Kindergarten Enrollment Form-Perryton ISD Legal First Name: _______________________________ Middle Name: ____________________ Legal Last Name: ____________________________________ Social Security: ______________________________ Sex: ____________ DOB: _____________________ Birthplace: __________________________________ Parent/Guardian Information 1. ___________________________________________ Relation_______________ Home Phone _____________________ Cell Phone _____________________ Physical Address____________________________________________________________ Is this a permanent or temporary address? Permanent Temporary Mailing Address ________________________________________________________ e-mail _______________________________ Internet Access? Yes No Employer __________________________________________________ Work Phone _________________________________ 2. ___________________________________________ Relation_______________ Home Phone _____________________ Cell Phone _____________________ Physical Address____________________________________________________________ Is this a permanent or temporary address? Permanent Temporary Mailing Address ________________________________________________________ e-mail _______________________________ Internet Access? Yes No Employer __________________________________________________ Work Phone _________________________________ Who does the child live with? (circle one)

Parent 1

Parent 2

Brother(s)/Sister(s) enrolled in our school district now Name

Both Parents

Guardian (legal papers)

Grade

Guardian (no legal papers)

Campus

Emergency Contact Information (Other than Parent/Guardian) Name __________________________________ Relation _________________ Phone ____________________ Cell ________________ Work ________________ Name __________________________________ Relation _________________ Phone ____________________ Cell ________________ Work ________________ Previous School(s) Attended-If Any School Name ____________________________________________ Address _________________________________________ Phone _____________________ I certify the above information is true and correct. I, the undersigned, do hereby authorize officials of the school to contact directly the person(s) named on this form. In the event that parent/guardian or others named on this form cannot be contacted, the school officials are hereby authorized to take whatever action is necessary, in their judgment, for the heals of aforesaid child. I will not hold the school district financially responsible for the emergency care and/or transportation for said child. Signature of Enrolling Parent/Guardian ___________________________________________ Date of Birth_________________________ Relation to Student ________________ Home Address _________________________________________________________________ Date_______________________ What language do you prefer to receive school correspondence?

English

Spanish

PERRYTON INDEPENDENT SCHOOL DISTRICT Home Language Survey Name of Student___________________________________________________________________________ Campus _______________________ Grade_______________________ Date ________________________

To be Filled in By Parent or Guardian •

What language is spoken in your home MOST of the time? (Please check only one) ( ) English ( ) Spanish ( ) Other __________________________________

•

What language does your child speak MOST of the time? (Please check only one) ( ) English ( ) Spanish

( ) Other __________________________________

(PLEASE COMPLETE BACK SIDE OF FORM)

Cuestionario de Idioma en el Hogar Nombre del Estudiante________________________________________________________________________ Escuela_________________________ Grado ______________________Fecha __________________________

Debe de ser Completado por el Padre o Guardián •

¿Cuál es el idioma que MAS se habla en su hogar? (Marque solamente uno) ( ) Ingles

•

( ) Español

( ) Otro _______________________________________

¿Cuál es el idioma que su hijo/a habla MAS? (Marque solamente uno) ( ) Ingles

( ) Español

( ) Otro _______________________________________

(POR FAVOR COMPLETE LADO DE ATRÁS DE ESTA FORM)

• Has your child lived outside the U. S. for two or more consecutive years? ___ Yes ___ No If yes, when: _________________________ (from month/year to month/year and grade) If yes, when your child lived outside the U. S. did he/she attend school regularly? (Check One) _____Yes, my child attended school regularly in all previous grades outside the U. S. _____No, my child missed significant portions of one or more school years as specified: _______________________________________________________________________

_______________________________________________________

Signature of Parent/Guardian

•

¿Ha vivido su hijo/a fuera de los Estados Unidos por dos o más años consecutivos? ____Sí ____No Si marcó sí, cuando: ________________________________ (de mes/ año ha mes/año y grado) ¿Cuándo su hijo/a vivió fuera de los Estados Unidos, asistió regularmente a la escuela? (Marque uno). _____Sí, mi hijo/a asistió con regularidad a la escuela fuera de los Estados Unidos y terminó sus grados escolares anteriores. _____No, mi hijo/a perdió porciones significativas de uno o más años escolares, como se especifica a continuación: ____________________________________________________________________________

________________________________________________________

Firma del Padre/Guardián

PERRYTON ISD/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)

__________________________________________ Student/Staff Signature

_______________________________ Date This space reserved for Local school observer – upon completion and entering data in student software system, file this form in student’s permanent folder. Ethnicity – choose only one: _______ Hispanic/Latino _______ Not Hispanic/Latino Observer Signature:

Race – choose one or more: _______American Indian or Alaska Native _______Asian ________Black or African American _______White ________Native Hawaiian/Pacific Islander Campus & Date: