Checklist for 6-12 Registration: Please bring the items listed below to enroll your child.

Transcription

1 WELCOME TO BANNING UNIFIED SCHOOL DISTRICT! Centralized Registration 161 W. Williams Street (951) Hours: 7:00 a.m. - 4:00 p.m. Checklist for 6-12 Registration: Please bring the items listed below to enroll your child. Proof of student s birth (provide ONE from the list below): o Birth Certificate (County Record), or o Hospital Record, or o Adoption Documents, or o Court Placement/Agency Agreement Current Immunization Record o Please see Guide to The Requirements of the California School Immunization Law for Parents Documents verifying your residence address o Current electric, water, or gas bills o Lease/rental agreement from landlord o Escrow papers with closing date within the past/future 30 days (*All documentation must have a date of the past 30 days) Copy of IEP (Special Education students only) Completed BUSD Registration Packet Copy of most recent grades/transcripts Parent/Guardian Photo ID o Current Driver s License/State Identification Card o Current Passport o Bank Identification Card with Photo o Foster/Group Home/Agency Identification Card M:\TRANSLATIONS\15-16 ENROLLMENT PACKET\Home Language Survey Eng-Span Revised 05/02/2016.

2 Date Entered: office use only EMERGENCY CONTACT / ENROLLMENT FORM PLEASE NOTIFY CENTRALIZED REGISTRATION OF ANY CHANGES ID # School Year School STUDENT INFORMATION Student's Last Name First Name MI Grade Male Female Home Address City State Zip Code Mailing Address (if different) City State Zip Code Birth Date Birth City/State Age Student Lives With: Both Parents Mother Father Foster Family Group Home Legal Guardian (with court papers) Informal Guardian (without court papers) Is the person checked above the legal guardian? Yes No If no then please complete a "Caregiver's Affidavit". FAMILY INFORMATION Parent/Guardian: Mother Stepmother Foster Guardian Name: Employer: Position: Military: Yes No Mother's Education Level: Not a High School Graduate HS Graduate/GED Some College College Graduate Masters/Graduate School Mother's Primary Language: English Spanish Other Parent/Guardian: Father Stepfather Foster Guardian Name: Employer: Position: Military: Yes No Father's Education Level: Not a High School Graduate HS Gradauate/GED Some College College Graduate Masters/Graduate School Father's Primary Language: English Spanish Other Phone Numbers Home ( ) Cell ( ) Work ( ) Home ( ) Cell ( ) Work ( ) Family Residence: House/Apartment/Mobile Home Living w/another family/relative Hotel/Motel Car/Van/Street Shelter/Transitional Housing Campsite/Park Other Home School Communication: Check the language in which you would like to receive school notifications. English Spanish Print Parent/Guardian Name Parent/Guardian Signature / / Date

3 OTHER CHILDREN IN THIS DISTRICT Name: School: Name: School: Ethnic Origin Is this child Hispanic or Latino? Race is separate from the previous question asking about Ethnic Origin. Please mark one or more boxes below to indicate this child's race. Asian: Chinese Japanese Korean Vietnamese Asian Indian Laotian Yes, No, Cambodian Filipino Hmong Other Asian Native Hawaiian or Other Pacific Islander: Hawaiian Guamanian Samoan Other American Indian or Alaskan Native Black or African American White Students Educational History MM/DD/YY first enrolled in CA school MM/DD/YY first enrolled in US School Previously enrolled in Banning Unified? Yes No Has this child ever been retained? Yes No Has this child ever been accelerated to another grade? If Yes, which grade? Yes No If yes, which grade? Has this child ever been suspended? Is child currently enrolled in a Special Education Program? Yes No Yes No If Yes, which programs? RSP SDC Speech & Language Is this child currently under an expulsion order or going through the expulsion process? Yes No If Yes, which District? What educational services has this child received? Please check all that apply. English Language Development GATE Indian Education 504 Plan Migrant Education Emergency Release Information IN THE EVENT OF ILLNESS OR AN EMERGENCY AT SCHOOL, WHEN I CANNOT BE REACHED, I GIVE PERMISSION FOR MY CHILD TO BE RELEASED TO THE FOLLOWING PEOPLE, THESE INDIVIDUALS MUST COME TO THE SCHOOL OFFICE AND PRESENT A CURRENT PHOTO IDENTIFICATION CARD TO PICK UP MY CHILD FULL NAME RELATION TO CHILD HOME PHONE WORK/CELL PHONE ( ) ( ) ( ) ( ) ( ) ( ) I authorize emergency diagnosis and treatment by a licensed physician/hospital/paramedics and will assume financial responsibility for care if my medical doctor or I am not available: Yes No Medical Doctor: Phone: ( ) Doctor's Address: City: Insurance Co: Policy #: MEDICATIONS your child is taking: Health Problems/Allergies: I understand that Banning Unified School District DOES NOT provide medical insurance covering students for accidents or school related injuries. However, they can refer me to student insurance for voluntary purchase. I am taking student insurance as offered I am NOT taking student insurance as offered / / Print Parent/Guardian Name Parent/Guardian Signature Date

