Forms and checklists are available online at ENROLLMENT TIMEFRAME & DEADLINES. Dear Prospective JRCES Parent/Guardian:
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1 Enrollment Dear Prospective JRCES Parent/Guardian: John Rex Charter Elementary School (JRCES) is a tuition-free public charter school that opened in August, Our mission is to offer quality educational opportunities to children in the heart of downtown Oklahoma City through an innovative public-private partnership. John Rex Charter Elementary School has a four-tiered priority system for enrollment: 1) 2) 3) 4) First, any child residing within the attendance boundaries for JRCES. Residency verification is required at time of application and annually thereafter*; Second, a child who resides outside the JRCES attendance boundaries but within the boundaries of OKC Public Schools. Residency verification is required at time of application and annually thereafter*; Third, a child who resides outside the boundaries of OKC Public Schools and whose parent, guardian, or other person with legal custody is employed within the JRCES attendance boundaries. Employment verification letters must be provided at time of application and annually thereafter*. An out-of-district transfer is required upon admission; Fourth, a child who resides outside the boundaries of OKC Public Schools and whose parent, guardian, or other person with legal custody is not employed within the JRCES attendance boundaries. An out-of-district transfer is required upon admission. Residency verification is required at time of application and annually thereafter*; st th We are very pleased that you are selecting JRCES as your school of choice! Pre-K, Kindergarten, and 1-5 grades will be offered during the school year. Tier 1 residents may enroll at any time. For those in Tiers 2-4 that have been offered a seat at John Rex, completed enrollment forms and required supporting documentation must be submitted no later than April 14, 2017 at 2:00PM, or the seat is forfeited. After Tier 1, enrollment priority is given to currently enrolled students, a legal sibling of a child currently enrolled in the School, and a child of a person directly providing educational services for the school (i.e. children of faculty/staff members employed by JRCES). Within Tier #2, additional priority will be given to applications for admission whose parent, guardian, or other person with legal custody is employed within the JRCES attendance boundaries. If, at any time, the number of eligible students applying for admission exceeds the capacity of the school/grade level, the Head of School will conduct a lottery, which shall be held within the priority level and/or grade level that is oversubscribed, to select the student(s) that may be admitted to JRCES. Enrollment and admission decisions will be based on school capacity limitations, class/grade capacity limitations, program availability, and/or educational needs of the student. *ADDITIONAL DOCUMENTATION REQUIRED: Students initially enrolling at JRCES in and in subsequent years that wish to retain their seat at JRCES, must annually complete an Intent to Re-Enroll form each spring, remain in good standing, and provide appropriate documentation to re-verify residency. Student information will be updated & siblings will be identified/enrolled. Each family must provide one of the following documents: o Proof of residency in JRCES Attendance Zone; or o Proof of residency in OKCPS School District; or o Proof of employment in JRCES Attendance Zone If a student is not able to provide these documents and they wish to continue to attend JRCES, they will be required to re-enter the lottery for their grade level. ENROLLMENT TIMEFRAME & DEADLINES On-going February 27, 2017 March 10, 2017 April 1, 2017 April 3, 2017 April 14, Any resident of our attendance zone (Tier 1) may enroll at any time -Window opens for new student applications (Tiers 2-4) -Window closes for new student applications (Tiers 2-4) at 2:00PM -Lottery notification for applications from Tiers 2-4 only -Students from Tiers 2-4 selected for enrollment may begin submitting all required items during the hours of: Monday-Friday 10:00AM-2:00PM & Thursday 4:00-5:30PM -Deadline for Tiers 2-4 only: Enrollment must be completed by 2:00PM or seat is forfeited Forms and checklists are available online at
