Rockdale ISD New Student Registration

Rockdale ISD New Student Registration Welcome to Rockdale ISD! This packet contains the following ROCKDALE ISD FORMS that need to be completed for your child s registration: Student Registration Form Home Language Survey TEA Ethnicity Race Survey TB Questionnaire Student Residency Questionnaire School Records Request Form, if needed Bus Request Form, if needed Rockdale ISD also needs the following DOCUMENTS on file for your student. Please bring these documents when you register your child. Student s Birth Certificate Student s Immunization Record Student s Social Security Card Proof of Residency Copy of Parent/Guardian ID Most recent Report Card/Transcript Custodial Protective Order, if applicable If you have any questions about Student Registration, please contact the registrar at the campus your child will be attending. Rockdale Elementary School (Grades PreK-2) Rockdale Intermediate School (Grades 3-5) 625 W Belton Rockdale, TX 76567 512-430-6030 ph 512-446-5229 fax 1338 W Hwy 79 Rockdale, TX 76567 512-430-6200 ph 512-446-3682 fax Registrar: Pat Voyles pvoyles@rockdaleisd.net Registrar: Kristi Moreland kmoreland@rockdaleisd.net Rockdale Junior High (Grades 6-8) Rockdale High School (Grades 9-12) 814 Bushdale Rockdale, TX 76567 512-430-6100 ph 512-446-2597 fax 500 Childress Rockdale, TX 76567 512-430-6140 ph 512-446-3512 fax Registrar: Gloria Zapata gzapata@rockdaleisd.net Registrar: Christy Betchan cbetchan@rockdaleisd.net New Student Registration Cover Letter

Student Registration Form Office Use only Student ID Campus Enrolled Grade Homeroom Teacher Enrollment Date Birth Cert Parent/Guard ID SS Card Report Card/Trans Immun Rec Legal Orders, if Proof of Res applicable Instructions: Complete all sections. Sign in both places on the back of the form and return to your child's school. Student Information: Last Name First Name Middle Name Grade Gender Birthdate Birth City, State and Country # of Years in US Schools Family 1 Information: Residence Address City State Zip Code Home Phone # Mailing Address (if different) City State Zip Code Family 1 Parent/Guardian Information: Parent/Guardian #1 Second Phone # (Work) Third Phone # (Cellular) Relationship Email Employer Parent/Guardian #2 Second Phone # (Work) Third Phone # (Cellular) Relationship Email Employer Family 2 Information (if necessary): Residence Address City State Zip Code Home Phone # Mailing Address (if different) City State Zip Code Family 2 Parent/Guardian Information (if necessary): Parent/Guardian #1 Second Phone # (Work) Third Phone # (Cellular) Relationship Email Employer Parent/Guardian #2 Second Phone # (Work) Third Phone # (Cellular) Relationship Email Employer Page 1 Student Registration Form

