2017-2018 REGISTRATION PACKET

Alice Buzanis, Principal Kimberly Easter, Assistant Principal

2017-2018

REGISTRATION PACKET

ALL INDIVIDUALS REGISTERING A CHILD TO SHERWOOD SCHOOL MUST BE THE LEGAL GUARDIAN. THE LEGAL GUARDIAN MUST PRESENT A DRIVERS LISCENCE OR A STATE IDENTIFICATION WITH THE CURRENT ADDRESS AND A UTILITY BILL. SHERWOOD IS OPEN TO ALL NEIGHBORHOOD CHILDREN.

ALL STUDENTS MUST WEAR A UNIFORM EVERYDAY. PRE-K-8TH GRADE STUDENTS BLACK BOTTOMS AND PURPLE TOPS. UNIFORMS AND GYM UNIFORMS CAN BE PURCHASED AT THE SCHOOL.

REGISTRATION CHECKLIST

At the registration meeting with each family:

Complete with the family:

Share with the family:

School Enrollment Form Parent Agreement Release Form Request for Emergency and Health Information Home Language Survey Media Consent Form and Release Family Partnership Needs Assessment Student Medical Information

Minimum Health Requirements Rights of Students in Temporary

Living Situations

Give to families to complete and return before the first day of enrollment:

Dental Form Certificate of Child Health Examination

Note: In accordance with the McKinney Vento Homeless Assistance Act, students in a temporary living situation are eligible for immediate enrollment (see Rights of Homeless Students).

CHI CAGO Public Schools

QUESTIONS?

Contact Alice Buzanis, Principal 773.535-0829

Rev. 07/2014

Chicago Public Schools School Enrollment Form

School Name Jesse Sherwood Elementary School

Student Information

Student's siblings' names if currently enrolled in CPS:

Student ID#

School Use Only:

Prevent duplicate student records. Search in SIM for an existing Student ID before creating a new one.

Last Name

First Name

Gender

_ Birth date (mm/dd/yyyy)

Middle Name

Generation (Jr., etc)

_ Registration Grade Level (when first entering CPS)

Personal, Immigrant, and

Refugee Information

Y / N

Birth Certificate on File

Birth Verification Type

To Parent/Guardian:

CPS is required to keep a count of immigrant students for Federal and State Guidelines in order to determine if additional resources and services for students are needed.

Note that this is not an inquiry on citizenship status, and all information will be kept confidential.

* Birth Country

Birth State

Birth City

* Complete if student was not born in the United States (US) or one of its Territories: Date of first enrollment in any US School:

Full Years completed school in US:

Student has refugee status: Y / N

Country of refugee:

School Use Only: Note that "Date of first enrollment in any US School" becomes a required field in SIM if "Birth Country" is not the US or one of its Territories.

Student Address/Phone

Physical (Home) Address Street Number and Name

Apt. City

State

Zip Code

Mailing Address (if different than Home) Street Number and Name

Home Phone Number

Apt. City

State

Zip Code

Demographic, Federal Ethnic and Race Categories: (Enter information into SIM from the Race and Ethnicity Survey form)

Home Language, Parent/Guardian Contacts, Emergency/Health Information

Home Language Survey: (Enter information into SIM from the Home Language Survey form) Parent/Guardian Contacts: (Enter information into SIM from the Request for Emergency and Health Information form) Emergency/Health Information: (Enter information into SIM from the Request for Emergency and Health Information form)

Enrollment

Enrollment Status Codes:

01 ? No Former School 02 ? Chicago Public School

(to incl. Charter/Contract) 03 ? Chicago Private School 04 ? IL Public Schl, not Chicago 05 ? IL Private Schl, not Chicago 06 ? US Public Schl, not Illinois 07 ? US Private Schl, not Illinois 08 ? Not in USA

*School Transferring From ((if not a Chicago Public, Charter or Contract School)

City and State

*Is the student in good standing? Y / N

(Instructions to school: for out-of-state public school or any private school students, a certification of "good standing" should be received from the Parent/Guardian. Refer to CPS Policy 10-0623-PO1 for more information.)

Last Chicago Public, Charter, or Contract School Attended

Is the student receiving any type of Special Education services? Y / N

(Instructions to school: if yes, please notify the Case Manager.)

Student Enrolled by

(Print Name and Relationship)

Signature of Parent/Guardian

School Use Only: Enrollment Status Code (insert a # from the left)

Grade Level

Date of Enrollment Homeroom/Division #

Jesse Sherwood Elementary School Alice Buzanis, Principal

PARENT AGREEMENT FORM

CHILD'S NAME:

DATE

SCHOOL NAME:

ROOM

I wish to have my child enroll at Jesse Sherwood Elementary School. I take full responsibility for his/her safe transportation to and from school and promise I will make sure he/she wears their uniform everyday. I understand the importance of daily attendance and agree to bring my child to school everyday and to fully participate in the program, including daily outdoor play during reccess. Additionally, I will adhere to the school schedule so that my child is dropped off and picked up on time.

