Fillable Enrollment Instructions and Check-Off Sheet

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Enrollment Instructions and Check-Off Sheet

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Enrollment Instructions and Check-Off Sheet
ALL forms are complete. (Even if I feel it does not apply to my child.)
I printed clearly and legibly.
I have filled out all the pages in this packet and made copies of all the requested
documents (list on next page). The Attendance Office will not be able to make copies
in order to reduce the spread of COVID. We appreciate your understanding.
I understand if I am missing any of the requested documentation, Sherman Oaks CES
will not accept the paperwork and I will be asked to make another appointment.
Instrucciones de inscripción y hoja de verificación
TODAS las formas están completas. (incluso si siento que no se aplica a mi hijo).
Imprimí claramente y legiblemente.
He hecho copias de todos los documentos solicitados (lista incluida con la información
de aceptación de Sherman Oaks CES). La Oficina de Asistencia no podrá hacer copias
para reducir la propagación de COVID. Agradecemos su comprensión.
Entiendo que si me faltan hojas de la documentación solicitada, Sherman Oaks CES no
aceptará el papeleo y se me pedirá que haga otra cita.
Sherman Oaks Center for Enriched Studies
In -Person Enrollment Information and Requirements
Please make sure to notify the current school you will be withdrawing so we can enroll
your child into our computer system.
Mandatory orientation meeting for all new students and parents
Please mark your calendars.
***Wednesday, June 16, 2021, 5:00pm-6:30pm***
via Zoom (link to be sent out at a later time)
□ Enrollment Forms (Forms in this document)
□ A COPY of your Acceptance Letter to SOCES (email printout from SOCES will only be accepted from
students accepted off the wait list)
□ A COPY of the most current Report Card (will not be returned)
□ A COPY of transcripts (students entering grades 10-12 only)
□ A COPY of your child’s most current Immunization Records from the doctor’s office. Student will not be
able to start school until turned in. Students in grades 7-12 will need to show proof of the Tdap requirement.
Click on the link for CA Dept of Public Health Info. https://www.shotsforschool.org/k-12/
□ A COPY of proof of residency (i.e. gas/electricity bill, rental/mortgage statement)
(Phone / cable bill/driver’s license are NOT an acceptable form of proof. PO Box addresses are not allowed)
□ A COPY of your child’s ENTIRE current I.E.P. or 504 Plan if applicable (This is for students who are part
of the Special Education Department. Will not be applicable for most students)
All sheets in this packet and copies listed above are due when you come in for your enrollment
appointment. If the enrollment packet is not complete, you will need to make another
appointment to submit your documentation. We cannot accept incomplete documentation.
BUS TRANSPORTATION
If in-person learning resumes, you will receive notification of your school bus schedule by mail in August before
the opening of school. Your child automatically receives transportation if you live outside the 2-mile radius of the
school (This may be subject to change).
If you have any questions, please email Ms. Sandra Tabares, Magnet Coordinator, at
sst8783@lausd.net
The following information is due during your enrollment appointment:
PLEASE BRING COPIES OF ALL DOCUMENTS AS
THE OFFICES WILL BE UNABLE TO MAKE PHOTOCOPIES.
Date of Appointment Instructions
For your safety and the safety of our Office Staff,
please be mindful and follow the instructions below.
1. Only the person submitting the documentation should be present for the
appointment. (if translation is needed, please notify Ms. Tabares before the
appointment)
2. The Attendance Office will not be able to make photocopies of any
documents being submitted. NO EXCEPTIONS
3. All safety protocols will be enforced...mask/face coverings required, social
distancing of 6 feet, hand sanitizing, etc.
4. Please stay home if you have been exposed to COVID or are experiencing any
symptoms. Please contact Ms. Tabares to cancel and reschedule your
appointment.
5. Please arrive on time to your appointment.
6. Please call the Attendance Office upon arrival at 818-758-5611, and you will
be directed in.
7. Please do not show up without an appointment – for safety purposes, we
cannot accommodate walk-ups.