Emergency Contact Information: Please list at least 2 adults that we may contact if we are unable to reach you in the event of an emergency. Check YES or if they may pick up your child from school. Name Relationship First Phone Second Phone Pick Up YES Name Relationship First Phone Second Phone Pick Up Name Relationship First Phone Second Phone Pick Up Name Relationship First Phone Second Phone Pick Up Transportation to School Bus # (fill out Bus Request Form) Walk/Bike/Drive Parent Drop-off Transportation after School Bus # (fill out Bus Request Form) Walk/Bike/Drive Parent Drop-off YES Custodial Protective Order: If a family member or other individual is not allowed to have contact with the student, please include his/her name in this box and bring a copy of court orders to the school. Military Connected - Educational Opportunities for Military Students Please check box to indicate if child is a dependent member of: Active Duty: Army, Navy, Air Force, Marine Corps, or Coast Guard (This includes Missing in Action) Texas National Guard Reserve Duty: Army, Navy, Air Force, Marine Corps, or Coast Guard Foster Care Student is currently in the conservatorship of the Department of Family and Protective Services? You must provide a copy of the Texas DFPS Placement Authorization Form (Form 2085) or a court order that designates the student is in the conservatorship of the Department of Family and Protective Services. YES or Pre-Kindergarten students only Pre-Kindergarten student was previously in the conservatorship of the Department of Family and Protective Services. You must provide a copy of the Texas DFPS verification letter of PK eligibility. YES or Pre-Kindergarten student is a dependent of: Armed forces or reserved forces of the United States (Army, Navy, Air Force, Marine Corps, or Coast Guard) or Texas National Guard who has been injured or killed while on active duty. YES or RELEASES: Please circle YES or for each item below to provide your consent. If an item is not circled, it will be considered a YES. FIELD TRIPS: My child has permission to go on all scheduled field trips this year. CORPORAL PUNISHMENT: I grant permission for my child to receive Corporal Punishment as a discipline management technique, in accordance with Rockdale ISD School Board Policy FO (Legal) and (Local). In case of an emergency, if I cannot be reached, I authorize Rockdale ISD to refer my child to the emergency room. My child's information may be released to a military recruiter. (JH & HS only) My child's information may be released to higher education institutions. (JH & HS only) My child's directory information may be released to ALL outside public organizations. My child's directory information may be used in local, school-sponsored publications such as, but not limited to: extra-curricular activity publications, yearbook, newsletters, or public recognitions. Pictures or videos of my child or my child's work may be posted on the district website or district social media sites. My child's name and photo may be released to media outlets, including press releases. Example: The Rockdale Reporter or KRXT 98.5 ACCEPTABLE USE FOR TECHLOGY RESOURCES: My child and I have read, understand, and agree to abide by the Student Agreement for Acceptable Use of the District's Technology Resources + Addendum Addressing Student Use of Personal Telecommunications or Other Electronic Devices for Instructional Purposes While on Campus. Parent/Guardian Signature: Student Signature: HANDBOOK & CODE OF CONDUCT: I would like to receive my Student Handbook and Student Code of Conduct in the following manner (check one): ONLINE at www.rockdaleisd.net PAPER COPY HANDBOOK & CODE OF CONDUCT ACKWLEDGEMENT: My child and I have read, understand, and agree to abide by the Student Handbook and the Student Code of Conduct. Parent/Guardian Signature: Student Signature: Page 2 Student Registration Form

OFFICE USE ONLY Student: Gender: Grade: ID: Date Enrolled: Rockdale ISD Home Language Survey 19TAC Chapter 89, Subchapter 89.1215 To be completed by parent or guardian (or student if grades 9-12): The State of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public schools. This survey shall be kept in each student s permanent record folder. NAME OF STUDENT STUDENT ID ADDRESS PHONE STREET CAMPUS: ELEMENTARY CITY, STATE INTERMEDIATE JUNIOR HIGH HIGH SCHOOL 1. What language is spoken in your home most of the time? 2. What language does your child (do you) speak most of the time? PARENT SIGNATURE DATE STUDENT SIGNATURE (IF IN GRADES 9-12) DATE DEBE DE COMPLETARSE POR EL PADRE/MADRE/ O REPRESENTANTE LEGAL: (O POR EL ESTUDEIANTE SI ESTA EN LOS GRADOS 9-12): El estado de Texas require que la siguiente información se complete para cada estudiante que se matricula por primera vez en una escuela pública de Texas. Este cuestionario se archivará en el expediente del estudiante. MBRE DEL ESTUDIANTE # ID DIRECCION ESCUELA: TELEFO ELEMENTARY INTERMEDIATE JUNIOR HIGH HIGH SCHOOL 1. Qué idioma se habla en su hogar la mayoria del tiempo? 2. Qué idioma habla su hijo/a (usted) la mayoria del tiemp? Firma del Padre/Madre/o Representante Legal Fecha Firma del estudiante si está en los grados 9-12 Fecha 2010- Texas Education Agency Home Language Survey

Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student s or staff member s ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Not Hispanic/Latino Part 2. Race: What is the person s race? (Choose one or more) American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Student/Staff Name (please print) Student/Staff Identification Number (Parent/Guardian)/(Staff) Signature Date This space reserved for Local school observer upon completion and entering data in student software system, file this form in student s permanent folder. Ethnicity choose only one: Race choose one or more: American Indian or Alaska Native Hispanic / Latino Asian Black or African American Not Hispanic/Latino Native Hawaiian or Other Pacific Islander White Observer signature: Campus and Date: Texas Education Agency March 2010

OFFICE USE ONLY Student: Gender: Grade: ID: Date Enrolled: Rockdale ISD TB Questionnaire NAME OF CHILD DATE OF BIRTH Organization administering questionnaire: ROCKDALE ISD DATE Tuberculosis (TB) is a disease caused by TB germs and is usually transmitted by an adult person with active TB lung disease. It is spread to another person by coughing or sneezing TB germs into the air. These germs may be breathed in by the child. Adults who have active TB disease usually have many of the following symptoms: cough for more that two weeks duration, loss of appetite, weight loss of ten or more pounds over a short period of time, fever, chills and night sweats. A person can have TB germs in his or her body but not have active TB disease (this is called latent TB infection or LTBI). Tuberculosis is preventable and treatable. TB skin testing (often called the PPD or Mantoux test) is used to see if your child has been infected with TB germs. No vaccine is recommended for use in the United States to prevent tuberculosis. The skin test is not a vaccination against TB. We need your help to find out if your child has been exposed to tuberculosis. Place a mark in the appropriate box: Yes No Don't Know TB can cause fever of long duration, unexplained weight loss, a bad cough (lasting over two weeks), or coughing up blood. As far as you know: Has your child been around anyone with any of these symptoms or problems? Or Has your child had any of these symptoms or problems? Or Has your child been around anyone sick with TB? Was your child born in Mexico or any other country in Latin America, the Caribbean, Africa, Eastern Europe or Asia? Has your child traveled in the past year to Mexico or any other country in Latin America, the Caribbean, Africa, Eastern Europe or Asia for longer than 3 weeks? If so, specify which country/countries? To your knowledge, has your child spent time (longer than 3 weeks) with anyone who is/has been an intravenous (IV) drug user, HIV-infected, in jail or prison or recently came to the United States from another country? Has your child been tested for TB? Has your child ever had a positive TB skin test? YES (if yes, specify date / ) YES (if yes, specify date / ) For school/healthcare provider use only *************************************************************************************************** PPD administered YES If yes, Date administered Date read Result of PPD test Type of service provider (i.e. school, Health Steps, other clinics) mm response PPD provider SIGNATURE PRINTED NAME PROVIDER PHONE NUMBER PROVIDER CITY If positive, referral to healthcare provider If yes, name of provider COUNTY YES EF12-11494 TB Questionnaire for Children (Rev. 08/04) TB Questionnaire

ROCKDALE INDEPENDENT SCHOOL DISTRICT Student Residency Questionnaire Name of Campus Name of Student Sex: Male Last First Middle Female Birth Date / / Grade: Social Security #: Month Day Year (or student identification number) This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this residency information help determine the services the student may be eligible to receive.! Is your current address a temporary living arrangement? Yes No! Is this temporary living arrangement due to loss of housing or economic hardship? Yes No If you answered yes, how long have you been living in this arrangement: If you answered YES to the above questions, please complete the remainder of this form. If you answered, you may stop here. Where is the student presently living? (Check one box)! In the home of a friend or relative because I lost my housing (examples: fire, hurricane, flood, lost job, divorce, domestic violence, kicked out by parents, parent in military and was shipped out, parent(s) in jail, etc.)! In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violence shelter, children/youth shelter, FEMA housing)! Moving from place to place! In a hotel or motel (examples: because of economic hardship, eviction, cannot get deposits for permanent home, flood, fire, hurricane, etc.)! In a tent, car, van, abandoned building, on the streets, at a campground, in the park or other unsheltered location Name of Parent(s)/Legal Guardian(s) Address Zip Phone Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d). Signature of Parent/Legal Guardian Date Please send a copy to Allen Sanders, Community Relations Director. I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act. Date McKinney-Vento Liaison Signature July 2014 Form: Student Residency Questionnaire

