Michael Galland

22 feb. 2016 - BRIAN OSBORNE, ED.D. ... Beginning February 22nd, you may call our main office @ (914) 576-4421 to schedule an appointment for initial.
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GEORGE M. DAVIS JR. ELEMENTARY SCHOOL 80 ISELIN DRIVE NEW ROCHELLE, NEW YORK 10804

BRIAN OSBORNE, ED.D.

MICHAEL GALLAND

SUPERINTENDENT OF SCHOOLS

PRINCIPAL

DIANE MASSIMO, ED.D.

ANTHONY BAMBROLA

ASSISTANT SUPERINTENDENT OF SCHOOLS

ASSISTANT PRINCIPAL PHONE: 914-576-4421 FAX: 914-576-4225

February 22, 2016 Families of Incoming Davis Kindergarten Students: Kindergarten registration at Davis School will be completed in two phases. Initial registration will take place the week of March 14th. Student interviews/evaluations will take place during Wednesday, May 4th through Tuesday, May 10th (final step). Beginning February 22nd, you may call our main office @ (914) 576-4421 to schedule an appointment for initial registration. It is only necessary for one parent/guardian to attend this session. Children do not attend during initial registration. During the initial registration, main office staff will collect forms and check residency. You will also meet with our school nurse, Ms. Nancy Pritz and our social worker, Ms. Heather Cayanan. Again, we will not complete an interview/evaluation of your child in March; however, we will schedule a second appointment for May at the initial registration meeting. The entire process should last no more than thirty minutes.

In order to speed the registration process and help us stick to our schedule, please complete all registration forms should be completed BEFORE arriving at school for your registration appointment. Registration forms can be downloaded off our school website—http://davis.nred.org. At the time of initial registration, you will need to present the following in order to establish residency and eligibility: • • • •

Your child’s original birth certificate (or a certified copy) or passport Your child’s immunizations records (vaccinations/shots) Three (3) proofs of residence (utility bill, phone bill, water bill, tax bill, lease agreement, etc.) showing name and address Photo I.D. of parent/guardian

Along with the co-Presidents of the Davis PTA and our Kindergarten teachers, I’m thrilled to invite your family to attend an orientation meeting on Thursday, March 24th at 10:15 a.m. in our AV room in order to learn about our Kindergarten programs and the registration process in general. Our teachers will provide a quick overview of their work, and we will offer a walking tour of the school as well. Please inform other families with entering students of this meeting if possible! For years, Davis Elementary has proudly cherished each of our students and worked to adapt our instruction to meet every child’s individual needs and strengths. Our teachers and staff care deeply about our school and their work. We look forward to meeting another group of eager kindergarteners shortly, and look forward to welcoming your family into our nurturing school community. Sincerely,

Michael Galland Michael Galland Principal EMBRACING DIVERSITY, DRIVING SUCCESS

GEORGE M. DAVIS JR. ELEMENTARY SCHOOL 80 ISELIN DRIVE NEW ROCHELLE, NEW YORK 10804

BRIAN OSBORNE, ED.D.

MICHAEL GALLAND

SUPERINTENDENT OF SCHOOLS

PRINCIPAL

DIANE MASSIMO, ED.D.

ANTHONY BAMBROLA

ASSISTANT SUPERINTENDENT OF SCHOOLS

ASSISTANT PRINCIPAL PHONE: 914-576-4421 FAX: 914-576-4225

22 de febrero de 2016 A las familias de alumnos que entraran al jardín de niños de Davis: La inscripción para el jardín de niños de la escuela Davis se llevara a cabo en dos etapas. La inscripción inicial se llevara a cabo durante la semana del 14 de marzo hasta el día 18 (primera etapa); y las entrevistas y evaluaciones tendrán lugar del 4 de mayo hasta el 10 de mayo (etapa final). A partir del 22 de febrero, usted podrá llamar a nuestra oficina (914-576-4421) para hacer una cita para la etapa inicial de la inscripción. Solo es necesario que un padre/guardián venga para registrar un niño. Durante la inscripción inicial, el personal de la oficina de la escuela recogerá los formularios de inscripción y las pruebas de domicilio. También, usted se reunirá con nuestra enfermera, la Sra. Nancy Pritz, así como a nuestra trabajadora social, la Sra. Heather Cayanan. Una vez más, no vamos a completar la entrevista y evaluación de su hijo/a en marzo; más bien en la reunión inicial de inscripción programaremos una segunda cita para el mes de mayo. Todo el proceso no durara más de 30 minutos.

Con el fin de acelerar el proceso de inscripción y para ayudarnos a apegarnos a nuestro programa, por favor complete todos los formularios de inscripción incluidos ANTES de llegar a su cita en la escuela. Estos formularios están disponibles, para ser descargados, en nuestra página escolar de internet http://davis.nred.org. En el momento de la inscripción inicial, deberá presentar la siguiente documentación con el fin de determinar domicilio y elegibilidad: • • • •

El certificado/acta/partida original de nacimiento de su hijo/a (o copia certificada) El registro de inmunización de su hijo/a (vacunas) Tres (3) comprobantes de dirección ( factura de servicios, recibo del teléfono, del agua, del pago de impuestos, un lease, etc.) que muestren su nombre y dirección actual Una identificación con fotografía del padre/guardián

Junto a las copresidentes de Davis PTA y los maestros del jardín de niños estoy encantado de invitar a su familia a asistir a una reunión el 24 de marzo a las 10:15 A.M. en la sala de artes visuales (AV room) con el fin de aprender acerca de nuestros programas de jardín de niños y el proceso de inscripción en general. Nuestros maestros les proporcionaran una visión rápida de su trabajo, también les ofreceremos un recorrido por toda la escuela. ¡Por favor si le es posible avise a otras familias con niños en edad escolar a cerca de esta reunión! Durante años la escuela Davis ha apreciado con orgullo a cada uno de nuestros alumnos y se ha esforzado por adaptar nuestra instrucción a las necesidades y capacidades individuales de cada niño/a. Nuestros maestros y personal se preocupan profundamente por nuestra escuela y su trabajo. Esperamos con interés reunirnos en breve con otro grupo de niños entusiastas que vengan al jardín de niños, y esperamos dar la bienvenida a su familia a nuestra cálida comunidad escolar. Atentamente

Michael Galland Michael Galland Director EMBRACING DIVERSITY, DRIVING SUCCESS

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GEORGE M. DAVIS JR. ELEMENTARY SCHOOL 80 ISELIN DRIVE NEW ROCHELLE, NEW YORK 10804

BRIAN OSBORNE, ED.D.

MICHAEL GALLAND

SUPERINTENDENT OF SCHOOLS

PRINCIPAL

DIANE MASSIMO, ED.D.

ANTHONY BAMBROLA

ASSISTANT SUPERINTENDENT OF SCHOOLS

ASSISTANT PRINCIPAL PHONE: 914-576-4421 FAX: 914-576-4225

February 22, 2016 To the Family of ___________________________: Welcome to Davis! Thank you for scheduling an initial registration appointment for your child. Your initial registration appointment has been scheduled for: _____________________________ Please complete all the enclosed forms PRIOR to your appointment so as to help us maintain an efficient and timely process each day. Also remember that at the time of initial registration, you will need to present the following in order to establish residency and eligibility: • • • •

Your child’s original birth certificate (or a certified copy) or passport Your child’s immunizations records (vaccinations/shots) Three (3) proofs of residence (a utility bill, phone bill, water bill, tax bill, lease agreement, etc.) showing name and address Photo I.D. of parent/guardian

If a question concerning your residence arises, the School District will ask you to provide additional documentation of your residence. If, after supplying such evidence, verification remains unresolved, the School District will conduct a formal investigation into your residency. The District may ask you to provide further proof of residency, including the name and address of your employer, and/or may ask that you attend a conference. During such a conference, a District representative will present you with the evidence we have collected regarding your residency, and you will be given an opportunity to respond. After the conference, the School District will reach its determination as to your actual residence. If our investigation reveals that you are not a District resident and that you have not relinquished custody and control of your child to a New Rochelle resident, your child will not be permitted to enroll in New Rochelle schools. Please sign (below) to affirm that you have read and understand our residency requirements and processes outlined in this letter, and to affirm that your children are indeed residents of the City School District of New Rochelle. Sincerely,

Michael Galland Michael Galland Principal Student’s Name: ________________________________________ Parent/Guardian’s Signature: ________________________________ Date: ___________

EMBRACING DIVERSITY, DRIVING SUCCESS

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GEORGE M. DAVIS JR. ELEMENTARY SCHOOL 80 ISELIN DRIVE NEW ROCHELLE, NEW YORK 10804

BRIAN OSBORNE, ED.D.

