YADKIN COUNTY SCHOOLS

Transcription

1 YADKIN COUNTY SCHOOLS Handbook Acknowledgment Form To Whom It May Concern: I have read the Yadkin County Schools Student/Parent Handbook and understand the rules and regulations stated therein. If I have a question or concern, I am encouraged to speak with the principal, or designee, of my student s school for clarification. Student Name (please print) Homeroom Teacher Parent Signature Student Signature 94

2 Yadkin County Schools Transportation Department School Bus Request and Deletion Form Please check one box below. Bus Stop Request Bus Stop Deletion School and Code Students Full Name (please print) Grade Students 911 Address (house #) (street name) Mailing Address (if different than above) City State Zip Home Phone Transportation Address A.M. (house #) Transportation Address P.M. (house #) (street name) (street name) Must have correct Transportation Address to provide transportation services. Please indicate reason for the change in transportation. Requestor s Signature OFFICE USE ONLY It is a State Law that this information be reported to the Transportation Office within 10 school days from the date of change. Please provide the Assistant Principal, Bus Coordinator, Power School data managers and bus drivers with a copy of this information. This will keep everyone well informed of the change being made with the bus routes for each school. Thank you. Bus # A.M. Assistant Principal/Bus Coordinator Signature Power School Data Manager Signature Bus Driver Signature TIMS Data Manager Signature Transportation Director Signature Bus # P.M. Stop # Run # Route # 95

3 SCHOOL Yadkin County Schools Student Information Sheet School Year: HOMEROOM _ STUDENTS WILL ONLY BE DISMISSED TO PERSONS ON THIS SHEET. This information is very important in the event your child becomes sick or is injured at school. If this information should change during the school year please notify the school as soon as possible. CUSTODAY PAPERS (circle one): YES NO *If circled yes, please provide a current copy to the school each year. STUDENT of Birth M F First Middle Last 911 Home Address Mailing Address City, State, ZIP Home Phone Father Cell Mother Cell Parent Address Student Address FEDERAL LAW NOW MANDATES THAT BOTH OF THESE QUESTIONS BE ANSWERED ABOUT THE ETHNICITY AND RACE OF EACH STUDENT. Questions may be addressed at NORTH CAROLINA DEPARTMENT OF PUBLIC INSTRUCTION S WEBSITE: Ethnicity: Hispanic Not Hispanic/Latino Race: White Black American Indian/Alaskan Native Asian Native Hawaiian/Pacific Language: English Spanish Other, please list FATHER Address (if different from child) MOTHER Address (if different from child) Employer Daytime Phone Employer Daytime Phone Other/Relationship Other/Relationship Employer Daytime Phone Employer Daytime Phone Student resides with (circle one): Both Parents Mother Only Father Only Mother/Stepfather Father/Stepmother Grandparents Guardian EMERGENCY CONTACTS: Please list three relatives/friends/neighbors that have permission to pick up, assume responsibility and temporary care of your child in the event he/she becomes sick and YOU cannot be reached. List others on the back of sheet if necessary. Name Daytime Phone Cell Phone Relationship Name Daytime Phone Cell Phone Relationship Name Daytime Phone Cell Phone Relationship Please list other children in the family: (List others on back of sheet if necessary.). Name Age Grade School Child Attends Name Age Grade School Child Attends Name Age Grade School Child Attends Physician s Name Phone Number Insurance Co. Policy No. DOES YOUR CHILD HAVE SPECIAL MEDICAL NEEDS? DOES YOUR CHILD HAVE ALLERGIES? (Please circle): YES NO If yes, please list: ex: Bee Stings, Drug, Peanuts Bus # AM PM Car Rider Permission to Walk Signature of Parent / Guardian: Office use / new enrollment: Previous School: : 96