ROCKDALE INDEPENDENT SCHOOL DISTRICT Cuestionario de Residencia para Estudiantes Nombre de la Escuela Nombre del Estudiante Sexo: Masculino Apellido Nombre Segundo Nombre Femenino Fecha de Nacimiento / / Edad: # de Seguo Social: Mes Dia Año (o número de indentificación escolar) El propósito de este cuestionario es presentar los objectivos del Acta McKinney-Vento (42 U.S.C.11435). Las respuestas a estas preguntas ayudarán determinar los servicios que el estudiate debe recibir. 1. Es su domicilio actual un arreglo de vivienda temporal (de poca duración)? Si No 2. Es este arreglo de vivienda temporal debido a la pérdida de su casa, vivienda o habitación, o debido a algún problema económico (ejemplo: desempleo)? Si No Si usted contestó SI a estas preguntas, por favor complete el resto de este formulario. Si usted contestó a estas preguntas, no siga. Dónde se encuentra viviendo el estudiante actualmente? (marque una opción.) En la casa de un amigo o pariente, porque perdí mi vivienda debido a (Ejemplos: huracán, indendio, inundación.perdida de trabajo, divorcio, violencia doméstica, corrido por los padres, padres en las furezas armadas y fueron asignados, padres en carcel, etc.) En un albergue porque no tengo vivienda permanente (ejemplos: viviendo en un alojamiento familiar, albergue de violencia doméstica, albergue de niños/jovenes, albergue de FEMA) Moviendo de un lugar a otro,. En hotel, motel (Ejemplos: por razones ecónomicas, evicción, no hay para hacer depósitosen una vivienda permanente, inundación, huracán, etc. En carpa, carro, camioneta, edificio abandonado, en la calle, en campamento, en el parqque, u otra ubicación sin protección. Nombre del Padre/Madre/Guardián Dirección Zona Postal Teléfono Presentar información falsa o la falsificación de documentos para uso escolar son ofensas bajo la Sección 37.10 del Código Penal, y la inscripción del estudiante usando documentos falsos traerá como consecuencia que los responsables estarán sujetos a pagar los gastos de instrucción u otros cargos. TEC Sec. 25.002(3)(d). Firma del Padre/Madre/Guardián Fecha Please send a copy to Allen Sanders, Community Relations Director. Yo certifico que el estudiate nombrado en este formulario califica para los programas de nutrición escolares bajo las provisiones del Acta McKinney-Vento Fecha Firma del oficial autorizado July 2014 Form: Student Residency Questionnaire

OFFICE USE ONLY Student: Gender: Grade: ID: Date Enrolled: Rockdale ISD School Records Request STUDENT LEGAL NAME LAST DATE OF BIRTH FIRST MIDDLE CURRENT GRADE MM/DD/YYYY PREVIOUS SCHOOL SCHOOL NAME SCHOOL PHONE CITY STATE SCHOOL FAX I hereby authorize you to release my child s school records to Rockdale Independent School District. I understand that any information you release will be confidential between the sending school and Rockdale Independent School District. PARENT SIGNATURE DATE TO THE PRINCIPAL OR DIRECTOR, The child listed above has applied for enrollment to: Rockdale Elementary School Pat Voyles pvoyles@rockdaleisd.net 512-430-6030 ph 512-446-5229 fax Rockdale Junior High Gloria Zapata gzapata@rockdaleisd.net 512-430-6100 ph 512-446-2597 fax Rockdale Intermediate School Kristi Moreland kmoreland@rockdaleisd.net 512-430-6200 ph 512-446-3682 fax Rockdale High School Christy Betchan cbetchan@rockdaleisd.net 512-430-6140 ph 512-446-3512 fax Please send the student s shot record, official transcript, including current school reports, last report card, standardized tests and any other relevant information including special services, attendance and discipline. If you have any questions regarding this request, please contact the above referenced school by email or phone. Thank you. Rockdale Independent School District PO Box 632 Rockdale, Texas 76567 512-430-6000 School Records Request Form

Form: Bus Request Form Student: Gender: Grade: ID: Rockdale ISD Bus Request Form Complete this form only if your child will ride a Rockdale ISD bus. CAMPUS: High School Junior High Intermediate STUDENT NAME GENDER ADDRESS PHONE Elementary M F GRADE PARENT PRIMARY PICK UP AND DROP OFF LOCATIONS Please include specific instructions here. PICK UP LOCATION DROP OFF LOCATION SIBLINGS, GRADE LEVELS Disciplinary policies and rules for buses will be provided to your child upon their first day on the bus. The student and parent MUST sign those rules. Failure to follow these rules and procedures can result in loss of bus riding privileges, as it is a privilege to ride Rockdale ISD buses. PARENT/GUARDIAN SIGNATURE DATE July 2014 Form: Bus Request Form