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ORANGE COUNTY PUBLIC SCHOOLS

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ORANGE COUNTY PUBLIC SCHOOLS
SCHOOL WITHDRAWAL INFORMATION
Parent/Guardian needs to:
Student Withdrawal Process:
*All students must have a withdrawal form from the previously attended school before the student can
be enrolled in the new school (includes charter schools, exceptional education, McKay Scholarship,
alternative school, contract schools, technical schools, and private school.)
Exception: students entering from JDC
Notify the current school of the intent to withdraw, include student name,
student number, and parent ID (parent may email or go in person)
Complete, sign, and return the withdrawal form provided by registrar (with ID)
Return books, electronics, and any other school materials (in person)
IF transferring from one OCPS school to another OCPS school
Complete Changing Schools Registration Form to update contacts/health
information and provide to new school (Changing Schools Registration
form attached below)
https://www.ocps.net/cms/One.aspx?portalId=54703&pageId=197816
Parenting Plan or Educational Guardianship (if appropriate)
Proof of Residency (send one only): Home ownership, current lease, or
Verification of Residence (VOR) issued by the Office of Student Enrollment
Documentation provided to the parent by current school:
Completed withdrawal form
*Please allow withdrawing school 24 hours to
complete the requested withdrawal*
ORANGE COUNTY PUBLIC SCHOOLS
Student Number: ______________________________
School: ____________________________________
Student Alias # ______________________________
Date Received: Grade:
_______________________
In Orange County public school before Yes No
STUDENT INFORMATION
Last Name (Legal) Name Suffix
(i.e.: JR, II)
First Name (Legal) Middle Name Preferred Name Student SSN # (optional)
Domicile Address Apt # City Zip Code
Primary Phone Number
Mailing Address City
Zip Code
Parent/Guardian - Primary E-mail Address
Gender Federal Ethnic Category Federal Race Categories
(Check all applicable)
Do you need communication sent home
in a language other than English?
Student Lives With
(check all that apply)
Male
Female
Non-Hispanic/Non-Latino
Hispanic/Latino
White Black or African American
Asian American Indian/Alaska Native
Native Hawaiian or other Pacific Islanders
No Spanish Haitian Creole
Yes French
Vietnamese
Portuguese
Both Parents
Mother
Father
OCPS Ed. Guardian
Legal Guardian
Other / Step Parent
OTHER SCHOOL AGE CHILDREN LIVING AT HOME
Child’s Name (First & Last) Relation to Student School Gr. Child’s Name (First & Last) Relation to Student School Gr.
1. 2.
3. 4.
5. 6.
Domicile is defined as the place where parents/guardians have their true and fixed, permanent home and to which they have, whenever absent, the intention of returning.
The parent/guardian's domicile determines the student's domicile. Common indicators of domicile are home ownership or in the absence of home ownership a residential lease.
837.06 False official statements.—Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her
official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
This is to certify that all the information on this registration form is true to the best of my knowledge and belief. I understand that inadequate information may result in delayed entry.
Falsification of information will forfeit student's athletic and extracurricular eligibility for one (1) calendar year from the date of discovery of the violation.
______________________________________________________
Parent/Guardian Signature Date Relationship to Student
______________________________________________________
Parent/Guardian Signature Date Relationship to Student
Birth Date (Month/Day/Year)
NoYes
2
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
Do you have wireless Internet service at home?
If yes, is your wireless service reliable enough to support all students in your home being online simultaneously
without slowness when loading web pages or dropping the connection?
The student is a twin, triplet, etc.
Birthplace (City/State/Country)
Yes No
Yes
No
Orlando, F
lorida
Changing Schools Reg
istration Form
Please choose grade level
Student Name: Student Number: _____________________________
PARENT/GUARDIAN INFORMATION (Please list parent/guardian in order of contact priority.)
Last Name (Legal) First Name (Legal) Middle Name
Business Phone
Domicile Address Apt # City Zip Code Primary Phone Number Cell Phone
Parent/Guardian - Primary E-mail Address
Pickup student?
Parent/Guardian Relation to Student
Parent
Legal Guardian
Other
Guardian Ad Litem
OCPS Ed. Guardian/
Surrogate Parent
Mother
Father
Legal Guardian
Stepmother
Stepfather
Grandmother
Grandfather
Brother
Sister
Aunt
Uncle
Cousin
OCPS Ed. Guardian
Other
Last Name (Legal)
First Name (Legal) Middle Name
Domicile Address Apt # City Zip Code Cell Phone
Primary E-mail Address
Pickup student?
Legal Documentation(example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
Parent/Guardian Relation to Student
Parent
Legal Guardian
Other
Guardian Ad Litem
OCPS Ed. Guardian/
Surrogate Parent
Mother
Father
Legal Guardian
Stepmother
Stepfather
Grandmother
Grandfather
Brother
Sister
Aunt
Uncle
Cousin
OCPS Ed. Guardian
Other
OTHER CONTACT - Relationship __________________________________
Last Name
First Name
Contact Phone
Pickup student? Pickup student?
Yes
No
837.06 False official statements.—Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty
shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
This is to certify that all the information on this registration form is true to the best of my knowledge and belief. I understand that inadequate information may result in delayed entry.
Falsification of information will forfeit student's athletic and extracurricular eligibility for one (1) calendar year from the date of discovery of the violation.
