New Student Enrollment Packet Please review the information below. Based on your student’s grade and applicable circumstances, you are required to submit documentation in order to complete the enrollment process. Item

Item Description

Provided by

Proof of Age

Official Birth Certificate (not the hospital issued certificate)

Provided by you

Social Security Card

A copy of the Social Security Card will be made by the office secretary.

Provided by you

Legal Guardian’s Drivers License

Legal Guardian’s Drivers License or State ID. (copy will be made by School Secretary)

Provided by you

Proof of Residency

Proof of Residency: Current Utility bill showing service address, Mortgage statement/Rental Contract including signature page, recent tax statement.

Provided by You

Current Immunization Records

Since many types of personal immunization records are in use, any document will be acceptable provided a physician or public health personnel has validated it. The month, day, and year that the vaccination was received must be recorded on all school immunization records created or updated after September 1, 1991.

Provided by you

(office use only)

Contents STUDENT REGISTRATION AND DATA VERIFICATION FORM ........................................................................................................................................................... 2  Affidavit of Student Residency ....................................................................................................................................................................................................... 4  STUDENT HEALTH HISTORY............................................................................................................................................................................................................ 5  Texas School Immunization Law .................................................................................................................................................................................................... 6  Occupational Survey ...................................................................................................................................................................................................................... 7  Texas Public School Student/Staff Ethnicity and Race Data Questionnaire ................................................................................................................................... 8  Home Language Survey ............................................................................................................................................................................................................... 10  Corporal Punishment ................................................................................................................................................................................................................... 11  Parent Consent Form ................................................................................................................................................................................................................... 11  Notice of Compulsory Attendance Law ....................................................................................................................................................................................... 12  Parent Permission – Technology ...................................................................................................................................................................................... 13  High School Student ‐Technology Acknowledgement ................................................................................................................................................................. 14  Open Campus Acknowledgement ................................................................................................................................................................................................ 15  Release of Student Information ................................................................................................................................................................................................... 16  Field Trips/Extracurricular Activities ............................................................................................................................................................................................ 17  Consent/Opt‐Out Form ................................................................................................................................................................................................................ 18  Student Handbook ....................................................................................................................................................................................................................... 19  Acknowledgment Form ................................................................................................................................................................................................................ 19  Student Code of Conduct ............................................................................................................................................................................................................. 19  Acknowledgment Form ................................................................................................................................................................................................................ 19  STUDENT LUNCH PRICES .............................................................................................................................................................................................................. 20 

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Office Use Only 

 

Student ID# ___________________________________      Texas Unique ID#____________________________________  Grade: ______                                                                               Entry Date:___________________________________   

STUDENT REGISTRATION AND DATA VERIFICATION FORM STUDENT INFORMATION  

Legal Name:  First_____________________ Middle___________________ Last_______________________________   

   

 

 

 

 

SSN: __ __ __‐__ __‐__ __ __ __         Date of Birth: __ __ /__ __ /__ __ __ __    Sex:   ____ Male  ____ Female                                                Hispanic/Latino:  Yes or No    Race:      White          Black/African American       Asian          American Indian     Hawaiian/Pacific Isl

  Phone Number: (__ __ __) __ __ __ ‐ __ __ __ __   Mailing Address:          ____________________________      ____________________________      ____________________________       

Cell Phone Number: (__ __ __) __ __ __ ‐ __ __ __ __  Physical Address:    (check if same as mailing)  _________________________  _________________________ 

Name of Last School Attended:   ___________________________________________________________________________    Address: ______________________  City, State, Zip ________________________________Grade enrolling in _____________    Please Provide the Following Information Yes No Is Student a minor not living with a parent or guardian? If “yes”, provide explanation (Grandparent, Foster  Parent, etc…)  :______________________________________________________________________  Has student been suspended or expelled from a previously attended school?  Has the student attended an out of state school? If “yes,” school (s) attended: ______________________________________________________________________________   Is Student a dependent of an active member of the US Military, US Military Reserves, or the Texas National  Guard?  Has the student ever been retained? If “yes,” what grade (s)?_____________________

             