MICHAEL GALLAND

SUPERINTENDENT OF SCHOOLS

PRINCIPAL

DIANE MASSIMO, ED.D.

ANTHONY BAMBROLA

ASSISTANT SUPERINTENDENT OF SCHOOLS

ASSISTANT PRINCIPAL PHONE: 914-576-4421 FAX: 914-576-4225

22 febrero 2016 To the Family of ___________________, ¡Bienvenido a Davis! Gracias por hacer una cita de inscripción inicial para su hijo. Su cita inicial de inscripción se ha programado para: ___________________________ Por favor, complete todos los formularios adjuntos antes de su cita con el fin de ayudar a mantener un proceso eficiente y rápido cada día. También recuerda que en el momento de la inscripción inicial, tendrá que presentar la siguiente con el fin de establecer la residencia y elegibilidad : • Certificado de su hijo de nacimiento original ( o copia certificada ) o pasaporte • vacunas de su hijo registros (vacunas / Remates) • Tres (3) comprobantes de domicilio ( una factura de servicios , factura de teléfono , recibo del agua, recibo de la contribución, lease, etc.) que muestran su nombre y dirección • Foto I.D. del padre / tutor Si una pregunta con respecto a su residencia se adquiere, el Distrito Escolar le pedirá que proporcione documentación adicional de su residencia. Si, después de suministrar dicha prueba, la verificación no se resuelve, el Distrito Escolar llevará a cabo una investigación formal en su residencia. El Distrito puede pedir que proporcione una prueba de domicilio, incluyendo el nombre y dirección de su empleador, y/o puede pedirle que asista a una conferencia. Durante una conferencia de este tipo, un representante del Distrito le presentará la evidencia que hemos recolectado con respecto a su residencia, y se le dará la oportunidad de responder. Después de la conferencia, el Distrito Escolar llegará a su determinación en cuanto a su residencia real. Si nuestra investigación revela que usted no es un residente del Distrito y que no ha renunciado a la custodia y el control de su hijo a un residente de New Rochelle, su hijo no se le permitirá inscribirse en las escuelas de Nueva Rochelle. Por favor, firme (abajo) para afirmar que ha leído y entendido nuestras necesidades y procesos descritos en esta carta de residencia, y afirmar que sus hijos son de hecho los residentes del Distrito Escolar de la Ciudad de New Rochelle Atentamente,

Michael Galland Michael Galland Director Student’s Name: ________________________________________ Parent/Guardian’s Signature: ________________________________ Date: ___________ EMBRACING DIVERSITY, DRIVING SUCCESS

FOR OFFICE USE ONLY: Birth Cert. Res. Medical forms ID# CENSUS # Magnet Yes No District-wide Special Education: Yes No

Lang. Survey

M F

Transportation

Verified by:

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM GEORGE M. DAVIS ELEMENTARY SCHOOL Registration Information Only students whose parents or legal guardians reside in New Rochelle may be registered in our district schools. Students attend school according to their area of residence, except in the cast of Magnet students. Proofs of residence must be provided in accordance with district policy. If the person registering the child is not listed as the parent, he/she must provide a copy of the following at time of registration: Court Order naming “Parent by Adoption” or “Legal Guardian” or “Order of Custody.” PLEASE PRINT:

Today’s Date:

Child’s Name: Date of Birth: Male Female City and Country of Birth: Cultural Ethnicity (optional) If Foreign Born: Date of entry into U.S. Did Child attend school outside of U.S: Yes No If yes, which Grade(s) attended: Language(s) Spoken at Home: Child’s Current Grade: Last Grade Attended: When? Name of Last School: Address of Last School: Telephone Number of Last School: Name of Contact Person: Has this child attended school in New Rochelle: When? Where? Home Address: Street

Home Telephone Number (s):

City

State

Zip Code

___________

Father’s Name: Home Address:

Birthplace: Street

City

Email address: Telephone Numbers Home: Work: Occupation: Employer: Marital Status (Please Check One) Single Married

State

Zip Code

Cell: Separated Divorced

Mother’s Name (First and Maiden): Home Address:

Widowed

Birthplace:

Street

City

Email address: Telephone Numbers Home: Work: Occupation: Employer: Marital Status (Please Check One) Single Married

State

Zip Code

Cell: Separated Divorced

Widowed

Guardian/Custodian Name (other than parent): Home Address: Street

Relationship to Student: Telephone Numbers Home: Occupation:

City

Email address: Work: Cell: Employer: (Please continue to page 2)

State

Zip Code

Name

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM DAVIS ELEMENTARY List below the FULL names of all other children in the family Age Date of Birth School Child attends

Grade

Previous Home Address: Street

Country if other than U.S.

City

State

Zip Code

Previous Home Telephone Number:

Does your child have an I.E.P. from Special Education? Yes No Please list where and when your child has attended school: Grade School Attended/Location Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Support Services

Check all that apply

Grade(s) in which Services were Received

English as a Second Language Bilingual Class Reading Help/Lab Resource Room Speech/Language PT/OT Special Education Counseling/Social Skills Group Repeated a Grade Recommended to Repeat a Grade Other: (explain)

(Please continue to page 3)

Date of Attendance

Optional – Please check appropriate box(es)

Father

Mother American Indian/Alaska Asian Black/African American Hispanic or Latino Multiracial Native Hawaiian/Pac. Isl. White

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM DAVIS ELEMENTARY Child’s Name: Emergency Contact: Relationship to Child: Parent/Guardian: Telephone Numbers Home:

Work:

Cell:

Other Designated Adult (Include Relationship to child): Telephone Numbers Home:

Work:

Cell:

PLEASE NOTE: IT IS IMPORTANT FOR YOU TO PROVIDE THE SCHOOL WITH YOUR CURRENT PHONE NUMBERS IN ORDER THAT YOU CAN BE REACHED IN THE EVENT OF AN EMERGENCY. PLEASE NOTIFY THE SCHOOL WITH ANY CHANGES TO YOUR CONTACT INFORMATION, I.E., CHANGES TO PHONE NUMBERS, ADDRESS CHANGE, EMERGENCY CONTACT NAMES, ETC.

SIGN FORM IN PRESENCE OF SCHOOL PERSONNEL AT THE SCHOOL REGISTRATION:

Print Name of Parent or Guardian Completing Form

Signature of Parent or Guardian Completing Form

Today’s Date

FOR OFFICE USE ONLY: Birth Cert. ID#

Res. Medical forms CENSUS #

Lang. Survey

Transportation

M F

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM GEORGE M. DAVIS ELEMENTARY SCHOOL Información sobre la inscripción Sólo podrá inscribirse en nuestros distritos escolares los estudiantes cuyos padres o custodios legales residan en New Rochelle. Los estudiantes concurrirán a la escuela que corresponda a su área de residencia, salvo los que asistan a una escuela “Magnet”. Las pruebas de residencia se suministraran con arreglo a la práctica del distrito. Si la persona que inscribe al alumno no es padre o la madre, deberá presentar al momento de inscribirlo copia de la orden judicial que lo o la designe: padre adoptivo”, “tutor legal” o una “orden de custodia”. ESCRIBA CON LETRA DE IMPRENTA:

Fecha

Nombre del estudiante:________________________________ Fecha de nacimiento:_______________ sexo: M F Ciudad y país donde nació :__________________________________ Identidad étnica / cultural (opcional))_________ Si nació en el extranjero: fecha de ingreso en los EE.UU. __________________ idioma materno __________________ ¿Fue a la escuela en su país?: Sí No En caso afirmativo ¿qué grado(s) curso? ________________________________ Idioma que se habla en casa: Grado que cursa el estudiante: _______ Último grado que curso: _____ ¿Cuando? _________________________________ Nombre y dirección de la última escuela: __________________________________________________________________ Teléfono (Persona que pueda dar información, si la hubiese): __________________________________________________ El estudiante asistió a la escuela en New Rochelle?: ¿Cuando? __________ Dónde?___________ Domicilio de estudiante: _________________________________ _________________ _________ __________ ciudad

calle y no.

estado

código postal

No. (s) de teléfono particular(es): Nombre del padre: _____________________________________________Lugar de nacimiento:__________________ Domicilio del padre: _____________________________________ __________________ _________ __________ calle y no.

ciudad

estado

código postal

Email: ______________________________________________ Teléfono casa: _______________ el trabajo: _________________ móvil : _______________ Profesión : ___________________________________ Empleador: __________________________________________ Estado civil Soltero  Casado  Separado  Divorciado  Viudo  Nombre de la madre (primer nombre y apellido de soltera): ________________________________________________ Lugar de nacimiento:__________________ Domicilio de la madre: ___________________________________ _________________ ________ __________ calle y no.