2 JOHN REX CHARTER ELEMENTARY SCHOOL ENROLLMENT FORM OFFICE USE ONLY: Received by Date: o Verified Address and Tier # o Verified Employer (if applicable) Student enrollment forms are very important for your family and for John Rex School. The information you provide allows us to: ü Distribute important school information to you including your student s academic progress reports and attendance information. ü Respond appropriately in the event of a medical situation involving your student. ü Contact you or others if there is a school emergency. Information from enrollment forms also supports students academic success by allowing the school to: ü Help your student receive support such as language services. ü Seek grants or donations to strengthen classroom instruction. ü Evaluate our work on behalf of student groups (racial/ethnic, socioeconomic, etc.). ü Ensure that we are in compliance with civil rights laws regarding students and staff. Instructions: The enrollment form is a required official record. The questions on this form ask for information that will help us provide services for your student. If you need help filling out this form, please contact us. Please complete all pages, print them, then sign & date the last page. If any information should change during the school year, notify the school immediately. Student Information: Grade Entering Legal Last Name Preferred Last Name Priority Level: q1 q2 q3 q4 Employed in Attendance Zone? qyes qno Legal Preferred _ Legal Middle Gender qfemale qmale Date of Birth: / / 20 Place of Birth: City State ZIP Country Family Primary Phone # (Note: Family phone number will be used for attendance and emergency notifications) Primary Phone # ( ) Residence Address Apt. # City, OK ZIP Neighborhood School: (List, even if you do not attend this neighborhood school) Student resides primarily with: **Custodial Parent: **Important Legal Information: A legal document must be provided to the school in advance to prevent a non-custodial parent from having access to a student at school. Documentation must be kept up to date. School records may be provided to the non-custodial parent upon request, unless the school is in possession of a legal document prohibiting the non-custodial parent from receiving such records. Upon enrollment, federal and state regulations require us to gather the following information for statistical reports. If you need more information, the school can help. Ethnicity Hispanic/Latino? qyes qno **Note: Both Ethnicity and Race must be selected Race select at least one: qamerican Indian or Alaska Native qasian qblack qnative Hawaiian or Other Pacific Islander qwhite
3 Parent Information: Contact phone numbers and addresses will be used to distribute important school information. Parent/Guardian: qmother qfather qguardian qother Legal Legal First Name Living with student? qyes qno Permission to pick up? qyes qno Same as Student Address qyes qno Address (if different than above) Apt. # City State ZIP Primary Phone No. ( ) Secondary Phone No. ( ) Work Phone No. ( ) Address Employer: Address: In our attendance zone? qyes qno Parent/Guardian: qmother qfather qguardian qother (Employment verification may be required) Legal Legal First Name Living with student? qyes qno Permission to pick up? qyes qno Same as Student Address qyes qno Address (if different than above) Apt. # City State ZIP Primary Phone No. ( ) Secondary Phone No. ( ) Work Phone No. ( ) Address Employer: Address: In our attendance zone? qyes qno (Employment verification may be required) Additional Emergency Contacts: In an emergency, the parent/guardian(s) listed above will be called first. By listing a name or names in this section as an emergency contact, you are authorizing those people to pick up your student at school if you cannot be reached.
4 Program Information: In order to best serve the needs of your child, please answer the following: Does your child currently receive any special education services? qyes qno If yes, briefly explain: Type of special education program/supports: Type of service(s): (e.g. Speech OT, PT, other) Has your child been evaluated by an outside/private agency? qyes qno If yes, briefly explain: Does your child receive any services from an outside/private agency? qyes qno If yes, briefly explain: Does your student have a current Individualized Education Plan (IEP)? qyes qno If yes, attach a copy of your student s most recent IEP. If no, does your child have an expired IEP? qyes qno If no, is your child currently being evaluated for eligibility for an IEP? qyes qno Does your student have a current Section 504 Plan? qyes qno If no, is your child currently being evaluated for a 504 Plan? qyes qno Has your student already been evaluated/qualified for a Gifted & Talented program? qyes qno Previous School(s) Attended: Last School Attended: School District: School Phone #: ( ) Years Attended: to Previous School Attended: School District: School Phone #: ( ) Years Attended: to Previous School Attended: School District: School Phone #: ( ) Years Attended: to Is your child currently under suspension from any school or school district? qyes qno If yes, explain: At any time, has your child ever been suspended or expelled from any school or district? qyes qno If yes, explain: Has your child ever been advanced (skipped) a grade? qyes qno Which grade and why? Has your child ever been retained (repeated) in a grade? qyes qno Which grade and why? Has a school ever recommended retention for your child? qyes qno Which grade and why? Student Medical Information: School staff needs to know if your student has a medical condition for which he/she may require assistance