Is the student receiving special education services? Is the student receiving speech?  Has the student been dismissed from a special education program? If “yes,” what date?_______________  Is the student a 504 student (handicapping conditions other than special education)? Is the student in the English as a Second Language Program (ESL) or a Bilingual Program? Is the student in a Dyslexia Program? If “yes,” what program? Has the student been identified as Gifted/Talented in a Texas school? If :yes”, what school district?   ____________________________      Year ____   Subject (s)_______ 

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Information on Person Enrolling Student Name: ____________________________________________________________________________ Address _____________________________________________________________________________ City ______________________ State ____ Zip _________ Home Phone (_____) __________________ Work phone (______) ______ - __________

Cellular phone (______) ______ - ___________

Driver’s License # ____________________ (State)________ D.O.B. _______________________

Parent/Guardian Information Father’s/Guardian Name: ______________________________________________________________ Address _____________________________________________________________________________ City ______________________ State ____ Zip _________ Home Phone (_____) __________________ Work phone (______) ______ - __________

Cellular phone (______) ______ - ___________

Driver’s License # ____________________ (State)________ D.O.B. ____________________________ Mother’s/Guardian Name: _______________________________________________________________ Address:_____________________________________________________________________________ City ________________________________ State ____ Zip ________ Home Phone ________________ Work phone (______) ______ - __________

Cellular Phone. (______) ______ - ___________

Driver’s License # ____________________ (State)_________ D.O,B. _________________________

Emergency Contact (Other than parents and/or guardians) Name: _____________________________________________________________________________ Address _____________________________________________________________________________ City ______________________ State ____ Zip _________ Home Phone (_____) __________________ Work phone (______) ______ - __________

Cellular phone (______) ______ - ___________

Name: ______________________________________________________________________________ Address:_____________________________________________________________________________ City ________________________________ State ____ Zip ________ Home Phone ________________ Work phone (______) ______ - __________

Cellular Phone. (______) ______ - ___________

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Affidavit of Student Residency Student Legal Name: First ___________________Middle _______________ Last Name ___________________ Student lives with the following person(s): _____________________________________and/or_________________________________ First and Last name of Father/Stepfather/Grandfather/Other

First and Last name of Mother/Stepmother/Grandmother/Other

At the Following Address: __________________________________________________________________ Street Address City, Zip Texas Education Code § 25.001 authorizes Texas school districts to obtain evidence that a person is eligible to attend the public schools of the district at the time of enrollment. To be eligible for continued enrollment in Rankin ISD, the parent or guardian of a student must show proof of residency at the time of enrollment. To comply with residency requirements, the parent or guardian of a student must return this document to Rankin ISD with an original of at least two of the following documents showing name and verifiable current address. El § 25.001 del código de la educación de Tejas autoriza districtos de la escuela de Tejas para obtener evidencia que una persona es elegible atender a las escuelas públicas del districto a la hora de la inscripción. Para ser elegible para la inscripción continuada en Rankin ISD, el padre o el guarda de un estudiante debe demostrar la prueba de la implantación a la hora de la inscripción. Para conformarse con requisitos de la implantación, el padre o el guarda de un estudiante debe volver este documento a Rankin ISD con una original de por lo menos dos de los documentos siguientes que demuestran la dirección actual conocida y comprobable.

(Documents showing evidence of any alteration will not be accepted.) Parent / Guardian must provide one of the following documents: _______ Current Utility Bill in parent/guardian’s name _______ Voter Registration Card _______ Executed lease agreement _______ Deed of Sale _______ Tax Statement ____________________________________________ ____________________________ Signature of Parent or Guardian Date I affirm that I have seen and reviewed the verification of residency. _______________________________________, ____________________________ Signature of School Official Date

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STUDENT HEALTH HISTORY Student: ___________________________________________________ Phone # (_______) - _______ -_______ LAST Campus_________

FIRST

MIDDLE

Student resides with Parent(s) _________________ Spouse _______________ Other _________________

Allergies Does your child have a food allergy?