ciudad

estado

código postal

Email: _________________________________________________ Teléfono casa: _______________ el trabajo: _________________ móvil : _______________ Profesión : ___________________________________ Empleador: __________________________________________ Estado civil Soltera Casada Separada Divorciada Viuda Nombre del tutor o custodio (si no es uno de los padres):____________________________________________________ Domicilio: ___________________________________________ _________________ ________ __________ calle y no.

ciudad

estado

código postal

Parentesco con el estudiante: ______________________________ Email : _________________________________ Teléfono casa: _______________ el trabajo: _________________ móvil : _______________ Profesión : ___________________________________ Empleador: __________________________________________ (siga en la página 2)

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM GEORGE M. DAVIS ELEMENTARY SCHOOL Indique más abajo los nombres COMPLETOS de todos los demás hijos Nombre Edad Fecha de Escuela la que asiste nacimiento

Domicilio anterior del estudiante: ____________________________ calle y no.

Grado

_________________ _________ ________ ciudad

estado

código postal

Teléfono anterior del estudiante:____________________________________________ ¿Su hijo recibe un plan especial de enseñanza (I.E.P.) de Educación Especial? Sí  No  Indique a qué escuelas asistió su hijo cuando : GRADO ESCUELA/LOCALIDAD

FECHAS DE ASISTENCIA

Preescolar Jardín de infantes

grado 2 º grado

3 º grado 4 º grado 5 º grado 6 º grado 7 º grado 8º grado 9 º grado 10 º grado 11 º grado 12 º grado SERVICIOS

* Inglés como Segundo idioma Clase bilingüe Ayuda /lab. de lectura Aula de recursos Dicción / lenguaje Terapia física / ocupacional Enseñanza especial Grupo de ayuda y socialización Repito un grado Recomendación de repetir un grado Otros servicios (describir)

GRADO(S) EN QUE SE RECIBIERON ESOS SERVICIOS

          

*MARQUE LO QUE CORRESPONDA (signa en la página 3)

Opcional-Marque lo que corresponda: Padre Madre  Indígena de los EE.UU.    Asiático  de las Islas del Pacífico    Hispano or Latino   Afroamericano   Caucásico   Otro

CITY SCHOOL DISTRICT OF NEW ROCHELLE REGISTRATION FORM GEORGE M. DAVIS ELEMENTARY SCHOOL

Nombre del estudiante:____________________________________________________________ Contacto de emergencia: __________________________________________________________ Relación con el estudiante: _________________________________________________________ Padre/Tutor:_____________________________________________________________________ Teléfono casa: _______________ el trabajo: _______________ móvil : _______________

Otro adulto designado (Relación con el estudiante):________________________________________ Teléfono casa: _______________ el trabajo: _______________ móvil : _______________

PADRES : Es importante para usted para proporcionar a la escuela con sus números de teléfono actual para que usted pueda ser alcanzado en el CASO DE EMERGENCIA FIRME EN PRESENCIA DEL PERSONAL DE LA ESCUELA EN LA REGISTRACION :

Imprimir Nombre del padre o tutor que llena el formulario

Firma del padre o tutor que llena el formulario

Fecha

NEW ROCHELLE CITY SCHOOL DISTRICT Office of Transportation 515 North Avenue, New Rochelle, NY 10801 AM BUS: ________________TIME:____________AM STOP:_____________________________________________ PM BUS: ________________TIME:____________PM STOP:_____________________________________________ BUS COMPANY: _______________________________________START DATE:_____________________________ Parent:/Guardian: Complete one application for each student being registered. The transportation office staff will identify and notify students by mail at the end of August those who meet the 1.5 mileage requirement necessary to receive bussing. PLEASE PRINT CLEARLY. REPORT PHONE NUMBER CHANGES TO THE TRANSPORTATION OFFICE IMMEDIATELY.

2016-2017 Transportation Application New Rochelle Public Elementary Schools Please check ONE of the four choices:

1. New Student:_________

3. Magnet

4. School Change:____________________________________

CILA

Kaleidoscope

2. Address Change:_________

(circle one) School:

Previous School

DAVIS ELEMENTARY

Grade (circle one):

Student ID#: (REQUIRED)_________________________

PA

PP

K

01 02 03 04 05

Today’s Date: __________________________

STUDENT DATA INFORMATION Student Name:_____________________________________________________________________________ LAST Name FIRST Name Middle Student Home Address: Street:____________________________________________________________ Apt No.:_________________ City:______________________________________ State:____________________ Zip:__________________ Date of Birth:__________________________

Sex:_____________________

Parent OR Legal/Custodial Guardian Information Title: (circle)

Dr.

