Sulphur Intermediate Student Enrollment Form

Student Full Name *

Student Full Legal Name (if different from above)

Name, City and State of last school attended

Grade Entering *

3rd

4th

5th

Gender *

Female

Male

Place of Birth (City, State) *

Date of Birth *

MM

/

DD

/

YYYY

Age *

Student's Physical Address (include city and state) *

Student's Mailing Address (if different from above)

What bus does student ride? (if applicable)

Bus 1

Bus 2

Bus 3

Bus 4

Bus 5

Youth Club Bus

JAMM Transit

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1st Contact Adult (with whom student resides) *

1st Adult Cell Number *

How is adult related to student? *

Father

Mother

Step Parent

Guardian

Other

1st Adult's Employer *

1st Adult's Work number

2nd Adult (with whom student resides)

2nd Adult cell number

How is adult related to student?

Father

Mother

Step-Parent

Guardian

Other

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2nd Adult Employer

2nd Adult Work Number

2nd Adult Email Address

If student's parents are divorced or separated, please indicate who has primary custody. You must submit a copy of custody papers to the office.

#1 Other Contacts-Please list anyone-other than custodial parents-that we may contact in an emergency OR that may pick up your child. Please list person's name and phone number. *

#2 Other Contacts-Please list anyone-other than custodial parents-that we may contact in an emergency OR that may pick up your child. Please list person's name and phone number. *

#3 Other Contacts-Please list anyone-other than custodial parents-that we may contact in an emergency OR that may pick up your child. Please list person's name and phone number. *

#4 Other Contacts-Please list anyone-other than custodial parents-that we may contact in an emergency OR that may pick up your child. Please list person's name and phone number.

After school babysitter or daycare information (name and phone number)

Is student of Hispanic/Latino culture or origin? *

Yes

No

What is student's race? *

American Indian or Alaska Native

Asian/Pacific Islander

Hispanic or Latino

African-American

White/other

Required

Are there any languages other than English spoken in the home? *

Yes

No

If yes, please indicate language

Medical Needs in which teacher/school should be aware

Does child take medications? If needed at school, please fill out form for medication administration.

Does child wear glasses?

Yes

No

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Does child wear hearing aides?

Yes

No

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Does your student have older siblings? (List brothers and sisters and ages)

Does your student have younger siblings? (List brothers and sisters and ages)

Please only select ONE option Family Educational Rights and Privacy Regulations (FERPA): Directory Information The Sulphur School District proposes to designate the following personally identifiable information contained in a student’s education record, as “directory information”, and it will disclose that information without prior written consent. 1. The student’s name 2. The names of the student’s parents 3. The student’s date of birth 4. The students' class designation (i.e. first grade, tenth grade, etc.) 5. The students extracurricular participation 6. The student’s achievement awards or honors 7. The student’s weight and height of a member of an athletic team 8. The student’s photograph 9. The school or school district the student attended before he or she enrolled in the Sulphur School District. Within the first three weeks of each school year, the Sulphur School district will publish in the Sulphur Times Democrat the above list, or a revised list, of the items of directory information it proposes to designate as directory information. For students enrolling after the notice is published, the list will be given to the student’s parent or the eligible student at the time and place of enrollment. After the parents or eligible students have been notified, they will have two weeks to advise the school district in writing (a letter to the school superintendent’s office) of any or all of the items they refuse to permit the district to designate as directory information about that student. At the end of the two-week period each student’s records will be appropriately marked by the records custodian indicating the items the district will designate as directory information about that student. This designation will remain in effect until it is modified by the written direction of the student’s parent or the eligible student. To serve as your “letter to the superintendent” expressing your decision regarding your student’s information, please indicate on the provided form your decision regarding directory information. You may return this letter to the principal’s office. If you have any questions, please contact the school at 622-4373. *

I GIVE MY CONSENT to release all of my student’s information.

I DO NOT wish to release any of my student’s information.

I CONSENT ONLY TO THE RELEASE OF THE FOLLOWING DIRECTORY ITEMS. (From the list above, type the items that you agree to release in next question.)