We appreciate your help in keeping all the members of our
family (including you) safe and healthy.
LOS ANGELES UNIFIED SCHOOL DISTRICT
STUDENT EMERGENCY INFORM ATI ON FORM
Parent Information: Please fill out completely and sign where indicated. In a major emergency, it is school district policy to retain students at school for their safety.
This form will be used by the school staff when students are released to go home. Please complete electronically or print clearly and return completed form to school.
STUDENT’S LAST NAME
FIRST NAME
STUDENT’S LAST NAME
BIRTH DATE
GRADE
HOME LANGUAGE
MALE FEMALE
STUDENT’S HOME ADDRESS -- NUMBER
STREET
APT #
CITY
MAILING ADDRESS -- NUMBER
(IF DIFFERENT FROM ABOVE)
STREET
APT #
CITY
PARENT’S / LEGAL GUARDIAN’S LAST NAME
FIRST NAME
RELATIONSHIP TO STUDENT
WORK ADDRESS -- NUMBER
STREET
CITY
CONTACT NUMBERS
Indicate which phone to call for each message type:*
EMAIL ADDRESS:
HOME
EMERGENCY
Home
Cell
Work
CELL
ATTENDANCE
Home
Cell
Work
WORK
GENERAL INFO
Home
Cell
Work
TEXT
I authorize receiving text messages and understand that I am responsible for all text related charges.
PARENT’S / LEGAL GUARDIAN’S LAST NAME
FIRST NAME
RELATIONSHIP TO STUDENT
WORK ADDRESS -- NUMBER
STREET
CITY
CONTACT NUMBERS
Indicate which phone to call for each message type:*
EMAIL ADDRESS:
HOME
EMERGENCY
Home
Cell
Work
CELL
ATTENDANCE
Home
Cell
Work
WORK
GENERAL INFO
Home
Cell
Work
TEXT
I authorize receiving text messages and understand that I am responsible for all text related charges.
To the principal: In case you are unable to reach me during any emergency, you are authorized to contact and, if necessary, release my child to any of the following:
NAME
RELATIONSHIP
HOME PHONE
CELL PHONE
WORK PHONE
FIRST NAME
NAME
RELATIONSHIP
HOME PHONE
CELL PHONE
WORK PHONE
NAME
RELATIONSHIP
HOME PHONE
CELL PHONE
WORK PHONE
List any other family members attending this school:
LAST NAME
FIRST NAME
HOME ROOM
GRADE
RELATIONSHIP
LAST NAME
FIRST NAME
HOME ROOM
GRADE
RELATIONSHIP
MILITARY CONNECTED FAMILY: In efforts to provide
resources and support to military connected students and their
families, please respond to the following:
Immediate family member in the military (Active Duty,
Guard, Reserve, or Veteran): YES NO
Relationship to Student: ______________________
Currently Deployed: YES NO
Military Branch: ____________________________________________
Status: Active Duty; Guard; Reserve; Veteran; Deceased
AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT
The undersigned, as parent/legal guardian of,
a minor,
(Print name of the student here)
hereby authorizes the principal or designee, into whose care the student has been entrusted, to consent to any X-ray examination, anesthetic, medical or surgical diagnosis, treatment, and/or hospital care
to be rendered to the student upon the advice of any licensed physician and/or dentist. It is understood that this authorization is given in advance of any required diagnosis, treatment, or hospital care and
provides authority and power to the Los Angeles Unified School District (“District”) to give specific consent to any and all such diagnosis, treatment, or hospital care which a licensed physician or dentist
may deem necessary. This authorization is given in accordance with Section 49407 of the California Education Code, and shall remain effective until revoked in writing and delivered to the District. I
understand that the District, its officers and its employees assume no liability of any nature in relation to the transportation of the student. I further understand that all costs of paramedic transportation,
hospitalization, and any examination, X-ray, or treatment provided in relation to this authorization shall be my sole responsibility as the student’s parent/guardian.