Parent/Guardian Signature Date Relationship to student
Parent/Guardian Signature Date
Relationship to student
Yes
No
Yes
No
______________________________________________________
______________________________________________________
Work Phone
Business Phone
Work Phone
Home Phone
Legal Documentation (example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
3
ORANGE COUNTY PUBLIC SCHOOLS
Orland
o, Florida
Changing Schools Registration Form
(page 2)
OCPS Stu (Revised
01 12 2021) OCPS0486Pup
Emergency Information - English
Student Number: ____________________
STUDENT INFORMATION
Medicine Currently Taking (Prescription and Over-the-Counter (OTC)
Medical History/Physical Limitations
Allergies to Medication, Food, or o
ther substances..
PARENT/GUARDIAN INFORMATION (Please list parent/guardian in order of contact priority.)
First Name
Relationship
Pick up
Yes No
Domicile Address
Apt #
City
Zip Code
Primary Phone
Cell Phone
Employer
Business Phone
First Name
Relationship
Pick up
Yes No
Domicile Address
Apt #
City
Zip Code
Cell Phone
Employer
Business Phone
Last Name (Legal) Name Suffix
(i.e. Jr., II)
First Name (Legal) Middle Name (Legal)
Preferred Name
Legal Documentation (example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
Gender
Birth Date
Primary Phone
Male Female
Parent/Guardian - Primary E-mail Address
Address Domicile
Address**
Apt #
City
Zip Code
Mailing Address Apt # City Zip Code
Do you need communication in a language other than English?
No Yes Spanish French Portuguese Haitian Creole Vietnamese
ORANGE COUNTY PUBLIC SCHOOLS
Orlando, Florida
Emergency and Student Health Information Form
School Year 20__‐20__
4
Medications
Other substances
Food
ADDITIONAL CONTACTS ON THE NEXT PAGE
**Proof of address must be presented to the school Registration Office in order for the address to be officially changed in the system.
*Diet Order Form - Parent/Guardians must complete and sign the front of the form in its entirety. A signature releasing medical information is necessary
should the physician need to be contacted regarding diets related to medical disabilities.
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
Student Name: Student Number:
ADDITIONAL CONTACTS
Last Name
First Name
Relationship
Contact Phone
Custody
Pick up
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
SCHOOL HEALTH SERVICES
I
hereby g
ive my
consent
for this
child
to
participate in
the School Health
Services Program. My child will receive emergency care in school, and
health appraisals including vision, hearing, growth and development.
If, upon administering a vision screening through the school or any other OCPS program, my child is determined to have a need for a follow-up
vision examination and if my child is eligible or otherwise financially qualified, I hereby authorize for OCPS or a designated third party to provide
a no-cost comprehensive vision examination by a licensed optometrist which may include dilation, refraction, and glasses if prescribed.
In the event of an EMERGENCY, I understand that the school will access the 911 emergency medical system immediately. To expedite care, I
give my permission for school personnel to provide
medical information to the responding emergency team to initiate treatment and transport to
an appropriate facility. I give my permission to first responders, medical personnel, and staff to initiate treatment immediately upon arrival. I
request to be notified of my child’s condition and admission as soon as possible. If I cannot be reached, I request that the admitting facility
notify one of the other persons listed above of my child’s condition and admission. I agree to be financially responsible for my child’s total
treatment and transport.
Parent/Guardian:
Date:
For child with IEP or receiving ESE related services, I authorize the School Board of Orange County, Florida
to release and exchange my child’s confidential information to agencies of the State of Florida which would
allow Orange County Public Schools to verify Medicaid eligibility, bill Medicaid for reimbursable Certified
School Match services reference on my child’s IEP and receive Medicaid reimbursement for Exceptional
Student Education (ESE) services it provides to my child while at school. I understand that my child will
continue to receive services referenced on his/her IEP whether or not I give consent. Please take the student's
Social
Security card to the school Registrar to finalize
authorization.
*The School Board of Orange County, Florida is authorized to collect social security numbers (“SSN”) of students as set forth in Sections 1008.386 and
119.071(5)(a)6, Florida Statutes.The provision of a student’s SSN on the enrollment form is optional and is not required as a condition for enrollment within the District.
Any SSN provided in connection with enrollment will only be used for research, reporting and recording purposes. The collectio
n of the SSN shall not be used for
immigration enforcement. Providing the student’s SSN to the School Board of Orange County, Florida for these purposes means that you consent to the use of the
student’s SSN in the manner described.
Florida Statute §837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official
duty shall be guilty of a misdemeanor of the second degree.
(This form is effective until the first day of next school year or one year from the date signed, whichever is later)
5
In the event of an incident or emergency and I cannot be reached, I consent and request additional contacts listed above be notified of my child’s
condition and/or of emergency medical services response to the incident.
By signing this form, I accept and acknowledge the terms herein.
OCPS Stu (Revised
01 12 2021) OCPS0486Pup
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ORANGE COUNTY PUBLIC SCHOOLS

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Completed 5 March 2021

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