4 Parent/Student Refusal Form for Military Information Requests (High School Students Only) Unless you request otherwise, your student s high school is required by federal law to give your student s name, address, and phone number to any military recruiter who asks. Any parent, or any student over the age of 18, may request that student s information NOT be released to military recruiters unless you formally consent. If you do not make this request, release of the information is automatic when military recruiters ask. Please sign below and return the form to your student s school, if you wish to require parental approval for release of your student s information to military recruiters. Parental permission is not required for any student over the age of 18. Students Under the Age of 18 School: Please DO NOT release my student s information to military recruiters unless I (parents) am contacted and provide written permission. Student s Name: Student Signature: Parent Name (print): Parent Signature: Students Over the Age of 18 Please DO NOT release my information to military recruiters unless I consent. I am 18 years old or older. Student Name (print): School: Student Signature: Parent/Student Refusal Form for Colleges/Universities/Potential Employers Information Requests (High School Students Only) Colleges, universities and potential employers may request directory information, such as name, address, and phone number from high schools for recruiting purposes. Students and parents may ask that your information NOT be released to college/university recruiters or to potential employers. If you do not make this request, release of the requested information is automatic when college/university recruiters or potential employers ask. Please sign below and return the form to your school if you wish to opt out of releasing directory information to colleges, universities and potential employers. Students Under the Age of 18 School: Please DO NOT release my student s information to college and universities recruiters or potential employers unless I (parents) am contacted and provide written permission. Student s Name: Student Signature: Parent Name (print): Parent Signature: Students Over the Age of 18 Please DO NOT release my information to college and universities recruiters or potential employers unless I consent. I am 18 years old or older. Student Name (print): School: Student Signature: (Reference Handbook, page 19, Family Educational Rights and Privacy Act) 97

5 YADKIN COUNTY SCHOOLS MEDICATION AUTHORIZATION FORM SCHOOL: HOMEROOM: GRADE: School Year: Dear Parent/Guardian: We attempt to discourage administration of medication in the schools. However, if your physician decides it is necessary for your child to receive medication during the school day, we must have an authorization and specific instructions from your child s physician. Please take this medication form to your physician and have the instructions recorded regarding the administration of your child s medication. Per Yadkin County Schools Medication Policy this includes prescription and over-the counter medications. Name Medication (include trade name) PHYSICIAN S INSTRUCTIONS FOR GIVING MEDICATION IN SCHOOL Birth date Dosage Medication to be Given (Circle) Tablet Ointment Capsule Inhalation Liquid or Other Relationship to Meals (Circle) Before After Does not matter How often or at what time? Side Effects Contraindications for administration Student allergies Physician s Signature Address Telephone Number Parental Permission I give permission for the exchange of information (verbal, written or faxed) between the above named health care provider and Yadkin County Schools School Nurses, as needed. I understand that this information will remain confidential. I request and give permission for the school to administer the above medication prescribed by my child s physician to be given during the school hours. I hereby release the Yadkin County School Board and their agents and employees from any and all liability that may result from the administration of the above medication. I agree to bring and or send the medication in a properly labeled container from the pharmacy. Signature Phone Number (Parent or Guardian) Section for SELF-ADMINISTRATION only PHYSICIAN, PLEASE COMPLETE AND SIGN The above named student has been diagnosed with asthma, anaphylaxis or diabetes and has demonstrated proper technique and understands the use of MDI (*Metered Dose Inhaler) MDI with spacer Epi-Pen or Insulin/Glucagon. This student may carry and selfadminister this medication for asthma or allergic reaction or diabetes. *Parent/guardian should provide an extra inhaler be kept at school in case of emergency. Physician s Signature I agree and feel competent to take my own medication as prescribed. I will not at any time, share my medication with another student and I will keep it secure from other students. Student s signature 98