I understand that I am expected to communicate with my child's teacher via email or via telephone weekly. I am willing to attend meetings, workshops or conferences at the school as may be requested.

I give my permission for my child to be taken on trips related to the classroom program, including walking trips within the community.

Home Visit Preference

I understand that the relationship between home and school is vital to a child's future success, and recognize that two home visits a year are an integral part of the school program. I prefer to have my child's preschool staff conduct a home visit in the following setting:

My home

Other place of my choice:

SIGNATURE OF PARENT/GUARDIAN

Chicago Public Schools Jesse Sherwood Elementary School

STUDENT RELEASE FORM

CHILD'S NAME SCHOOL NAME PARENT'S NAME

DATE ROOM

The following people have permission to pick up my child from Sherwood:

SIGNATURE OF PARENT

NAME PHONE NUMBER

NAME PHONE NUMBER

RELATIONSHIP TO CHILD RELATIONSHIP TO CHILD

NAME PHONE NUMBER

NAME PHONE NUMBER

RELATIONSHIP TO CHILD RELATIONSHIP TO CHILD

Child WILL NOT be released to anyone other than the individuals named above. Changes must be made in WRITING by the legal guardian. Please ask the individual picking up your child to bring identification with a picture.

Rev. 01/2014

Request for Emergency and Health Information

Chicago Public Schools

School Name: Jesse Sherwood Elementary School

PARENTS/GUARDIANS: The school must have on file emergency information that can be used to contact you. Please print clearly. Whenever there is a change in this information, immediately notify the school in writing.

Student ID#

Last Name

First Name

Middle Name

Homeroom #

Birth Date (mm/dd/yyyy) Student Home Address

Confidential Information Box 1

Complete this box only if (1) it reflects your child's current living situation; OR (2) it reflects your living situation if you are a youth not living with a Parent or Guardian. (Your answer will help school staff with enrollment and may enable the student to receive additional services.) Check one box:

awaiting foster care placement in a car/park/other public place doubled-up in a hotel/motel in a shelter in transitional housing School Note: If any box is checked, see the CPS Policy 702.5.

Student Home Phone #

Confidential Information Box 2

Is there a current Order of Protection or No Contact

Order which concerns this student? Yes

No

School Note: If "Yes," follow CPS Policy 704.4 procedures. Enter information in Legal Alert field and update contact information, as needed, in SIM.

Parent/Guardian and Emergency Contact Information: Add extra contacts on the back of this form, if needed.

Parent/Guardian Contact

Parent/Guardian Contact

Contact Name

Relationship to Student

Check all that apply:

Home Address, if different from student's Home Phone Number, if different from student's Cell Phone Number

Lives With Emergency

Gets Mailings Permission to Pickup

Lives With Emergency

Gets Mailings Permission to Pickup

Email Address

Name and Address of Employer

Work Phone Number

* Communication Language

* CPS communicates via phone calls. Select the language that should be used to communicate with you. Languages available for mass communication at this time are English and Spanish (note: other languages upon availability).

List the na me of a relative or neighbor who can also be notified in an emergency and has permission to pick up the student:

Name

Home Address

Telephone #

Relationship

Family Doctor's Name, Address, and Phone Number: I authorize you to call my family doctor, if necessary, in an emergency.

Student Health Insurance: (select only one of the three)

Illinois Medical Card/All Kids: provide student's medical ID #

No Insurance: are you interested in applying for the Illinois Medical Card/All Kids?

Yes

No

Private/Employer Health Insurance: no additional information needed

(9-digit number located on back of card)

Children of Military Personnel (optional)

As the Parent or Guardian, are you a member of a branch of the armed forces of the United States?

Yes

No

If yes, are you either deployed to active duty or expect to be deployed to active duty during the school year?

Yes

No

I certify that the information on this form is correct:

(Parent/Guardian Signature)

(Date)

Chicago Public Schools

Complete this Home Language Survey at the student's initial enrollment in a Chicago Public School.

This form must be kept in the student's folder.

School: Jesse Sherwood Elementary School

Room:

Unit:

Area:

Student Name:

English 1. Is a language other than English spoken in your home?

No

Yes

(Language)

2. Does the student speak a language other than English?

No

Yes

(Language)

If the answer to either question is yes, the law requires the school to assess your child's English language proficiency.

Student ID No.:

IMPACT REGISTRATION PROCESS

(For Office use only)

? The Non-English language identified on either question is the Home Language. ? If two different non-English languages are identified, enter the language identified in question 2 as the Home Language. ? Enter ENGLISH as a Home Language ONLY when both questions are answered no.

