 18A:38-2. The child of a parent or guardian who previously resided in the district but is a member of the New Jersey National Guard or the United States reserves and has been ordered to active service in time of war or national emergency pursuant to N.J.S.A. 18A:38-3(b). Residing on federal property within the State pursuant to N.J.S.A. 18A:38-7.7 et seq. Note that the following do not affect a student s eligibility to enroll in school: Physical condition of housing or compliance with local housing ordinances or terms of lease. Immigration/visa status, except for students holding or seeking a visa (F-1) issued specifically for the purpose of limited study on a tuition basis in a United States public secondary school. Absence of a certified copy of birth certificate or other proof of a student s identity, although these must be provided within 30 days of initial enrollment, pursuant to N.J.S.A. 18A: 36-25.1. Absence of student medical information, although actual attendance at school may be deferred as necessary in compliance with rules regarding immunization of students, N.J.A.C. 8:57-4.1 et seq. {F&H00089867.DOC/1} 1
Cresskill Public Schools One Lincoln Drive, Cresskill, NJ 07626 Phone: (201-227-7791) Fax: (201) 567-7976 Absence of a student s prior educational record, although the initial educational placement of the student may be subject to revision upon receipt of records or further assessment by the district. The following forms of documentation may demonstrate a student s eligibility for enrollment in the district. Particular documentation necessary to demonstrate eligibility under specific provisions in law will be indicated in the appropriate section of the registration form. Property tax bills, deeds, contracts of sale, leases, mortgages, signed letters from landlords and other evidence of property ownership, tenancy or residency. Voter registrations, licenses, permits, financial account information, utility bills, delivery receipts, and other evidence of personal attachment to a particular location. Court orders, State agency agreements and other evidence of court or agency placements or directives. Receipts, bills, cancelled checks and other evidence of expenditures demonstrating personal attachment to a particular location, or, where applicable, to support of the student. Medical reports, counselor or social worker assessments, employment documents, benefit statements, and other evidence of circumstances demonstrating, where applicable, family or economic hardship, or temporary residency. Affidavits, certifications and sworn attestations pertaining to statutory criteria for school attendance, from the parent, legal guardian, person keeping an affidavit student, adult student, person(s) with whom a family is living, or others, as appropriate. Documents pertaining to military status and assignment. Any business record or document issued by a governmental entity. Any other form of documentation relevant to demonstrating entitlement to attend school. The totality of information and documentation you offer will be considered in evaluating an application, and, unless expressly required by law, the student will not be denied enrollment based on your inability to provide certain form(s) of documentation where other acceptable evidence is presented. You will not be asked for any information or document protected from disclosure by law, or pertaining to criteria which are not legitimate bases for determining eligibility to attend school. You may voluntarily disclose any document or information you believe will help establish that the student meets the requirements of law for entitlement to attend school in the district, but we may not, directly or indirectly, require or request: Income tax returns; Documentation or information relating to citizenship or immigration/visa status, unless the student holds or is applying for an F-1 visa; {F&H00089867.DOC/1} 2
Cresskill Public Schools One Lincoln Drive, Cresskill, NJ 07626 Phone: (201-227-7791) Fax: (201) 567-7976 Documentation or information relating to compliance with local housing ordinances or conditions of tenancy; Social security numbers. Please be aware that any determination of the student s eligibility to attend school in this district is subject to more thorough review and subsequent re-evaluation, and that tuition may be assessed in the event that an initially admitted student is found ineligible. If your student is found ineligible, now or later, you will be provided the reasons for our decision and instructions on how to appeal. If you experience difficulties with the enrollment process, please see the Superintendent of Schools, Cresskill Board of Education, One Lincoln Drive, Cresskill, NJ 07626, 201-227-7791. {F&H00089867.DOC/1} 3