If you selected specific release of specific directory items list here:

Field Trip Permission - We will be taking field trips through out the year. I give my child permission to attend field trips. *

Yes

No

Discipline Policy Minor Offenses: *Running in the building *Being outside designated areas before school, at lunch, and/or after school *Playing in the restroom and/or halls. *Not following classroom, playground, cafeteria, and/or hallway procedures. *Disrupting instructional time. Consequences for Minor Offenses: Privileges lost and/or Lunch detention and/or Parent Notification ~If a minor offense continues after previous consequences have been implemented, it then becomes a major offense resulting in major consequences being implemented. Major Offenses: *Bullying *Threatening a teacher *Being disrespectful *Fighting *Possession of weapons *Possession of drugs Consequences for Major Offenses: *Parent/Student conference with Principal and/or Behavior Management Program (BMP) and/or Suspension For more details, consult the Sulphur Public Schools Student Handbook. *

I have read and understand the Sulphur Intermediate School Discipline Policy

Comments regarding discipline form

Student Name: Parent/Student/Teacher/School Compact In an effort to identify the expectations from everyone involved in the schooling process, Sulphur Schools in consultation with parents, teacher, the administration, and the school board, has developed this written agreement. Expectations have been listed and followed by a promissory signature to ensure knowledge of each person’s obligation. As a student, I promise to: Be prepared for and attend school regularly Strive to do my best on school work Follow school rules for student conduct Respect others

Parent Name Parent/Student/Teacher/School Compact In an effort to identify the expectations from everyone involved in the schooling process, Sulphur Schools in consultation with parents, teacher, the administration, and the school board, has developed this written agreement. Expectations have been listed and followed by a promissory signature to ensure knowledge of each person’s obligation. As a parent, I promise to: Make sure that my child attends school regularly Schedule study time and check to see if homework is completed Communicate with teachers regularly about my child’s performance Provide high expectations and encouragement for my child’s performance

Statement from Teacher, Staff, Administration and school board: As a teacher, I promise to: Communicate through phone calls, notes or conferences with parents to support student learning Provide a caring environment for all students Have a high expectation for all students Follow the teacher’s code of conduct In conjunction with the school administration and school board, we promise to: Promote education Communicate in a caring way with students, staff and community Provide the best school environment possible within our means Have challenging expectations for students, families and staff

This is a statement from Sulphur School staff, Administration and Board. No selections need to be made

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TRANSPORTATION AGREEMENT - (RURAL TRANSPORTATION ONLY) **PLEASE FILL OUT IF YOU LIVE 1 1⁄2 MILES FROM THE SCHOOL AND YOUR CHILD WILL RIDE THE SCHOOL BUS** This agreement is between the Sulphur Public School and the parents/guardians of students being transported to and from school. The school bus driver has a great responsibility. Each day he/she carries a “precious cargo” to your child and his/her only concern should be to ensure that all of his/her passengers are transported to and from school safely. Unfortunately, there are times when children (young and old) do things that cause the driver to be distracted from his/her job. This is dangerous and cannot be allowed. It is necessary therefore, that Student Conduct Rules and Regulations be in force and that they be followed. Each parent/guardian must ensure that their child understands the importance of good behavior while riding a bus. Riding a school bus is not a right but a privilege granted to those who are eligible and are able to abide by the rules and regulations. It is not right that a student be allowed to ride a school bus when he/she continues to jeopardize the safety of others. The Board of Education realizes that a hardship may result in your having to transport your child to and from school, but it is sometimes necessary. Therefore, the School System asks the parents/guardians to sign an agreement that their child will abide by the rules and regulations. If the rules are broken, there will be punishment administered on an increasing scale. The rules and regulations can be found in the Student Handbook. We the parents/guardians have read and discussed with our children the school bus policy and rules. We agree with the School District that these rules should be in force and that if any student who cannot abide by them should and shall be disciplined in accordance to the school policy. As parents/guardians, we ask the school district to contact us each time our children are involved in incidents so we may further counsel our children on proper bus conduct.

We live 1.5 miles or more from Sulphur Schools, my child qualifies to ride the bus

We DO NOT live 1.5 miles or more from Sulphur Schools

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Directions to your house

Name and grade of siblings that will ride the bus (type n/a if doesn't apply)

Bus # (if known)

Student's School *

Section A Do you rent/own your own home or apartment? *

Yes

No

If you own/rent your own home or apartment you may skip to the bottom and fill in your name.

Option 1

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If you own/rent your own home or apartment you may skip to the bottom and fill in your name.

Option 1

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Section B Other Housing Options

Temporarily with another family member or friend until we can locate affordable housing

In an emergency or transitional shelter

In a vehicle, park, campbground, or on the streets

In a house, building, or trailer WITHOUT running water or electricity

in a hotel or motel

with an adult that is not a parent or legal guardian

alone or in different locations, without an adult serving as a caregiver

wherever I can find a place to stay at night

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If you selected anything from Section B, Please list all children currently living with you who attend Sulphur Public Schools (first/last name, gender, dob, grade)

Would you like to be contacted by an employee of the school to discuss additional educational services that may be available to your child?

Yes

No

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