HEALTH ALERTS -- List any medical condition which restricts physical activity or requires special attention. Include conditions such as asthma and allergies such as
peanut and bee stings. If none, please indicate “none”.
DOES THE STUDENT HAVE HEALTH INSURANCE? (Check One) YES NO* If “Yes”: Private Health Insurance Medi-Cal Healthy Families
MEDI-CAL / HEALTHY FAMILIES ID Number:
MIDDLE INITIAL
1. PRIVATE HEALTH INSURANCE NAME
GROUP NO.
2. PRIVATE HEALTH INSURANCE NAME
(If covered under more than one plan)
GROUP NO.
NAME OF DOCTOR / MEDICAL OFFICE
PHONE NUMBER OF DOCTOR / MEDICAL OFFICE
*If the student currently does not have health insurance, information on free or low-cost health care programs is available by calling the District’s toll-free HELPLINE 1(866)742-2273.
MY CHILD IS ALLERGIC TO THE FOLLOWING MEDICATIONS:
MY CHILD CURRENTLY TAKES THE FOLLOWING MEDICATIONS:
I CERTIFY THAT I HAVE READ AND UNDERSTOOD THIS FORM AND DO HEREBY GIVE MY AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT, AND THAT ALL OF THE INFORMATION I
HAVE PROVIDED ON THIS FORM IS TRUE AND CORRECT.
X
DATE
SIGNATURE OF: (CHECK ONE) PARENT LEGAL GUARDIAN CAREGIVER (AFFIDAVIT)
*
Selected telephone number must be a direct dial number (no extensions). Revised January 2014
1 Form 33.18 Rev. 2/19
LOS ANGELES UNIFIED SCHOOL DISTRICT
DISTRICT NURSING SERVICES
HEALTH QUESTIONNAIRE FOR SCHOOL ENROLLMENT
Student Name ______________________________ M F Date of Birth ___________
Name of person completing form _________________________________________________
Cell phone ______________________________ Today’s Date: ______________
Relation to Student: Parent Guardian Grandparent Other __________________
Name of Doctor_____________________________ Doctor’s Phone # ____________________
1. Does the student have a health condition? *
No Yes _______________________________________________________________
Indicate Diagnosis if know
2. Does the student need to take medicine on a daily basis? *
No Yes _______________________________________________________________
Medication / Dose / Frequency
Does the student need to take medicine during the school day? *
No Yes _______________________________________________________________
Medication / Dose / Frequency
3. Does the student have a vision problem?
No Yes _______________________________________________________________
Indicate the vision problem
Does the student need to wear glasses / contacts at school?
No Yes _______________________________________________________________
Indicate when the child needs to wear glasses / contacts
4. Does the student have a diagnosed hearing problem? *
No Yes _______________________________________________________________
Does the student need to wear hearing aids? *
No Yes _______________________________________________________________
5. Does the student have a history of any of the following health conditions? *
The child has (check condition):
Asthma Diabetes Severe allergies to: ________________________________
Seizure / Convulsion type: ___________________ Date of last convulsion: ___________
Other health condition: _____________________________________________________
6. Does the student have a history of surgery within the last 2-3 years? *
2 Form 33.18 Rev. 2/19
No Yes _______________________________________________________________
Type of surgery
7. Does the student need assistance walking? *
No Yes _______________________________________________________________
Student will need to use: Braces Crutches Walker Wheel Chair
Other ___________________________________________________________________
8. Does the student need assistance in feeding? *
No Yes _______________________________________________________________
Special diet prescribed by health care provider ____________________________________
9. Does the student need assisting with toileting? *
No Yes _______________________________________________________________
10. Does the student need medical treatments throughout the school day? *
No Yes _______________________________________________________________
Please check the medical treatments that will be needed *:
Blood glucose (Sugar) Testing
Insulin
Epi-Pen for severe allergic reaction
G-Tube Feedings / Care
Glucagon for severe low blood sugar
Mechanical Nebulizer Treatment for Asthma
Ostomy Care
Oxygen
Tracheostomy Suctioning / Care
Urinary Catheterization
Ventilator Assistance
Other ___________________________________________________________________
I have completed this form to the best of my ability. I am aware it is my responsibility to
notify the school nurse of any health-related issues my child has.
