Fillable WILSON K-8 SCHOOL Kinder Student Registration Checklist Birth (Amphitheater Public Schools)

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WILSON K-8 SCHOOL Kinder Student Registration Checklist Birth (Amphitheater Public Schools)

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  • 151 check-boxes
  • 241 other fields

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File type: PDF

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WILSON K-8 SCHOOL
Kinder Student Registration Checklist
Student Last Name: _________________________ First Name:_______________
Parent Signature: ________________________________ Date: _____________
Documents
Birth Certificate (we will need to see the original birth certificate not a copy)
Immunization Records (*see Nurse)
Proof of Residency document (Mandatory)
Attach ONE of the following: homeowner/renter: utility bill, tax, deed, pay stub, insurance, bank statement,
purchase agreement, mortgage, lease or rental agreement
Forms
Acknowledgement/Registration Checklist
Student Registration
Residency Form
McKinney-Vento Questionnaire
Primary Home Language Survey
Kinder Transportation Form
Kindergarten Questionnaire
PTO Form
↓↓↓↓↓ Additional Documents If Applicable ↓↓↓↓↓
Custody document Pending Custody
(Court Order/Decree/Custody Document/Court Hearing date document /Power of Attorney)
IEP Evaluation Reports 504 Gifted
Office Use Only
Hearing & Vision Screen – Nurse
Map Test
Student ID
Agenda, Map, Bell Schedule, Class Schedule
Fee Receipt (pd)
Parent Portal setup
Open Enrollment (New-1
st
yr)
In-district __________ Out of District ________________
AZDES - CPS (Notice to Provider)
Grp Hm _____________
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political beliefs/affiliation,
disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the District’s non-discrimination
policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student
Services, (520) 696-5230, kmcgraw@amphi.com.
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Revised 1/6/2020
Amphitheater Public Schools - Student Registration Form
School
School Year
Entering Grade Level
for Given School Year
STUDENT INFORMATION (Please PRINT student name exactly as it appears on the birth certificate)
Legal Last Name
Legal First Name
Full Middle Name
Generation
(Jr. III, IV, etc.)
□ M □ F
Ethnicity:
□
Hispanic
□ Non-Hispanic
Race:
(Check
all that
apply)
□
Black / African American
□
White
□
Native Hawaiian / Pacific Islander
□
Asian
□
American Indian / Alaskan Native
Tribal Affiliation and Number
____________________________
Date of Birth (mm/dd/yyyy)
Country of Birth
State of Birth (US only)
Place of Birth (City)
Residential Address: Apt.# City ST Zip
Preferred Mailing Address (if different): Apt.# City ST Zip
For High
School
Student
Email
@
Student
Phone
( ) -
Enrollment History
Has this student ever attended school in Arizona before?
□
Yes
□
No
Has this student ever attended an Amphitheater school any time in the past?
□
Yes
□
No
Last school attended:_________________________________________
□
Public
□
Charter
□
Private
□
Homeschool
Year Grade Level District City State
Special Programs, Accommodations or Services (Check all that apply past or present and provide paperwork.)
□
Special Education
□
504
□
Speech
□
English Language Development
□
Gifted/Accelerated
□
Chronic Illness
□
Other______
Comments:
Other Information (Check all that apply)
□
Active Military Dependent
□
Foster
□
DCS
□
Refugee Status
□
McKinney-Vento/Homeless
□
Open Enrollment
Other Children/Siblings Under 18 Living at this Address
Name (Last Name, First Name)
Date of Birth
School
Grade
Transportation (Students must meet eligibility guidelines as listed in Board Policy. Please see Amphitheater website.)
If riding bus, student will ride:
□To AND From School □To School Only □From School Only □Day Care:____________________
Other modes of transportation: □Walk □Bike □Parent Drop Off / Pick Up □Student Drives (HS only)
Office Use
Only
AM Bus#_______ Stop_________
PM Bus#_______ Stop_________
Student ID: _____________ Entry Code:________ Start Date: __________
Data Entry Date:___________ Initials of Person Ente
ring Data:__________
Student Name:______________________________ Grade:______
Parent/Guardian Contact #1 (Only contact #1 is the PRIMARY contact and will be contacted first)
□
Mother
□
Father
□
Foster Mother
□
Foster Father
□
Step-Mother
□
Step-Father
□
Guardian
□
Other_________________
Last Name
First Name
Employer
Cell Phone ( ) -
Home Phone ( ) -
Work Phone ( ) -
□
Address same
as the student
Address if different than student: Apt.# City ST Zip
Email:
@
Contact #1 Spoken Language
□
Agrees to be contacted electronically for education items. (Teacher emails, progress reports, etc.)