________yes or _________no

Please list student allergies to medicine, food, environmental, or other that you are aware of or suspect: _____________________________________________________________________________________________

  My child’s medical needs are served by: _____Private Insurance 

        _____Medicaid 

 

_____No Insurance 

  

Does your child have a medical condition requiring continuing medical care during the school day?    YES    NO    (circle one)    If Yes, explain: _______________________________________________________________________________________________    

Has your child ever been hospitalized, had surgery, or been involved in a serious accident?    YES   NO     (circle one)  If Yes, explain: _______________________________________________________________________________________________    

Is your child on any kind of medication? If so, what? _______________________________________________________________  For what condition(s)?_________________________________________________________________________________________    To be taken at school?    YES    NO    (circle one)    If yes, a medication form MUST BE COMPLETED.     Student Medical Information Yes No Student Medical Information Yes No Arthritis Hearing Loss Asthma (mild , severe) circle one

Hearing Disease/Disorder

Attention Deficit Disorder (ADD) Attention Deficit Hyperactivity Disorder (ADHD) Ausism Spectrum Disorder

Migraine Headaches

Blood Disorder

Seizure Disorder

Cancer Chicken Pox Disease

Vision Loss (glasses, contacts) circle one Other (list)

Chicken Pox Vaccination

Other (list)

Fracture

Other (list)

Scoliosis

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Texas School Immunization Law Rule 97.66 & 97.69 Effective April 1, 2004 Student Name: _______________________________________________ Date of enrollment: ____________________________________________ 30 Days after enrollment: _______________________________________ The law requires that students be fully vaccinated against the specified disease. A student can be provisionally enrolled for no more than 30 days if: La ley requiere que vacunen a los estudiantes completamente contra la enfermedad especificada. Un estudiante puede ser alistado provisional por no más de 30 días si: 1.

He/She transfers for one Texas school to another. estudiante transferencias para una escuela de Tejas a otra

2.

A dependent of a person who is on active duty with the armed forces of the United States. Un dependiente de una persona que está en servicio activo con las fuerzas armadas de los Estados Unidos

3. A student is homeless, as defined by 103 of the McKinney Act, 42 USC 11302 or 4. Un estudiante es sin hogar, según lo definido por 103 del acto de McKinney, 42 USC 11302 o 4. 4.

A student has at least one does of specified age –appropriate vaccine and completing the scheduled vaccine series as rapidly as is medically feasible. Un estudiante tiene por lo menos uno hace de edad especificada - vacuna apropiada y terminar la serie vaccínea programar tan rápidamente como es médicamente factible.

At the end of the 30 day period if the student is not in compliance, then the school shall exclude the student from school attendance until the required dose is administered. En el final del período de 30 días si el estudiante no está en conformidad, entonces la escuela excluirá a estudiante de la atención de escuela hasta que se administra la dosis requerida.

I have read the information above and understand that if the proper immunization records have not been received by Rankin ISD with 30 days of enrollment, then my child will be withdrawn from school until valid documentation of immunizations is on file. He leído la información arriba y entiendo que si los expedientes apropiados de la inmunización no han sido recibidos por Rankin ISD con 30 días de la inscripción, después retirarán a mi niño de escuela hasta que la documentación válida de inmunizaciones está en archivo.

Furthermore, I realize that it is my responsibilities to verify receipt of such records prior to the deadline. Además, realizo que es mis responsabilidades verificar el recibo de tales expedientes antes del plazo.

_________________________________________ Signature (Parent/Guardian)

______________________ Date

     

 

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Occupational Survey Your Children May Be Eligible for Extra Services (Sus niños pueden ser elegibles para los servicios adicionales)

IMPORTANT: Please complete the survey below and return it to your school office. (INPORTANTE: Termine por favor el examen abajo y vuélvalo a su oficina de la escuela.)

Name of Student ______________________________Grade________________ Within the past three (3) years, has your child(ren) traveled or moved alone with a parent, relative, guardian, or a spouse so that a family member could look for or do temporary or seasonal agricultural work or employment? (Dentro de los últimos tres (3) años, tiene su niño viajó o se movió solamente con un padre, pariente, guarda, o un esposo de modo que un miembro de la familia pudiera buscar o lo haga trabajo agrícola o empleo temporal o estacional?)

Yes ____ No ___ Signature of Parent/Guardian_____________________________ Date _______________ If No, please stop here and hand this survey back to your school district. (Si no, para por favor aquí y da este examen de nuevo a su districto de la escuela.)

Did you seek or obtain employment in agricultural or fishing related activities within the last three years? (e.g. field work, canneries, lumbering, dairy work, meat processing) Trabeja usted in la agricultura o en la pesca? (per ejemple, la labor, fabrica de conservas, explotacion de bisques, trabajo en la lecheria, el proceso de carne)

___ Yes ___ No Have you moved within the last 3 years to find this type of work? Ha viajado usted o alguien en su familia para encontrar este tipo de trabajo?