during the school day. Remember to advise the school of any changes in information. Doctor s Name (optional) Dentist s Name (optional) Preferred Hospital Phone No. (optional) ( ) Phone No. (optional) ( ) Phone No. (optional) ( ) Emergency Medical Services Authority (EMSA) makes the final decision for site of best available care when serious illness, accident or other emergency event directs need for transporting to a hospital. If possible, the school will advise EMSA of your hospital preference. Insurance Carrier (optional) Last physical exam date (optional) Please check any current medical conditions: qserious Allergies (List:) Life Threatening? qyes qno qdiabetes qtype I qtype II qasthma qheart Disease qseizure Disorder qother special health needs at school: Medications to be taken at school: (You MUST also complete an Authorization for Medication form) List:
5 Title X McKinney-Vento Program: This program guarantees that students, no matter their living situation, have access to public education, including transportation to and from school. A school representative will be in touch if you check a box. qyou are staying in a motel, car or campsite until you can find affordable housing qyou are sharing housing with another family due to economic hardship qyour child is living with a relative, friend or anyone other than his/her biological parents qyou are living in a shelter, temporary housing or moving from place to place without permanent housing qyou are experiencing housing difficulties related to finances and would like to be contacted about services. Language Information: Does your family need an interpreter for school meetings? qyes qno If yes, please indicate language: Other: Briefly state why you wish to have your child attend John W. Rex Charter Elementary School: Sibling Information: List all siblings, even in enrolled at another school Name Age/DOB School Attending Grade Affirmations & Authorizations: X INITIAL CHARTER SCHOOL: I understand that by enrolling my child, I am waiving my right to attend the local/non-charter public school. X INITIAL MISSION: I understand and agree to support the mission statement of JRCES To offer quality educational opportunities to children in the heart of downtown Oklahoma City through an innovative public-private partnership. I also agree to support the Head of School and other faculty members in accomplishing this mission. X INITIAL TRANSPORTATION: I understand that JRCES does not provide transportation services for students to and/or from school. I further understand that it is my responsibility to provide or arrange for transportation for my child to and/or from school each day. I will comply with state compulsory attendance laws. JRCES will work through transportation issues and needs with families on a case-by-case basis. X INITIAL ATTENDANCE & UNIFORM DRESS CODE: I understand the JRCES school hours and that attendance & punctuality are very important. I pledge to be punctual, maintain good attendance, and comply with the uniform dress code. Failure to maintain satisfactory attendance, punctuality, and/or dress in accordance to the Uniform Policy may result in revocation of a transfer, if applicable, or other disciplinary actions. X INITIAL DISCIPLINE & EXPECTATIONS: I acknowledge that my child will follow the JRCES Code of Conduct & Expectations as well as the Leveled Discipline Plan. To maintain a climate conducive to learning, each child is responsible for his/her own behavior and learning. Complying with the school rules is mandatory. Failure to do so may result in revocation of transfer, if applicable, or other disciplinary actions. X INITIAL LEGAL DOCUMENTATION: I understand that, to the extent possible, copies of any legal documentation related to my child must be provided to the school and must be kept up to date. The school must have documentation on file to prevent a non-custodial parent from having access to a student at school. Additionally, school records may be provided to the non-custodial parent upon request, unless the school is in possession of a legal document prohibiting the non-custodial parent from receiving such educational records.
6 Enrollment Declaration: I hereby certify I am the parent and legal guardian of, or have obtained legal guardianship through the courts for, (Student s Name). I also certify that all the information I provided in this enrollment packet is current and accurate. I certify that any false information, omissions, or misrepresentations of facts may result in rejection of this enrollment packet, revocation of a transfer, or dismissal of the enrollee. I shall submit proof of legal guardianship and/or other necessary requested documentation to complete the enrollment. Failure to do so will result in my child s enrollment being ineligible. Signature of Parent/Legal Guardian: Date: Signature of Parent/Legal Guardian: Date: John W. Rex Charter Elementary School a launch pad for learning & discovery
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