Check all that apply:
□Can pick up student
□Lives with student
□
Is an
Emergency Contact
□Receives Report Card
□Can have Parent Portal Access
Parent/Guardian Contact #2
□Mother □Father □Foster Mother □Foster Father □Step-Mother □Step-Father □Guardian □Other_________________
Last Name First Name Employer
Cell Phone ( ) - Home Phone ( ) - Work Phone ( ) -
□Address same
as the student
Address if different than student: Apt.# City ST Zip
Email: @
Contact #2 Spoken Language
□Agrees to be contacted electronically for education items. (Teacher emails, progress reports, etc.)
Check all that apply:
□Can pick up student □Lives with student □Is an Emergency Contact
□Receives Report Card □Can have Parent Portal Access
Who has legal custody of the child? □Contact #1 □Contact #2 (Check both if applicable.)
Is there a joint custody or parenting plan in effect? □Yes □No (If yes, plan must be on file with the school.)
Is this student in care of a guardian? □Yes □No (If yes, legal guardianship records must be on file with the school.)
Is there a restraining order in effect? □Yes □No Against: □Mother □Father □Other (Papers must be on file with school.)
Additional Information:
Additional Contact #3
□Mother □Father □Foster Mother □Foster Father □Step-Mother □Step-Father □Guardian □Other_________________
Last Name First Name #3 Spoken Language
Cell Phone ( ) - Home Phone ( ) - Work Phone ( ) -
Check all that apply:
□Can pick up student □Lives with student □Is an Emergency Contact
Additional Contact #4
□Mother □Father □Foster Mother □Foster Father □Step-Mother □Step-Father □Guardian □Other_________________
Last Name First Name #4 Spoken Language
Cell Phone ( ) - Home Phone ( ) - Work Phone ( ) -
Check all that apply:
I VERIFY ALL OF THE INFORMATION ON THIS FORM IS ACCURATE
Enrolling Parent/Guardian Printed Name Enrolling Parent/Guardian Signature Date
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status,
marital status, political beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other
designated youth groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity &
Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com. Revised 1/6/2020
□Parent Portal
email: ________________________________
□Can pick up student □Lives with student □Is an Emergency Contact
□Parent Portal
email: ________________________________
Transportation for Kindergarten Students
Wilson K-8 School
Parents please complete this form if your student will be using District Bus Transportation
District Bus Transportation services are provided within Amphitheater School district boundaries to
kinder students to/from locations which are at least ½ mile from school. In order for the district to
plan a bus route they need to know if a student will be using the bus service and the address of the
student so they can make bus stop locations available. The following information is required to
complete this process:
Student Last Name Student First Name
Will your child be ½ day or full day Kinder
Half-day Full Day
Please check one
Will your child ride a bus to and/or from school
Yes No
Please check one
Child’s Home Address
Parents Last Name Parent First Name
Home Phone Cell Phone
Who will be meeting this student at the bus stop? Please list ALL persons authorized to meet
student at the bus stop:
Name of sibling that rides same bus home if it applies:
Is sibling authorized to walk kinder student home from the bus stop? Yes No
Please check one
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital
status, political beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated
youth groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance
Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
School Office complete the following: Student ID Number
Email completed form to Lisa Stickney @ lstickney@amphi.com
For Transportation Office use only
Bus AM number: Pick-up Time: Code:
Bus PM number: Drop Time: Early-Out Bus:
Start Date: Date School Notified: Parents called:
Arizona Department of Education
Office of English Language Acquisition Services
Office of English Language Acquisition Services
1535 West Jefferson Street • Phoenix, Arizona 85007 • (602) 542-0753 • www.azed.gov/oelas
Home Language Survey
The responses to this Home Language Survey (HLS) are used by the school to provide the most
appropriate instructional programs and services for the student. The answers below will
determine if a student will take the Arizona English Language Learner Assessment
(AZELLA). Please respond to each of the three questions as accurately as possible. If you need
to correct any of your responses, this must be done before the student takes the AZELLA
Placement Test.
1. What language do people speak in the home most of the time?
_____________________________________________________________
2. What language does the student speak most of the time?
_____________________________________________________________
3. What language did the student first speak or understand?
_____________________________________________________________
Please provide a copy of the Home Language Survey to the EL Coordinator/Main Contact on site.
In AzEDS, please enter all three HLS responses.