4

5 HOME LANGUAGE SURVEY FOR OFFICE USE ONLY: Date Enrolled / / SCHOOL: Student ID#: CELDT Test Date: ELL I-FEP REP DI Student Last Name First Name Grade Sex: M F Date of Birth / / Birth City/State Name of Last School Attended District City/State Banning USD School(s) Previously Attended Parent/Guardian Address _ Home Phone # Cell Phone # Work Phone # The California Education Code requires schools to determine the language(s) spoken at home by each student. This information is essential in order for schools to provide meaningful instruction for all students. If a language other then English is spoken in the home, the district is required to do further assessment of your son/daughter in their primary language. Which language did your son/daughter learn when he/she first began to talk? What language does your son/daughter most frequently use at home? What language do you most frequently speak to your son/daughter? What language do the adults in your home most frequently speak? Please list other children attending school. Name Grade School Name Grade School Name Grade School Name Grade School For statistical purposes, we are occasionally asked to report the racial/ethnic background of our student body. To what racial/ethnic group does the student usually claim his/her heritage? If more than one racial/ethnic background, put in order of preference listing 1 and 2. (Mark appropriate ethnicity.) Hispanic American Indian/Alaskan Native Pacific Islander Hmong/Other Asian Lao White African American Filipino Has your student been identified as Gifted/Talented (GATE)? Yes No Has your student been identified as Special Education? Yes No Has your student been identified as having a Section 504 Plan? Yes No If applicable: Circle years in U.S. 1 year or less 3 years or less 4 years or more Date entered U.S. I am the parent/guardian of this student. All information is true and accurate as entered. Signature Date NOTE: This Home Language Survey is available in Hmong and Lao if requested. C:\Users\dwagner\AppData\Local\Temp\Temp2_enrollmentpacket612english.zip\Home Language Survey Eng-Span Revised doc 1

6 STUDENT HEALTH HISTORY Student Name: Grade: Date of Birth / / Please read and check any related illness or condition that your child has currently or has had in the past: Allergy: Bee sting medication required: Yes No Hemophilia Allergy: Food (explain in comment section) Hyperactive: Medication Required: Yes No Allergy: Medication (explain in comment section) Kidney Disorder Allergy: Pollen/Dust/Hay Fever Medications prescribed to student (explain in comment section) Allergy: Unknown Causes Medications needed at school (explain in comment section) Anemia Menstrual Cramps (severe) Arthritis (Rheumatoid) Migraine Headaches: Medication Required: Yes No Asthma (Mild) Mumps Asthma (Medication Required) Muscular Dystrophy Birth Defect/Chromosome Disorder Nose Bleeds (frequent) Blood Disorder Osgood-Schlatter Disease Cancer/Leukemia Physical Activity Limitations (doctor s note required) Cerebral Palsy Rheumatic Fever History Chicken Pox Rubella: 3-day Measles Color Blindness Rubeola: 10-day Measles Cystic Fibrosis Scarlet Fever Diabetic: Insulin Dependent: Yes No Scoliosis Eating Disorders: Sickle Cell Anemia (explain in comment section) Underweight Overweight Endocrine Disorders Tuberculosis Epilepsy/Seizures: Medication Required: Yes No Ulcer Growth Disorder (explain in comment section) Vision Impairment (wears glasses/contacts) Hearing Loss: Hearing Aid Used Yes No Vision Impairment (visually handicapped) Heart Disease/Defect Other (explain in comment section) No known health problems Comments:

7

8 To Registrar of: Phone # Centralized Registration 161 W. Williams Street Banning, CA (951) REQUEST FOR RECORDS Student s Name: Date of Birth: / / Grade: Name of Previous School Fax # Address of Previous School City State Zip Code Forward Records to: Phone # Fax # st Request Date: 2 nd Request Date: 3 rd Request Date: Registrar Name of Requesting School Address of Requesting School City State Zip Code Is the student participating in any Special Education Program? Yes No Is the student under an Expulsion Order? Yes No Please Fax a copy of the following Documents: Birth Certificate Immunizations Dental Physical *TDAP s stamp cum Transcript/Exit Grades/CST scores CELDT/Eng.Prof Results Current Court/Legal papers The Federal Rights and Privacy Act of 1974, Sections and 99.34, and California Law do not require the school forwarding pupil records to obtain permission to release records. The parent signature is provided below because your state or procedures may require parent authorization to release records for the student named above. I authorize all of my child s records to be sent to the present school. Please send all pupil records, including grades, educational information, psychological, special education, health records, as well as developmental information for the student indicated above. Parent/Guardian Signature: Date: In compliance with California Education Code 49068, the Banning Unified School District will inform the parent/guardian of their rights to inspect, review, receive a copy and challenge the content of the records for the above student.