___ Yes ___ No

  Is this type of work an important source of income for your family? Es este tipo de trabajo necesario para cubrir las necesidades basicas de la familia?

___ Yes ___ No Contact Information Name of Child(ren)_______________________________ Age_________

Grade ______

Father/Guardian _______________________________________________________ Mother/Guardian_______________________________________________________

  Home Phone (____) _________________________ Other Phone (____) ______________

       

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Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire  The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Not Hispanic/Latino Part 2. Race: What is the person’s race? (Choose one or more) American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

   

________________________________ Student/Staff Name (please print)

________________________________ (Parent/Guardian)/(Staff) Signature

________________________________ Student/Staff Identification Number

________________________________ Date

 

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Agencia de Educación de Texas Cuestionario de Información de Datos Raciales y de Etnicidad de Estudiantes/Miembros de Personal de las Escuelas Públicas de Texas El Departamento de Educación de Estados Unidos (USDE) requiere que todas las instituciones estatales y locales de educación, recopilen datos sobre etnicidad y raza de los estudiantes y de miembros de personal. Esta información es utilizada para los reportes estatales y federales así como para reportar a la Oficina de Derechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo (EEOC). Al personal del distrito escolar y los padres o representante legal de estudiantes que deseen matricularse en la escuela, se le requiere proporcionar esta información. Si usted rehúsa proporcionarla, es importante que sepa que el USDE requiere que los distritos escolares usen la observación para identificación como último recurso para obtener estos datos utilizados para reportes federales. Favor de contestar ambas partes de las siguientes preguntas sobre la etnicidad y raza del estudiante así como del miembro de personal. Registro Federal de Estados Unidos (71 FR 44866). Parte 1. Etnicidad: ¿Es la persona Hispana/Latina? (Escoja solo una respuesta) Hispano/Latino – Una persona de origen cubano, mexicano, puertorriqueño, centro o sudamericano o de otra cultura u origen español, sin importar la raza. No Hispano/Latino Parte 2. Raza. ¿Cuál es la raza de la persona? (Escoja uno o más de uno) Indio Americano o Nativo de Alaska – Una persona con orígenes o de personas originarias de Norte y Sudamérica (incluyendo America Central), y que mantiene lazos o apego comunitario con una afiliación de alguna tribu. Asiático – Una persona con orígenes o de personas originarias del Lejano Este, Sureste de Asia o el subcontinente indio, incluyendo, por ejemplo a Cambodia, China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia y Vietnam. Negro o Áfrico-Americano – Una persona con orígenes de cualquier grupo racial negro de África. Nativo de Hawai u otras islas del pacífico – Una persona con orígenes o de personas originarias de Hawai, Guam, Samoa u otras Islas del Pacífico. Blanco – Una persona con orígenes de personas originarias de Europa, el Medio Este o el Norte de África.

________________________________

________________________________

Nombre del Estudiante/Miembro de Personal

Firma (Padre/Representante legal)

(por favor use letra de imprenta)

/(Miembro de personal

________________________________ Número de Identificación del Estudiante/Miembro del personal

________________________________ Fecha

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Home Language Survey

Student / Estudiante___________________________________________________

Age / Edad __________

Campus / Escuela ____________________________________________________

Grade / Grado ________

Schools are required by Texas law to determine the following information for all students. Please help us meet this requirement by answering every question and signing and dating the form. A parent, guardian or student may sign when the student is in ninth grade or higher; otherwise, a parent or guardian must sign. 1. In what month and year did the student first enroll in a school in the United States? ____/_______ 2. What language is spoken in your home most of the time?_________________________________ 3. What language does the student speak most of the time?_________________________________ 4. If your child moved here from another country within the last three years, what year did he/she enter the United States. ______________/_______________ Month