Mr.

Mrs.

Ms.

Mr. & Mrs.

(print)

Other___________________

Mother________________________________________Father_______________________________________ Last name Primary Phone#

First name Mother Cell#

Last name

First name Father Cell#

E-Mail

Signature of Mother or Father or Legal/Custodial Guardian___________________________________________Relationship to Student:______________ (mother, father, other)

Emergency Contact (other than parent or legal/custodial guardian) Relationship Contact Name:_________________________________________________to Student: ____________________ Last name

First name

Preferably New Rochelle resident (friend, neighbor, other)

Home Phone: (______)__________________________ Work/Cell Phone: (_____)________________________ Revised 2-4-15

Dr. Brian Osborne, Superintendent of Schools Dr. Diane Massimo, Assistant Superintendent Please Print

City School District of New Rochelle Dismissal and Contact Form Despido y Contacto

Student’s Name / Nombre del estudiante

2016-2017 ID:

Date of Birth/ fecha de nacimiento

Home Address / dirección

City / ciudad

Teacher/ Maestro(a)

State / estado Zip / código de zip

Emergency Early Dismissal / Despido de Emergencia

In the event of an early dismissal due to an emergency (weather, etc.), please indicate how you child should go home. En caso de que las escuelas despachen los estudiantes temprano debido a una emergencia (clima, etc.), favor de indicar cómo niño(a) debe irse a su casa. Please check ALL boxes that apply:  Contact by phone any of the adults listed below in case of emergency / En caso de emergencia contacte a cualquier adulto nombrado en este documento abajo.  My child who normally walks has my permission to walk home. / Mi niño(a) que usualmente camina puede caminar a casa.  My child who normally is bused has my permission to be bused home. / Mi niño(a) que usualmente toma el autobús puede ir en autobús.  My child may be dismissed to any one of the adults listed below. / Mi niño(a) puede ser recogido (a) por uno de los adultos nombrado abajo.  My child may not be dismissed to anyone. / Mi niño (a) puede NO DEBE ser despachado con nadie.

All students dismissed to an adult must be met and signed out at the Principal’s Office. Todo estudiante despachado a un adulto se debe presentar al personal de la escuela ye tiene que firmar para recojer el estudiante en la oficina del director de la escuela.

Parent/Guardian #1 Padre/Tutor

Name / Nombre

Home / Casa

Telephone / Teléfono Work / Trabajo

Mobile / Móvil

Parent/Guardian #2 Madre/Tutor Adult #1 / Adulto #1 Adult #2 / Adulto #2

Emergency Contacts / Información de emergencia

Two people we can notify in an emergency, if you are not available. Please list a neighbor or relative who lives nearby and who is generally at home. Dos personas que se pueda llamar por alguna emergencia y que estén en casa. Name / Nombre 1 Telephone / Teléfono Home: Cell: Address / dirección Name / Nombre 2 Telephone / Teléfono Home: Cell: Address / dirección Doctor’s Name / Nombre del Doctor

Address / dirección

Telephone / Teléfono Home:

ATTENDANCE NOTIFICATION / NOTIFICACION DE ASISTENCIA

The School District routinely announces school related information by telephone, and also notifies parents of student absences. Please provide your preferred contact information to receive absence notices. / El Distrito Escolar anuncia habitualmente por teléfono información relacionada a las escuelas, incluyendo información sobre falta de asistencia a clases. Le pedimos proporcione el modo en el que desea ser informado sobre las faltas de asistencia. School Related Calls: Home / Casa Work / Trabajo Mobile / Móvil Text 9 Digits / Texto eMail

Regular Dismissal / Despido Normales

At Regular Dismissal my child will / Al Despido Regular mi niño(a) Be picked-up / Va a ser recogido Walk home alone / Caminar solo en casa Persons Authorized to pick-up my child / Personas autorizadas para recoger a mi niño(a) 1. 2. 3. 4.