6 Annual Notification of Pest Management Program Dear Parent, Guardian, or Staff Member: This notice is being distributed to comply with the North Carolina School Children s Health Act. Yadkin County Schools has adopted an Integrated Pest Management (IPM) Policy to comply with this law. IPM is a holistic, preventive approach to managing pests that minimizes pesticide use in our schools and on school grounds. IPM is explained further in the school's Pest Management Policy, a copy of which is included with this notice. The IPM Coordinator for our school district is: Name: Michael Pardue Title: Safety,Energy,IPM Coordinator Phone number: (336) address: Michael.pardue@yadkin.k12.nc.us Office address 300 N. Lee Ave., Yadkinville, NC The IPM Coordinator maintains the pesticide product label and the Material Safety Data Sheet (MSDS) of each pesticide product that may be used on school property. The label and the MSDS are available for review upon request by a parent, guardian, staff member, or student attending the school. Also, the IPM Coordinator is available to help answer any questions you might have about the school system s pest management program and pesticide use decisions. Notification of Pesticide Use: Our school system may find it necessary to use pesticides to control pests at your school or other school system site. North Carolina state law gives you the right to be notified annually of our school system s pesticide application schedule, and 72 hours in advance of pesticide applications made outside that schedule, but the latter only if you request notification ahead of time using the enclosed form. Exemptions: Certain relatively low-risk pesticides are exempted from these notification requirements, including antimicrobial cleansers, disinfectants, self-contained baits and crack-and-crevice treatments, and any pesticide products classified by the US Environmental Protection Agency (EPA) as belonging to the US EPA s Toxicity Class IV, relatively nontoxic. Your right to be notified extends to all non-exempt pesticide applications at your school or other non-school site (office building, garage, workshop, etc.), both indoor and outdoor pesticide applications, and including applications that take place over summer recess, holidays, weekends, or after school hours. Emergency Pesticide Use: In the event that a non-exempt pesticide must be used for a pest control emergency at your school or other site and there is not adequate time to notify you more than 72 hours in advance, and you have requested advance notice, you will receive a notice of emergency pesticide application less than 72 hours before, or as soon as possible after the pesticide application. To request advanced notification of non-exempt pesticide applications at your school or other site, please return the enclosed form to 300 N. Lee Ave, Yadkinville, NC ATTN. Michael Pardue. 99

7 Request for Notification before Non-Exempt Pesticide Applications Dear IPM Coordinator, Yadkin County Schools, I am writing to request notification in advance of non-exempt pesticide applications at my child s school, and/or at the school or other site where I am employed by the school district, as per my legal right under the NC School Children s Health Act. I understand that I can request 72 hour advanced notification for pesticide applications that are not already listed on the school district s annual schedule, if it has one. If there is an annual schedule of pesticide applications for my school site, it has been sent to me, and I can view it at any time by contacting IPM coordinator. I also understand that notification requirements apply to all non-exempt pesticide applications at the relevant school or other non-school site (office building, garage, workshop, etc.), both indoor and outdoor pesticide applications, and including applications planned for summer recess, holidays, weekends, or after school. Pesticide products exempt from notification requirements include: antimicrobial cleansers, disinfectants, self-contained baits and crack-and-crevice treatments, and any pesticide products classified by the United State Environmental Protection Agency (EPA) as belonging to the US EPA Toxicity Class IV, relatively nontoxic. In addition, I understand that should a pest control emergency require a pesticide application for which there is not adequate time to notify me 72 hours in advance, I will receive a notice of emergency pesticide use less than 72 hours, or as soon as possible after, the emergency pesticide application. I am requesting notification of pesticide use in the following schools or other sites: 1) Name of Student or Employee: School or other site, homeroom or office number: 2) Name of Student or Employee: School or other site, homeroom or office number: I would like my primary notification method to be (please check one): ( ) Mail. Mailing address: ( ) Phone. Home phone: Work Mobile ( ) . address: In case of a problem with my primary notification method, I would like my back up notification method to be (please write in back up info below: Back up Information: I understand that it is my responsibility to maintain communication through the means I have designated above, and that the school is required to try to contact me only once about a pesticide application. If I do not receive the notification because I have not updated my mailing address; my voic or answering machine are full or not functioning; or because my account is not functioning, over quota, or notification from the school is auto-filtered as spam; it is my responsibility to correct the problem. Though they will attempt to alert me to the issue, the school system is not liable. Sincerely, Full Name (please print): Signature: : School Grade Student Last Name (print) 100