Year

Cuestionario del Idioma en el Hogar Bajo la Ley de Texas se requiere que las escuelas determinen la siguiente información por cada estudiante. Por favor, ayúdenos por contestar cada pregunta y por firmar y notar la fecha. Cuando el estudiante esté cursando el noveno grado o uno más alto, pueden firmar el padre, la madre, el guardián, o el estudiante. De otra manera, solamente pueden firmar los padres o los guardianes. 1. En qué mes y año se inscribió el estudiante por primera vez en Los Estados Unidos? __________ 2. Cuál es el idioma que más se habla en su casa? _________________________________________________ 3. Cuál es el idioma que más habla el estudiante?__________________________________________________ 4. Si su nino se movio aqui desde otro pais en el plazo de los tres anos pasados, que ano hizo la entran en los Estados Unidos? _______________/_______________

                   

 

 

Ano

Mes De

Signature (Firma)_________________________________________ Date (Fecha)___________

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Corporal Punishment Parent Consent Form The local School Board Policy and the Laws of the State of Texas allow the use of corporal punishment as an option in  the discipline plan of each school. This form is provided to give you (parent/guardian) the option of whether or not you  want to give permission to the school to have corporal punishment as a discipline option available in working with your  child.  Please complete the form below.  YES, I give my permission for the school to administer  corporal punishment to my child  NO, I do not give my permission for the school to administer  corporal punishment to my child.    _______________________________________________________                       __________________  Student Name                          Grade  _______________________________________________________    __________________  Parent/Guardian Signature                Date   

Costigo Corporal Forma Del Consentimiento del Padre La política local de la escuela y los leyes del estado de Tejas permiten el uso del castigo corporal como una opción en el plan de la disciplina de cada escuela. Esta forma se proporciona para darle (padre/guarda) la opción de si o no usted desea dar el permiso a la escuela de tener castigo corporal como opción de la disciplina disponible en el trabajo con su niño. Llene el froma abajo. SÍ, doy mi permiso para que la escuela administre el castigo corporal a mi niño NO, no doy mi permiso para que la escuela administre el castigo corporal a mi niño.   _______________________________________________________                       __________________________ 

Estudiante ________________________________________ Firma (Padre/Representante legal)

Grado __________________ fecha

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Notice of Compulsory Attendance Law This notice is to advise you that according to Section 25.085 of the Texas Education Code, children between the ages of six (6) and their 18th birthday are required to attend school on a daily basis unless specifically exempted by Section 25.086. A child who is required to attend school under this section shall attend school each day for the entire period the program of instruction is provided. The law places the responsibility on parents or those who stand in parental relationship to see that children attend school regularly. Any parent or person failing to require his child to attend school as required by law may be subject to a fine–an offense under this section is a Class C Misdemeanor and is punishable by a fine of UP TO $500 for each offense. Section 25.095 states that a parent will be notified in writing if a child is absent 10 days or parts of days during a sixmonth period or three (3) or more days or parts of days during a four-week period. Responsive Education Solutions will enforce these laws as stated by the Education Code and will report all offenses to the local authorities. By signing below I am acknowledging the receipt of this notification ___________________________________________________________________ Este aviso es aconsejarle que según la sección 25.085 del código de la educación de Tejas, requieran a los niños entre las edades de seises (6) y su décimo octavo cumpleaños atender a la escuela sobre una base diaria a menos que sean eximidos específicamente por Section 25.086. Un niño que se requiere atender a la escuela bajo esta sección atenderá a la escuela cada día para el período entero que el programa de la instrucción se proporciona. La ley pone la responsabilidad en los padres o los que están parados en la relación parental para considerar que los niños atienden a la escuela regularmente. Cualquier padre o persona que no puede requerir a su niño atender a la escuela según los requisitos de ley puede estar conforme a una ofensa fina-uno bajo esta sección es un delito menor de la clase C y es castigable por una multa de HASTA $500 para cada ofensa. La sección 25.095 indica que notificarán a un padre en la escritura si un niño es 10 días o partes ausentes de días durante un semestre o tres (3) o más días o porciones de días durante un período cuatrisemanal. Las soluciones responsivas de la educación harán cumplir estos leyes según lo indicado por el código de la educación y divulgarán todas las ofensas a las autoridades locales. Firmando abajo me estoy reconociendo el recibo de esta notificación

Signature (Firma)_________________________________________ Date (Fecha)___________

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Parent Permission – Technology I understand that this form must be signed and returned to the School Office before my child is allowed access to District Networks, computer systems, and the internet. Entiendo que esta forma se debe firmar y volver a la oficina de la escuela antes de que no prohiban mi niño el acceso a las redes del districto, a los sistemas informáticos, y al Internet.