These HLS questions are in compliance with Arizona Administrative Code (R7-2-306(B)(1),(2)(a-c). (Revised 01-2020)
Student Name________________________________ District Student ID_______________
Date of Birth_________________________________ SSID__________________________
Parent/Guardian Signature______________________________ Date___________________
District or Charter____________________________________________________________
School_____________________________________________________________________
Amphitheater Public Schools
Richard B. Wilson K-8 School
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Arizona Department of Education
Office of English Language Acquisition Services
Office of English Language Acquisition Services
1535 West Jefferson Street • Phoenix, Arizona 85007 • (602) 542-0753 • www.azed.gov/oelas
Encuesta sobre el Idioma en el Hogar
La escuela utiliza las respuestas a esta Encuesta del idioma del hogar (HLS) para proporcionar los
programas y servicios educativos más apropiados para el estudiante. Las respuestas que
aparezcan a continuación determinarán si un estudiante tomará la Evaluación de aprendices
del idioma inglés de Arizona (AZELLA). Responda a cada una de las tres preguntas con la mayor
precisión posible. Si necesita corregir alguna de sus respuestas, esto debe hacerse antes de que el
estudiante tome el Examen AZELLA.
1. ¿Qué idioma hablan las personas en el hogar la mayoría del tiempo?
_____________________________________________________________
2. ¿Qué idioma habla el estudiante la mayoría del tiempo?
_____________________________________________________________
3. ¿Qué idioma habló o entendió el estudiante primero?
_____________________________________________________________
Distrito
Nombre del estudiante___________________________ Núm. de identificación_____________
Fecha de nacimiento ____________________________ SSID___________________________
Firma del padre o tutor_____________________________________ Fecha________________
Distrito o Charter_______________________________________________________________
Escuela_______________________________________________________________________
Please provide a copy of the Home Language Survey to the EL Coordinator/Main Contact on site.
In AzEDS, please enter all three HLS responses.
Preguntas en conformidad con (R7-2-306(B)(1),(2)(a-c) del Código Administrativo de Arizona. (Revised 01-2020)
Amphitheater Public Schools
Richard B. Wilson K-8 School
WILSON K-8 PROOF OF RESIDENCY FORM
Amphitheater Unified School District
Name Wilson K-8
Parent/Legal Guardian
As a Parent/Legal Guardian of the Student, I attest that I am a resident of the
State of Arizona and submit in support of this attestation a copy of the following
document that displays my name and residential address or physical description
of the property where the student resides:
Real Estate deed or mortgage documents signed by all parties
Current Gas, electric or water bill.
Residential lease or rental agreement signed by all parties
Property tax bill
Certificate of tribal enrollment or other identification issued by a recognized
Indian tribe that contains an Arizona address
Documentation from a state, tribal or federal government agency (Social
Security Administration, Veteran’s Administration, Arizona Department of
Economic Security)
I am currently unable to provide any of the foregoing documents. Therefore,
I have provided an original affidavit signed and notarized by an Arizona resident
who attests that I have established residence in Arizona with the person signing
the affidavit.
_
Signature of Parent/Legal Guardian Date
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political beliefs/
affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the District’s
non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw,
Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
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signature
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KINDERGARTEN QUESTIONNAIRE
NOTE: The following information is utilized by the child’s teacher only and is
destroyed at the end of the year. It enables the teacher to plan and implement the
best education for your child. This information does not become a part of your
child’s records. Thank you!
Child’s Name: ____________________________ Birth Date: __________________
Name to be used in school: __________________ Home Phone: _______________
Parent’s
current marital status: __________________________________________
Does
your child have any health problems the school should be aware of? Explain:
__________________________________________________________________
___
________________________________________________________________
___
________________________________________________________________
If yo
ur child has any food allergies, please list: ______________________________
Has your child attended preschool? If so, where ? ___________________________
For how long? _______________________________________________________
Is your child right or left handed? _________________________________________
Do you celebrate birthdays in your home? If no, please explain: ________________
___________________________________________________________________
Does
your child dress him/herself? _______________________________________
How often do you read to your child? _____________________________________
How high can your child count correctly? __________________________________
Is your child interested in writing the numbers or letters? ______________________
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital
status, political beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth
groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520)
696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
Does
your child like to color? ____________________ Sing? __________________
Can your child complete a simple task in a timely manner (like set the table, take out
the trash, make their bed?______________________________________________
Wha
t do you expect your child to acquire through the kindergarten experience?
___
_______________________________________________________________
Wha
t else would you like your child’s teacher to know about your child? __________
___________________________________________________________________
My child
can:
p
rint first name knows zip
cares for own toilet needs
tie shoes lace shoes
button
read reads
knows phone number
rec
ognize letters of the alphabet (check) few most all
a
recog
nize numerals 0 – 9 (check) few most all
a
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital
status, political beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth
groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520)
696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
Amphitheater Public Schools
McKinney-Vento Eligibility Questionnaire
This questionnaire is intended to address the McKinney-Vento Act, Title X, Part C of No Child Left Behind. Answers to
these questions will help determine services a student may be eligible for. See the attached page for a description of
the McKinney-Vento Act. Filling out this questionnaire is voluntary.