I have read the California State requirements regarding immunizations that was available on
the enrollment website.
Parent Signature Date
* If you answered yes to any
of the questions with an
asterisk, you must see the
nurse. It is important she is
familiar with your child’s
medical needs.*
REF-041180.0 ATTACHMENT A
October 2, 2017
Los Angeles Unified School District
Migrant Education Program
Family Work Questionnaire
Your children may be eligible to receive FREE educational and health services.
Possible services may include:
• After-School Tutoring • Summer College Academies
• Saturday School • Summer Outdoor Camp
• Preschool Programs • Summer Science Academies
• Help Recovering High School Credits • Dental Screenings/Medical Referrals
Parents receive training on:
How to become involved in their children’s schools, how to support their children’s academic success, requirements for college
admissions and other services. We also provide information for classes to obtain a GED certificate, which is an equivalent to a
high school diploma.
Have you or any family member moved to work or seek work in agriculture within the last 3 years? Yes NO
If you answered YES, please answer the next question
Did your children move with you during the time you worked or went to seek work? Yes
NO
(Please check all the agricultural and fishing jobs, temporary and seasonal, that applies.)
Field Work/
Agriculture
Examples: (plant, prune, pick,
harvest, pack, sort or transport
fruits, vegetables, grains, or
other crops; soil preparation,
irrigation, fumigation, etc.)
Orchard
Examples: (pick, prune, sort
fruit, nut trees, vines, etc.)
Nursery
Examples: (plant, cultivate,
harvest flowers, plants, trees,
bushes, herbs, sod, etc.)
Fishing
Examples: (catch, sort, pack,
process, transport fish or
shellfish, etc.)
Dairy/Farm/Ranch/
Livestock
Examples: (milking, cattle
feeding, transporting animals;
raising farm animals such as
poultry, goats, pigs, etc.; and sale
of its products such as milk,
eggs, cheese, etc. for someone or
for family support.
Packing
Examples: (process, store,
freeze, can, pack fruits,
vegetables, meats, etc.)
Food Processing
Examples: (prepare, process
foods like tomato sauce, fruit
jellies, chili sauce; processing of
wheat or flour for tortilla items,
pack cut or pack an assortment
of meats.)
Forestry/Lumber
Examples: (plant, grow,
cultivate, harvest trees; thinning
and vegetation control, etc.)
I
mportant:
Proof of family income or immigration status is NOT required to receive services.
Please provide the following information to your school:
Parent(s)/Guardian(s) Name: ___________________________________________________________ Date: ______________
Address:
Telephone:
What is the best time to call you? 8am-12pm 12pm-6pm 6pm-8pm
Student Name(s):
Student’s School: Grade(s):
For more information call the Los Angeles Unified School District,
Migrant Education Office at: (213) 241-0510
*** TO HOME SCHOOL STAFF ***
Please return this survey to the Migrant Education Office at the Beaudry Bldg. 29
TH
Floor, within two weeks of student’s enrollment, so that
services can made available to eligible families. Please call (213) 241-0510 for more information.
Sherman Oaks CES
4
Sherman Oaks Center for Enriched Studies
Special Education Survey
Student Name: _____________________________________ Grade in Fall 2021: _________
(Please Print)
Parent Name: _____________________________________ Cell Phone #: _________________
(Please Print)
1. Does this student have a current Individualized Education Program (IEP) from the previous
school?
Yes. No. (Skip to question 3)
2. Do you have a copy of the student’s IEP with you?
Yes No
3. Does this student have a Section 504 Plan from his/her previous school?
Yes. (See question 4) No. (you have completed this form)
4. Do you have a copy of the student’s Section 504 with you?
Yes No
-select one-
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Enrollment Instructions and Check-Off Sheet

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Completed 6 August 2021

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