Important – Please read each of the following paragraphs then check the options below, stating you understand the extensive use of the electronic systems as an important tool in the 21st Century classroom and that you grant permission for your child to participate in the District’s electronic computer system including the Internet and certify that the information contained on this form is correct. Computer based instruction including computer literacy is part of the Rankin ISD curriculum at every grade level. If you deny permission for your child to participate in the computer based instruction and/or guided internet activities, be aware that it will impact your child’s classroom experience. Importante - lea por favor cada uno de los párrafos siguientes después compruebe las opciones abajo, indicándole entienda que el uso extenso de los sistemas electrónicos como herramienta importante en la sala de clase del siglo XXI y ése usted conceden el permiso para que su niño participe en el sistema informático electrónico del districto incluyendo el Internet y certifique que la información contenida en esta forma está correcta. La instrucción computarizada incluyendo conocimiento de informática es parte del plan de estudios de Rankin ISD en cada nivel del grado. Si usted niega el permiso para que su niño participe en la instrucción computarizada y/o las actividades dirigidas del Internet, esté enterado que afectará la experiencia de la sala de clase de su niño.

From time to time the school may wish to publish examples of a student’s work or participation in activities on our district webpage. With your permission, your child’s picture and/or project may be posted on a page. La escuela puede desear de vez en cuando publicar ejemplos del trabajo o de la participación de un estudiante en actividades en nuestro Web page del districto. Con su permiso, el cuadro y/o el proyecto de su niño se pueden fijar en una página.

Video Conferencing is a two way video and two-way audio technology in which cameras are used to send images and sound for one location to another. These sessions are live and an interactive learning experience, and may be taped for educational purposes. With your permission, your child will be able to participate in an Interactive Video Conference that may be scheduled throughout this school year. La comunicación video es un vídeo de dos vías y una tecnología audio de dos vías en los cuales las cámaras fotográficas se utilizan para enviar imágenes y el sonido para una localización a otra. Estas sesiones son vivas y una experiencia de aprendizaje interactiva, y se pueden grabar para los propósitos educativos. Con su permiso, su niño podrá participar en una videoconferencia interactiva que se pueda programar a través de este año escolar.

My child may participate in computer-based instruction on the school network.

____ Yes ____No

Mi niño puede participar en la instrucción computarizada de la escuela.

My child may participate in guided Internet activities.

____ Yes ____No

Mi niño puede participar en actividades dirigidas del Internet.

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My child may have his/her picture published on the District Webpage.

____ Yes ____No

Mi niño puede hacer su fotografa en el Web page del districto.

My child may have his/her project published on the District Webpage.

____ Yes ____No

Mi niño puede hacer su proyecto publicar en el Web page del districto.

My child may participate in Interactive Video Conferences.

____ Yes ____No

Mi niño puede participar en conferencias video interactivas.

My child may be videotaped for educational purposes or projects.

____ Yes ____No

Mi niño puede ser grabado para los propósitos o los proyectos educativos.

I certify that I understand this policy, and that I have read and reviewed it with my child and explained it implications. I understand that I will be held accountable for my child’s actions, and the disciplinary and/or legal actions will result from violations of this policy. In consideration for the privilege of my child using the District’s computer system and in consideration for having access to the public networks, I hereby release the District, it’s operators and any institution with which they are affiliated from, any and all claims and damages of any nature arising from my child’s use of, or inability to use, the system, policy, and administrative regulations. Certifico que entiendo esta política, y que lo he leído y lo he repasado con mi niño y he explicado las implicaciones. Entiendo que me sostendrán responsable de las acciones de mi niño, y las demandas disciplinarias y/o legales resultarán de violaciones de esta política. En la consideración para el privilegio de mi niño que usa el sistema informático del districto y en la consideración para tener acceso a las redes públicas, lanzo por este medio el districto, es los operadores y cualquier institución con de quienes sean afiliados, cualquiera y todas las demandas y daños de cualquier naturaleza que se presenta del uso de mi niño de, o inhabilidad de utilizar, el sistema, la política, y las regulaciones administrativas.