CRESSKILL BOARD OF EDUCATION 1 LINCOLN DRIVE CRESSKILL, NJ 07626 Dear Parent/Guardian, On behalf of the staff and administration, we would like to welcome you and your child to the Cresskill school district. Coming to a new school is such an exciting time for your child to explore, learn, and socialize with other children. Our staff wishes to make your child s transition to school a pleasant and positive experience. To help achieve this goal, we are requesting that you complete the attached questionnaires and return them to your school nurse with your child s medical information. The social history and pertinent medical information will be shared with the teachers so they may better meet your child s individual needs. Enclosed you will also find a packet of information necessary for enrollment into school. The registration packet contains information regarding the New Jersey Department of Health immunization and Mantoux TB test requirements for school attendance. The New Jersey Department of Health and Senior Services requires that a medical exam be completed no more than 365 days prior to entry and must state what, if any, modifications are required for full participation in the school program. Please ask your physician to complete the medical form including immunization data and return it to your school nurse NO LATER THAN JUNE 1 ST. You must speak to the school nurse prior to June 1 st if extenuating circumstances prevents you from meeting this deadline. Feel free to contact your child s school nurse if you have any questions or concerns. We are looking forward to working with you and your children. Sincerely, Merritt Memorial School Nurse 201-569-8381 ext. 3037 Edward H. Bryan School School Nurse 201-569-1191 ext. 2038
HOW THE NEW IMMUNIZATION LAW AFFECTS YOU WHO IS COVERED BY THE IMMUNIZATION REGULATIONS? Children over one year of age now attending school, as well as those about to enroll in any public or private school in New Jersey are covered by these regulations. The definition of school includes child care centers, nursery schools and kindergartens as well as elementary, intermediate and high schools. WHAT DO THE REGULATIONS REQUIRE? The regulations require the parent or guardian of every pupil to submit acceptable evidence to school authorities indicating that the required immunization shots have been received. Acceptable evidence generally means any immunization record from a physician, public health department or school provided the record includes the date when each immunization was given. Question: My child s pediatrician advised us against completing the DTP series due to her history of convulsions. Will she be forced to receive them now? Answer: No! The regulations exempt children who have a bona fide medical reason for avoiding certain vaccines. You will be required, however, to obtain a medical contradiction form from your doctor stating which immunization(s) should not be given as well as the doctor s reasons and the period of time this exemption shall remain in effect. Question: My son and I are members of a religious organization whose basic tenants oppose the practice of immunizations/tb testing. Will he be kept out of school for failing to comply with these required shots? Answer: No! If you sign and submit a written statement requesting an exemption on the grounds that receiving any immunizations will interfere with the free exercise of your child s religious rights, you will exempt him from all immunization/tb requirements. This exemption, however, may be suspended during an emergency as determined by the State Commissioner of Health. (Forms to be used in requesting exemptions are available from local schools and health departments.) Question: My child has started his immunizations but will not be able to complete all of them by the time school begins. Will my child be permitted to attend school? Answer: Yes! If a physician or health department indicates that your child has begun the required immunization and is in the process of complying with all immunization requirements, your child can be admitted to school on a provisional or temporary basis. Provisional admittance forms can be obtained from school and local health departments and must be signed by both the parent and the physician. The provisional admission can be extended up to one year, but most children will be expected to have completed all the requirements within 90 days. COUNTRIES WITH AN INCIDENCE OF TB INSUFFICIENT TO REQUIRE MANTOUX TUBERCULIN SKIN TESTING AS A REQUIREMENT FOR SCHOOL ENTRY IN NEW JERSEY Antigua and Barbuda Australia Austria Barbados Belgium Bermuda Canada Cayman Islands Cuba Cyprus Czech Republic Denmark Finland France Germany Greenland Grenada Iceland Ireland Israel Italy Jamaica Jordan Lebanon Luxembourg Malta Monaco Montserrat Netherlands Netherlands Antilles New Zealand Norway Oman Puerto Rico Saint Kitts and Nevis San Marino Sweden Switzerland Trinidad and Tobago United Kingdom of Great Britain and Northern Ireland United States of America United States of Virgin Islands Students entering a U.S. school for the first time in New Jersey or transferring into a New Jersey school from ANY country NOT listed above must be Mantoux tuberculin skin tested unless they meet an exemption criterion.
Chris Christie, Governor Kim Guadagno, Lt. Governor State of New Jersey OFFERED BY THE STATE OF NEW JERSEY NJ FamilyCare is publicly funded health insurance for NJ residents. It provides free or low cost quality health care. Beginning January 2014, the NJ FamilyCare program will include CHIP, Medicaid and Medicaid expansion populations. What s Covered? NJ FamilyCare offers full health care coverage through health plans contracted by the state. NJ FamilyCare covers most health care needs including: doctor visits x-rays eyeglasses prescriptions hospitalization mental health services lab tests dental specialist visits Who is Eligible: Qualified NJ residents of any age can be eligible for NJ FamilyCare. This includes children, parents, caretaker relatives, and adults without dependent children. Eligibility is based on the income and household size that was reported on applicant s latest federal tax return. However, NJ FamilyCare can use other sources, such as pay stubs, to verify information. Income eligibility for children is higher than income eligibility for adults. (See chart) What Does it Cost? For many people, NJ FamilyCare will cost nothing: no monthly premiums or co-payments. New Maximum Household Income as of Oct. 1, 2013 Please review the chart. It is based on the family size and income reported on your latest federal tax return. Family Size and Monthly Income Reported on your Federal Taxes Family Children s Coverage Adult s Coverage Size* (Age 18 and younger) (Age 19 and older) 1 $3,352 $1,274 2 $4,524 $1,720 3 $5,697 $2,165 4 $6,869 $2,611 5 $8,042 $3,056 6** $9,214 $3,502 * Includes parents/caretaker relatives and their children in the household. **For larger families, call to determine your monthly guidelines For higher income families with children there is a sliding scale for co-payment s and monthly premiums. Are There Any Restrictions? Pre-existing conditions do not affect eligibility. In most cases, children must be without medical insurance for at least 3 months to qualify. Because there are exceptions, it is a good idea to call NJ FamilyCare in case you have a question. Adults must have legal permanent resident status for at least five years to be eligible. For undocumented residents, their children may be eligible if born in the U.S. How to Find Out More? To find out if you are eligible, or for more information, call or visit our website. 1-800-701-0710 (Multilingual operators available) www.njfamilycare.org Apply online! TTY 1-800-701-0720 (For hearing impaired individuals) NJFC-FS-0913
CRESSKILL PUBLIC SCHOOLS Kindergarten Medical History Child s Name Nickname (Child to be called) Address Home Phone Date of Birth Male Female Mother s Name Cell Phone Father s Name Cell Phone Pediatrician Phone Address Nursery School (Name and address) Dates Attended Length of Sessions Siblings: Name Age Name Age Name Age FAMILY MEDICAL HISTORY Please indicate family member: Seizure Disorder Diabetes Scoliosis Cardiac/Hypertension Other CHILD S BIRTH HISTORY Hospital/Facility Address Child s Birth Weight Birth Defects (if any)
Other noteworthy information Motor Development Crawls Walks Speech Approximate Age Illness or Injury (Hospitalization Reasons and dates) Accidents (broken bones, sprains, sutures, etc.) Known Allergies Foods (List) Medication required Explain Asthma Medication required Explain Bee Sting Medication required Explain HEALTH HISTORY Has your child had any of the following? Please supply dates. Bronchitis Fever greater than 104 degrees Strep Throat Convulsions/Seizures Sinus Infection Eye Function Glasses Other Ear Problems Frequent Infections Other Is there any other medical information you would like to supply to enable us to better service your child s medical needs?
CRESSKILL PUBLIC SCHOOLS BOARD OF EDUCATION POLICIES ACKNOWLEDGEMENT PAGE Edward H. Bryan School/Merritt Memorial School Student s Name Student s Grade Parent s Signature Date: I hereby acknowledge reading and understanding, and agree to comply with the following Board of Education policies posted on the Cresskill Public Schools (http://www.cboek12.org) website. 1. Computer Internet Acceptable Use Policy 2. Substance Abuse & Co-Curricular Policy 3. Harassment, Intimidation and Bullying Policy 4. Cyber-Bullying Policy Please read the student handbook posted on the website of each Cresskill public school for other rules and regulations.
CRESSKILL PUBLIC SCHOOLS One Lincoln Drive Cresskill, NJ 07626 (201) 227-7791, Fax: (201) 567-7976 We are requesting permission for your child in the two areas below. 1. Your child may be included in photographs/videos of school activities. These pictures may then be sent to our district or town newsletter or to the local press. 2. Your child may be asked to accompany his/her class on a walking trip in the neighborhood. We would like your permission to include your child in this activity. Any trip the class takes will be with appropriate adult supervision and the children will always return to the school before dismissal. Your response to these activities will remain in effect while your son/daughter attends the Cresskill schools. To change either of these, the office must be notified in writing. Thank you for your cooperation. PERMISSION FOR PHOTOGRAPHS/VIDEOS & TAKE A WALKING TRIP I give my child who attends Edward H. Bryan Merritt Memorial Middle School High School Permission to: be photographed/video and take a walking trip (please check). I understand that these pictures may be published in local publications. No names will be printed. Parent Signature: Date: The Cresskill Schools will utilize the core curriculum content standards to promote academic excellence and foster self-esteem in a dynamic, caring environment and will prepare students to be life-long learners and contributors in an evolving and ever-changing world.