8 Student Last Name First Name School Grade Technology Responsible Use The aim of the Technology Responsible Use is to ensure that students will benefit from learning opportunities offered by the school s Internet resources in a safe and effective manner. Internet use and access is considered a school resource and privilege. At no time should there be any expectation of privacy when using school resources or on school grounds when accessing the web or utilizing your account. Policies are available on the county website under the District tab or upon request written copies can be provided. Policies include but are not limited to the following: Policy 3220-Technology in the Education Program Policy 3225/4312/7320-Technology Responsible Use Policy 3226-Internet Safety Policy 3227-Web Page Development Policy 3220 Copyright Policy 1710/4021/7230 Prohibition Against Discrimination, Harassment and Bullying School Strategies: The school employs a number of strategies and has expectations for students when using the school internet and equipment. General Internet sessions within the classroom are supervised by a teacher. Students will use a variety of internet tools to enhance their learning experience. All tools are examined by experienced educators and are used commonly in education today. Filtering software and or equivalent systems will be used in order to minimize the risk of exposure to inappropriate material. However, no filter is 100% effective. The school monitors student internet use in the classroom. Students and teachers are provided with internet safety training on a yearly basis. Students will use the internet for educational purposes. Students should not disclose or publish personal information such as address, social security number etc.. Students will treat others with respect at all times and will not take any actions that may disrupt the school day. Cyber bullying on/against anyone while using school resources or tools will be subject to school discipline. Students should not send or receive any information that is considered illegal, obscene or defamatory. accounts will be established for all students, the main function will be for sharing assignments with teachers, collaboration and for accessing their google account for chromebooks. Students will not tamper with computer hardware or software. Unauthorized entry into computers and/or vandalism to computer equipment or files will result in criminal charges. Students may be given opportunities to publish projects, artwork or school work on the World Wide Web. 101

9 Student and Parent Agreement I have read the Yadkin County Schools Technology Responsible Use and the related policies listed above and understand my responsibilities. I understand access is intended for educational purposes and that student users will be provided with supervision in using it in the classroom. I understand the school system makes a reasonable effort to filter internet access, but the school system cannot control the internet or the information found on it. I understand there is no expectation of privacy when using the school provided , equipment or infrastructure. Student Signature Parent Signature Photographs, Artwork, Videos and Audio Material Please Check One YES I do grant permission for photographs, artwork, videos and audio materials of my child or produced by my child to be used in the newspaper; on television; Yadkin County School Websites; or for other educational purposes (such as assessment) to promote our school and/or student achievement. NO I do NOT grant permission for photographs, artwork, videos and audio materials of my child or produced by my child to be used in the newspaper; on television; Yadkin County School Websites; or for other educational purposes (such as assessment) to promote our school and/or student achievement. Parent Signature Creative thinkers today, innovative leaders tomorrow Revised 2015/

10 Yadkin County Schools Learn Today, Lead Tomorrow Policy 4150 Yadkin County Schools Request for Student Reassignment One copy of this form must be completed for each student and submitted to the Office of the Superintendent, Yadkin County Schools, 121 Washington Street, Yadkinville, NC by June 1. This form must be completed in accordance with timelines specified in Policy In applying for a student transfer, please read all requirements outlined in Policy ************************************************************************************************** I. GENERAL INFORMATION Application for student reassignment must be made each school year. Student: Parents/Guardian: Age: Grade Entering: Telephone: Address: City: State: Zip: Identify School District Residence Location: School Currently Attending: Names of siblings attending Yadkin County Schools ************************************************************************************************************ II. TYPE OF REASSIGNMENT REQUESTED. Please complete all information on your chosen type of reassignment. In-County Reassignment. Note: Principals signatures of approval are required. From: To: School Principal s Signature Has student previously been reassigned outside their attendance area? Yes or No If yes, From: School To: School Release from Yadkin County Schools to School System. (Signature Required You may skip Sections 3, 4, 5 and 6; this form does not need to be notarized) Admission to Yadkin County Schools From: To: School Principal s Signature (Please attach copy of release from system where student is legally domiciled.) Tuition fee must be paid at time of application. Is student currently under suspension from another school? Yes No Has student ever been convicted of a felony in any state? Yes No NOTE: Denial by the Board of a request for admission on a non-domiciliary student to Yadkin County Schools may not be appealed to the Board. ************************************************************************************************************ III. REASON(S) FOR REQUEST: Please check all applicable reasons. Medical hardship, including physical or mental disabilities. (Complete V) Parents or legal guardians are full time/permanent employees of the Yadkin County Board of Education. Documented proof of hardship circumstances resulting in the need for the student to attend another school. (Complete V) Child care for a student not yet entering 9th grade if the working hours of the parents are such that if the pupil is not reassigned, the pupil would be unsupervised either before or after school hours. (Complete VI) Please explain reason(s) for this request on the form below, complete Part V or Part VI on the next page if required, and attach supporting documentation. Note: Previously reassigned requests are not a valid reason for student reassignment to be approved. 103