Parents/Guardian ______________________________________________________ Please print Signature _____________________________________________ Date _______________________

High School Student ‐Technology Acknowledgement

(6-12 grades only)   I understand that my computer use is not private and that the District will monitor my activity on the computer system. I have read the District’s electronic communication system policy and administrative regulations and agree to abide by their provisions. I understand that violation of these provisions may result in suspension or revocation of system access.

Student’s Printed Name: _______________________________________________________ Student’s signature _____________________________________________Date _______________ 14 | P a g e                                                                           R I S D   E N R O L L M E N T   F R O M S   ( R E V I S E D   7 / 1 0 / 2 0 1 7 )    

Open Campus Acknowledgement Junior High (6-8) Students Only

Rankin High School is an open campus during the lunch period. This form must be completed and turned into the high school office before your middle school student is allowed to leave campus for lunch. Student’s Name____________________________________ Grade: (circle one)

6th, 7th or 8th

I, ___________________________________________, certify that I am the parent/guardian of the above listed student. I am requesting my student be allowed to leave campus for lunch. I take full responsibility for my child and his/her safety. I release Rankin Independent School District from any liability resulting in my child leaving school for lunch. I understand that if my child violates any policy in the student handbook; he/she may lose their off-campus lunch privilege at the discretion of and for a time to be determined by the high school principal.

Signature _________________________________________ Date _________

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Parent’s Response Regarding Release of Student Information

(All Students)   According to the Federal Family Education Rights and Privacy Act of 1974 (FERPA), directory information about students  may be released by the district without parental consent, provided annual notification has been given and the School  does not have on file written denial to release directory information; however, schools do use discretion when they  receive requests for directory information and will not release such information if it is the principal’s judgment that  releasing such information would not be in the best interest of the student.   

  Rankin Independent School District has several publications, including The Pitchfork, The Red  Devil Yearbook, and our website, which is located at www.rankinisd.net.  The purpose of the  publications is to inform others about our school and to share the accomplishments of our  students and our school district.  Our Yearbook and Pitchfork staff take many pictures  throughout the year of our students participating in the Classroom, UIL, Athletics, Clubs, and  Organizations.  Due to the fact that our publications are made available to the public, we are  requesting your permission to include your student’s work, name, and/or photograph.  Please  note that if your permission is not given, your child’s name and/or photograph will be  excluded from all school publications.  If you have any questions, please feel free to contact  Kendra Davidson at (432) 693‐2451 ext. 1171.    By my signature, I give permission for my child’s photograph, writing, school work, video,  and/or name to be included in the publications provided by Rankin Independent School  District.  (Check One)   ________ Permission Granted           ______Permission Denied    Student Name: ______________________________   Grade: _____________  Parent Signature: ____________________________   Date: ______________ 

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Student Participation Field Trips/Extracurricular Activities   I, ______________________________, agree to allow my child,_________________________________, to attend all  field trips and/or short excursions at any time during the school year that the teacher may deem necessary for concrete  experiences or extracurricular travel based on the sport/academic team my child may be a part of.      I understand that while my child’s safety is a high priority for the District, under State Law, the school may not be  responsible for the medical cost associated with a student injury.    I expressly waive all claims for medical expenses, loss of services, or other claims, and I agree to indemnify and hold  harmless the District, its Trustees, employees, and agents from all claims made against it or them on behalf of my child.     I agree to indemnify and hold harmless the District, its Trustees, employees and agents from all claims made by third  parties against it or them which result from my child’s actions on the trip.     I have read and understand this release and sign it voluntarily and with full knowledge of its significance.    Signature ___________________________________________________ Date ______________

Consent to Medical Treatment By my signature below, I authorize the principal, professional employee, or volunteer who is supervising curricular and extracurricular activities to consent to emergency medical treatment for my minor child’s illness or injury that may occur while my child is participating in curricular and extracurricular activities. Known Allergies:_______________________________________________________________ Current Medications:____________________________________________________________ Insurance Information:____________________________________________________________ Insurance Responsible Party:______________________________________________

Signature ___________________________________________________ Date ______________

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Consent/Opt‐Out Form Rankin ISD is required by federal law to notify you and obtain your consent for or denial of (optout) for your child’s participation in certain school activities. The activities include any student survey, analysis, or evaluation, known as “protected information survey” that concerns one or more of the following eight areas: 1. 2. 3. 4. 5. 6. 7. 8.