1. Is your current address a temporary living arrangement? Yes __ No __
2. Is your temporary address due to loss of housing or economic hardship? Yes __ No __
If you answered “NO” to both of these questions you may stop here. Thank you.
Responses to the rest of this page are also voluntary and will tell us that you are interested in possible services under
McKinney-Vento. If you answered “yes” to the questions above, please fill out the remainder of this form. You may fill out
one form for all of your children.
Names of adults in the home: ____________________________________________ Date: _______________
__________________________________________________________________
Name of School Name of Student Grade Address Phone number
1. Where are these students presently living? (Check one box.)
Doubled up with relatives or friends
In a transitional housing program
In a motel
In a shelter
Moving from place to place
In a place not considered traditional “housing” (campground, car, public place, etc.)
2. Do you also have pre-school children at home? Yes __ No __
3. Are you a high school student who is currently living on your own due to hardship? Yes __ No __
Unaccompanied youth also qualify for services under this law.
4. Are there any pressing needs that could prevent your child from being successful in school?
Yes __ No __
Please explain: _______________________________________________________________________________
Rev. 01/2013
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political beliefs/affiliation, disability, home language, family,
social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by
Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
McKinney-Vento Regulations
If your living arrangement is both temporary and the result of economic hardship, you may qualify for services
under the McKinney-Vento Act. The purpose of this law is to provide academic stability for students of families in
transition.
You may want to talk with the Amphitheater Homeless Education Liaison if your family’s temporary living
arrangement is one of the following:
You are living with friends or relatives, or moving from place to place, because you cannot currently
afford your own housing.
You are living in a shelter or a motel.
You are living in a Transitional Housing Program
You are living in housing without water or electricity.
You are living in a place not considered traditional “housing”, like a car or a campground.
You are a student living on your own (in a similar situation) without a parent or legal guardian.
*A student may qualify as an “unaccompanied youth” if he or she is living with someone who is not a parent or
guardian, or if he or she is moving from place to place without a parent or guardian.
Children who qualify under McKinney-Vento have the right to:
Attend the school they were attending when their family was forced to move to a temporary address
because of economic hardship, even if that school is in another school district. The choice must be a
reasonable one that is in the best interest of the children involved. Check with the district Homeless
Education Liaison if you are not sure.
Attend the school closest to where they are being sheltered.
Stay in this school for the duration of the school year if their families are forced to move to another
temporary address because of economic hardship.
Receive assistance with transportation to attend school while they are being temporarily housed.
Start school immediately while people at school help families obtain school and immunization records
or other documents necessary for enrollment.
Enroll in school without having a permanent address.
Participate in the same programs and services that other students participate in.
Receive Title 1 services, including free breakfast and lunch.
If you feel your family may be eligible under the McKinney-Vento Homeless Assistance Act, please contact M
ary Beth Santillan,
McKinney-Vento Ed. Liaison, @ 696-6946 or mbsantillan@amphi.com Rev. 01/2013
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political beliefs/
affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the District’s non-
discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw, Executive
Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
Communication
This form is to ensure that your family will receive communication via email from the Wilson
office, administration, and PTO. Emails are sent out weekly (Notes Home) with all the most up
to date information about what is going on around the school and community.
We only need ONE form per family!
Parent Name: _______________________________________
Parent Email: _______________________________________
There are times when we want to send separate emails to either Middle School or Elementary
School so please mark where your children are attending, if attending both, please mark both.
I have children in Middle School
I have children in Elementary School
Volunteering at Wilson
There are many opportunities to volunteer at Wilson. Please choose all the opportunities you
would be interested in volunteering for!
Round Up/Chili Cook Off
Silent Auction
Father/Daughter Dance
Spring Festival
8
th
Promotion Activities
STEM Night
Mother/Son Event
Trunk or Treat
Book Fair
Amphitheater Unified School District does not discriminate on the basis of race, color, religion/religious beliefs, gender, sex, age, national origin, sexual orientation, creed, citizenship status, marital status, political
beliefs/affiliation, disability, home language, family, social or cultural background in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding the
District’s non-discrimination policies are handled at 701 W. Wetmore Road, Tucson, Arizona 85705 by Anna Maiden, Equal Opportunity & Compliance Director, (520) 696-5164, amaiden@amphi.com, or Kristin McGraw,
Executive Director of Student Services, (520) 696-5230, kmcgraw@amphi.com.
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WILSON K-8 SCHOOL Kinder Student Registration Checklist Birth (Amphitheater Public Schools)

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Completed 31 January 2021

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