Spanish

1. ?Se habla alg?n otro lenguaje que no sea ingl?s en su hogar?

No

S?

(Lenguaje)

2. ?Habla el estudiante un lenguaje que no sea el ingl?s?

No

S?

(Lenguaje)

Si la respuesta a cualquiera de las preguntas es "S?", la ley requiere

que la escuela eval?e la fluidez de su ni?o en el idioma ingl?s.

Chinese

Polish

1. Czy jzykiem innym ni angielski m?wi si w domu?

Nie

Tak

(jzyk)

2. Czyt ucze m?wi innym jzykiem ni angielski?

Nie

Tak

(jzyk)

Jeli udzielili Pastwo twierdzcej odpowiedzi na kt?rekolwiek z powyszych pyta, przepisy wymagaj, aby szkola sprawdzila poziom znajomoci jzyka angielskiego waszego dziecka.

Arabic

"",

Bosnian/Croatian/Serbian

.

Urdu

Office of Language and Cultural Education

Revised: Mar. 2009

Ukoliko ste na bilo koje od ovih pitanja odgovorili sa "Da", skola e biti zakonski duzna da procijeni nivo znanja engleskog jezika kod vaseg djeteta

Signature of School Official

Date

Signature of Parent/Guardian

Date

Notes: ? If the parent/guardian does not speak English and the school does not have staff who speaks the parent/guardian's language, identify the

language spoken by the parent/guardian through any assistance available in the school.

? If exact name of the language cannot be determined, enter "Other" as a temporary entry. The exact language must be determined within two weeks after the enrollment. Assistance from Area Compliance Facilitators is available.

? Questions or concerns, contact your Area Compliance Facilitator.

Media Consent Form and Release

Consent/Release

I hereby consent to have my child photographed, digitally recorded, video taped, audio taped and/or interviewed by the Board of Education of the City of Chicago (the "Board") or the news media when school is in session or when my child is under the supervision of the Board. Further, I consent for these photos, digital recordings, video tapes, audio tapes and/or interviews to be shared with third parties who have received written approval from the Office of Communications. I understand in the course of the above described activities that the Board might like to celebrate my child's accomplishments and work. Therefore, I further consent for the Board's release of information on m y child's name, academic/non-academic awards and information concerning m y child's participation in school-sponsored activities, organizations and athletics.

I also consent to the Board's use of m y child's name, photograph or likeness, voice or creative work(s) on the Internet or on a CD or any other electronic/digital media or print media.

As the child's parent or legal guardian, I agree to release and hold harmless the Board, its members, trustees, agents, officers, contractors, volunteers and employees from and against any and all claims, demands, actions, complaints, suits or other forms of liability that shall arise out of or by reason of, or be caused by the use of my child's name, photograph or likeness, voice or creative work(s), on television, radio or motion pictures, or on the Internet, or on a CD, or any other electronic/digital media or print media.

It is further understood and I do agree that no monies or other consideration in any form, including reimbursement for any expenses incurred by me or my child, will become due to me, my child, our heirs, agents, or assigns at any time because of m y child's participation in any of the above activities or the above-described use of my child's name, photograph or likeness, voice or creative work(s).

I understand that I may cancel this release by providing written notice to the principal. I also understand that this release is valid for one school year, including the following summer.

Instructions: Check Box #1 or Box #2

1.

I consent as outlined in the above consent/release section.

2. I DO NOT consent as outlined in the above consent/release section.

Signature of Parent/Guardian/Student if age 18 or older

Printed Name of Parent/Guardian/Student if age 18 or older

Student's Name

Student ID #

Date

School

I understand that I have the right to inspect and copy my student's records, challenge the contents of such records; and limit my consent to the designated records or designated portions of information within the records.

Department of Education Policy and Procedures

08.28.2014

Family Partnership Needs Assessment

Please check, sign and date one category below:

( ) Yes, I am interested in developing family goals as part of the Family Partnership Agreement. I may need information or assistance with: (please check all that apply)

Basic Life Skills

Housing

Child Care

Legal Assistance

Child Development

Literacy

Mental Health

Education

Domestic Violence

Employment

Health/Nutrition

Substance Abuse

Parent Involvement

Other:

My personal goal for this year is: (Example: GED; job training; employment)

Steps needed to reach this goal are:

I may need assistance to reach this goal: If yes, please explain:

Yes _No

( ) No, I am not interested in developing family goals, at this time. I understand that I may choose to develop family goals at anytime during my child's enrollment.

The process of developing family goals as part of the Family Partnership Agreement has been explained to me.

Parent Signature

_ Date

Staff Signature

Date

School

Classroom Room

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