Political affiliations or beliefs of the students or student’s parents. Mental of psychological problems of the student of student’s family. Sexual behavior of attitudes. Illegal, antisocial, self-incrimination or demanding behavior. Critical appraisals of others with whom the student has a close family relationship. Legally recognized privileged relationships, such as a lawyer, doctor, or minister. Religious practices, affiliations, of beliefs of the student or parent. Income, other than as required by law to determine program eligibility or to receive financial assistance under such program.

This notice and consent/opt-out requirement also applies to the collection, discloser, or use of student information for marketing purposes and to certain physical exams and screenings. Following activities requiring parental notice and consent or opt out for the 2017-2018 school year. Please note that this notice and authority to consent transfer from the parent to student when the student turns 18 or is an emancipated minor under state law. Date: On or about March, 2018. Grades: 5th – 12th Activity: Safe & Drug Free Schools Survey Summary: This is an anonymous survey that asks students questions about safety in their school and if they think there is a drug problem in their school. ***Contact Principal no later than August 31, 2017, if you do not want your child to participate in this activity If you wish to review any survey instrument of instructional material used in connection with any protected information survey, please submit a request to the campus principal. The campus principal will notify you of the time and place where you may review these materials. You have the right to review a survey and/or instructional materials before the survey is administered to a student.

Student’s Printed Name: _______________________________________________________

Student’s signature _____________________________________________Date ___________

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Student Handbook Acknowledgment Form My child and I have received a copy of the Rankin Independent School District Student Handbook and the Student Code of Conduct for 2017-2018. I understand that the handbook contains information that my child and I may need during the school year and that all students will be held accountable for their behavior and will be subject to the disciplinary consequences outlined in the Student Code of Conduct. If I have any questions regarding this handbook and/or the Student Code of Conduct, I should direct those questions to the principal. High School: Mr. Adrian Gallardo, 432-693-2451, [email protected]; Elementary: Mr. Brad Riker, 432-693-2455, [email protected] Printed name of student: __________________________________________ Signature of student:

_______________________________________________

Signature of parent:

_______________________________________________

_____________________________________________________________________________

Student Code of Conduct Acknowledgment Form I have read the Rankin ISD Extracurricular Code of Conduct and agree to adhere to these rules as a condition for my voluntary participation in Rankin ISD extracurricular activities. I understand that failure to do so will result in disciplinary measures related to my extracurricular participation Printed name of student:

__________________________________________

Signature of student: I have read the Rankin ISD Extracurricular Code of Conduct and understand requirements for my child’s voluntary participation in Rankin ISD extracurricular activities. I understand the consequences that my child will face if he or she fails to adhere to these rules and agree to such terms. Signature of parent: Date:

_________________________________________________________

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STUDENT LUNCH PRICES PK-6th grade $2.00

7th – 12th grade $2.50

REDUCED PRICE (if qualified) 40¢

District serves breakfast at no cost to students. Please complete the School Meals Application (next pages) LUNCHES MAY BE PURCHASED IN ADVANCE AT CAMPUS OFFICES, CAFETERIA OFFICE, AND ONLINE AT MySchoolBucks.com (link to this site on the Rankin ISD website www.rankinisd.net). MEALS MAY BE PURCHASED IN THE CAFETERIA AT THE TIME OF SERVICE. NO CHARGE POLICY Although no student will be denied lunch, “CHARGING” is strongly discouraged. A student may be asked to call a parent or make other arrangements. If a student’s charges exceed $15.00 the student will receive an alternate meal. Termine por favor applicasion de las comidas de escuela (la página siguiente) Los ALMUERZOS SE PUEDEN COMPRAR POR ADELANTADO EN LAS OFICINAS del CAMPUS, la OFICINA de la CAFETERÍA, Y EN LÍNEA EN MySchoolBucks.com (acoplamiento a este sitio en el Web site www.rankinisd.net). LAS COMIDAS SE PUEDEN COMPRAR EN LA CAFETERÍA A LA HORA DE SERVICIO. Aunque no se negará ningún estudiante la comida, la “CARGA” se desalienta fuertemente. Un estudiante puede ser pedido llamar a un padre o tomar otras medidas. Si las cargas de un estudiante exceden de $15.00 el estudiante recibirá una comida alterna. The U.S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected]. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.

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