11 ************************************************************************************************************ IV. VERIFICATION OF SPECIAL NEEDS/STUDENT HARDSHIP A release/reassignment is requested for this student based on special curriculum or medical needs or other hardship. Please identify the special needs of this student and indicate why a new assignment is warranted. Signature of Physician/Professional Specialty Area Address Telephone ************************************************************************************************************ V. VERIFICATION OF EMPLOYMENT/CHILD CARE Name and Address of Father s Employer Telephone Employer s Signature Name and Address of Mother s Employer Telephone Employer s Signature Name and Address of Child Care Provider Telephone Service Began Days and Hours of Care Signature & Title (Relationship if any) of Provider ************************************************************************************************************ THIS FORM MUST BE NOTARIZED My signature below certifies that I have completely and accurately supplied the requested information. In submitting this application, I acknowledge and accept the terms and conditions of Yadkin County School Board Policy 4150 governing the reassignment of students. I understand that falsification of this application by be grounds for revocation of the reassignment. Signature of Parent/Guardian Sworn to and subscribed before me this day of Notary Public My Commission Expires: ********************************************************************************************************** DECISION OF THE YADKIN COUNTY BOARD OF EDUCATION of Decision This request is Approved Denied Superintendent 104

12 STUDENT ACCOUNTABILITY AGREEMENT The Yadkin County Board of Education has adopted policies requiring students to meet local Board of Education standards for promotion in grades K 8 and for graduation from high school. The staff of your child s school is committed to providing a safe and orderly environment that is conducive to learning. As the instructional leader of the school, the principal will support the teachers in their efforts to teach all students. Opportunities for the establishment and attainment of high expectations will be made available to all students. Learning can take place best when there is shared effort, interest, and motivation by students, parents, and staff. We are committed to s success in school and promise to work together to promote his or her achievement. As a student in the Yadkin County Schools, I pledge to: Demonstrate a serious attitude toward learning Respect myself and the rights of others Attend school regularly and be on time Follow the Code of Student Conduct Come to school dressed appropriately, with necessary materials, and prepared to work Ask my teacher questions when I don t understand Complete all my assignments on time Attend intervention (extra help) opportunities outside the school day as needed to master required North Carolina competencies Signed As the parent of, I pledge to: Provide ample, quiet study time at home, encourage good study habits and regular school attendance Make sure my child is well-rested, at school on time, and present for the entire instructional day Support the school staff in their efforts to promote appropriate behavior Encourage my child to read more and monitor my child s homework Encourage my child to demonstrate a serious attitude toward learning Communicate regularly with my child s teacher Monitor my child s homework Read, sign, and return my child s progress reports Attend parent/teacher conferences as requested Make sure my child attends intervention (extra help) opportunities outside the school day as needed to master required North Carolina competencies Signed As a classroom teacher in the Yadkin County Schools, I pledge to: Explain my expectations, instructional goals, and grading system to the student and parent Teach the North Carolina Standard Course of Study Provide a climate in my classroom that is conducive to learning Communicate with parents through conferences, progress reports, report cards and by telephone Employ various teaching methods which work best for the student Provide enrichment and remediation opportunities for the student as needed Respect the cultural differences of my students Parental involvement is essential as we work to give your child the best educational experiences possible. Signed 105