New York State Immunization Requirements for School Entrance/Attendance 2015-16

Haemophilus influenzae type b conjugate vaccine (Hib)8

1 to 4 doses

Not applicable

Pneumococcal Conjugate vaccine (PCV)9

1 to 4 doses

Not applicable

Polio vaccine (IPV/OPV)4

3 doses

Measles, Mumps and Rubella vaccine (MMR)5

1 dose

2 doses

Hepatitis B vaccine6

3 doses

3 doses or 2 doses of adult hepatitis B vaccine (Recombivax) for children who received the doses at least 4 months apart between the ages of 11 through 15 years of age

Varicella (Chickenpox) vaccine7

1 dose

Tetanus and Diphtheria toxoid-containing vaccine and Pertussis vaccine booster (Tdap)3

2 doses 4 doses or 3 doses if the 3rd dose was received at 4 years of age or older

1 dose 3 doses

2 doses 4 doses or 3 doses if the 3rd dose was received at 4 years of age or older

Not applicable

Diphtheria and Tetanus toxoid-containing vaccine and Pertussis vaccine (DTaP/DTP/Tdap)2

4 doses Prekindergarten (Day Care, Head Start, Nursery or Pre-k)

Vaccines

1 dose 3 doses

1 dose

5 doses or 4 doses if the 4th dose was received at 4 years of age or older or 3 doses if the series is started at 7 years of age or older Kindergarten through Grade 1

3 doses

Grades 2 through 5

Grades 6 through 7

Grades 8 through 12

Dose requirements MUST be read with the footnotes of this schedule. For grades Pre-k through 7, intervals between doses of vaccine should be in accordance with the ACIP-recommended immunization schedule for persons 0 through 18 years of age. (Exception: intervals between doses of polio vaccine need to be reviewed only for grades kindergarten, 1, 6 and 7.) Doses received before the minimum age or intervals are not valid and do not count toward the number of doses listed below. Intervals between doses of vaccine DO NOT need to be reviewed for grades 8 through 12. See footnotes for specific information for each vaccine. Children who are enrolling in grade-less classes should meet the immunization requirements of the grades for which they are age equivalent. by the Advisory Committee for Immunization Practices (ACIP).

NOTES: Children in a prekindergarten setting should be age-appropriately immunized. The number of doses depends on the schedule recommended

2015-16 School Year New York State Immunization Requirements for School Entrance/Attendance1 1. Demonstrated serologic evidence of measles, mumps, rubella, hepatitis B, varicella or polio (for all three serotypes) antibodies is acceptable proof of immunity to these diseases. Diagnosis by a physician, physician assistant or nurse practitioner that a child has had varicella disease is acceptable proof of immunity to varicella.

6. Hepatitis B vaccine a. Dose 1 may be given at birth or anytime thereafter. Dose 2 must be received at least 4 weeks (28 days) after dose 1. Dose 3 must be at least 8 weeks after dose 2 AND at least 16 weeks after dose 1 AND no earlier than 24 weeks of age. b. Two doses of adult hepatitis B vaccine (Recombivax) received at least 4 months apart at age 11 through 15 years will meet the requirement.

2. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15 through 18 months, and 4 years of age or older. The fourth dose may be received as early as age 12 months, provided at least 6 months have elapsed since the third dose. However, the fourth dose of DTaP need not be repeated if it was administered at least 4 months after the third dose of DTaP. The final dose in the series must be received on or after the fourth birthday and at least 6 months after the previous dose. b. If the fourth dose of DTaP was administered at age 4 years or older, the fifth (booster) dose of DTaP vaccine is not necessary. c. For children born prior to 1/1/2005, doses of DT and Td meet the immunization requirement for diphtheria toxoid-containing vaccine. d. Children ages 7 through 10 years who are not fully immunized with the childhood DTaP vaccine series should receive Tdap vaccine as the first dose in the catch-up series; if additional doses are needed, use Td vaccine. A Tdap vaccine (or incorrectly administered DTaP vaccine) received at 7 years or age or older will meet the 6th grade Tdap requirement. e. For previously unvaccinated children 7 years of age and older, the immunization requirement is 3 doses. Tdap should be given for the first dose, followed by two doses of Td in accordance with the ACIP recommended immunization schedule for persons 0-18 years of age: an initial Tdap followed 4 weeks later by a Td, and 6 months later by another Td.

7. Varicella (chickenpox) vaccine. (Minimum age: 12 months) a. The first dose of varicella vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. Two doses of varicella vaccine are required for students in grades kindergarten, 1, 6 and 7. c. One dose of varicella vaccine is required for prekindergarten and grades 2 through 5 and 8 through 12.

8. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive Hib vaccine at 2 months, 4 months, 6 months and 12 through 59 months of age. b. If 2 doses of vaccine were received before 12 months of age, only 3 doses are required with dose 3 at 12 through 15 months of age and at least 8 weeks after dose 2. c. If dose 1 was received at ages 12 through 14 months of age, only 2 doses are required with dose 2 at least 8 weeks after dose 1. d. If dose 1 was received at 15 months of age or older, only 1 dose is required. e. Hib vaccine is not required for children 5 years of age or older.

9. Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks)

3. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. (Minimum age: 7 years)

a. Children starting the series on time should receive PCV vaccine at ages 2 months, 4 months, 6 months and 12 through 59 months of age. The final dose must be received at 12 through 59 months of age. b. Unvaccinated children 7 through 11 months of age are required to receive 2 doses, at least 4 weeks apart, followed by a third dose at age 12 through 15 months. c. Unvaccinated children 12 through 23 months of age are required to receive 2 doses of vaccine at least 8 weeks apart. d. If one dose of vaccine was received at 24 months of age or older, no further doses are required. e. For further information, refer to the PCV chart available in the School Survey Instruction Booklet at: www.health.ny.gov/prevention/immunization/schools

a. Students 11 years of age or older entering grades 6 through 12 are required to have one dose of Tdap. A dose received at 7 years of age or older will meet this requirement. b. Students who are 10 years old in grade 6 are in compliance until they turn 11 years of age.

4. Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks) a. Children starting the series on time should receive a series of IPV at ages 2, 4, 6 through 18 months, and 4 years of age or older. The final dose in the series must be received on or after the fourth birthday and at least 6 months after the previous dose. b. For students who received their fourth dose before August 7, 2010, 4 doses separated by at least 4 weeks is sufficient. c. If the third dose of polio vaccine was received at age 4 years or older and at least 6 months after the previous dose, the fourth dose of polio vaccine is not necessary.

For further information contact:

5. Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months) a. The first dose of MMR vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. Students in grades kindergarten through 12 must have received 2 doses of measles-containing vaccine, 2 doses of mumps-containing vaccine and at least 1 dose of rubella-containing vaccine. c. One dose of MMR is required for prekindergarten.

New York State Department of Health Bureau of Immunization Room 649, Corning Tower ESP Albany, NY 12237 (518) 473-4437 New York City Department of Health and Mental Hygiene Program Support Unit, Bureau of Immunization, 42-09 28th Street, 5th floor Long Island City, NY 11101 (347) 396-2433

New York State Department of Health/Bureau of Immunization health.ny.gov/immunization

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New York State Immunization Requirements for School Entrance/Attendance 2015-16

1 to 4 doses

Pneumococcal Conjugate vaccine (PCV)9

1 to 4 doses

Haemophilus influenzae type b conjugate vaccine (Hib)8 Varicella (Chickenpox) vaccine7

Not applicable Not applicable

1 dose

Hepatitis B vaccine6

2 doses

1 dose

Polio vaccine (IPV/OPV)4

3 doses

Tetanus and Diphtheria toxoid-containing vaccine and Pertussis vaccine booster (Tdap)3 Diphtheria and Tetanus toxoid-containing vaccine and Pertussis vaccine (DTaP/DTP/Tdap)2

4 doses

1 dose

2 doses 4 doses or 3 doses if the 3rd dose was received at 4 years of age or older

4 doses or 3 doses if the 3rd dose was received at 4 years of age or older

3 doses

Not applicable Prekindergarten (Day Care, Head Start, Nursery or Pre-k)

Vaccines

2 doses

3 doses or 2 doses of adult hepatitis B vaccine (Recombivax) for children who received the doses at least 4 months apart between the ages of 11 through 15 years of age

3 doses

Measles, Mumps and Rubella vaccine (MMR)5

1 dose

1 dose

5 doses or 4 doses if the 4th dose was received at 4 years of age or older or 3 doses if the series is started at 7 years of age or older Kindergarten through Grade 1

3 doses

Grades 2 through 5

3 doses Grades 6 through 7

Grades 8 through 12

Dose requirements MUST be read with the footnotes of this schedule. For grades Pre-k through 7, intervals between doses of vaccine should be in accordance with the ACIP-recommended immunization schedule for persons 0 through 18 years of age. (Exception: intervals between doses of polio vaccine need to be reviewed only for grades kindergarten, 1, 6 and 7.) Doses received before the minimum age or intervals are not valid and do not count toward the number of doses listed below. Intervals between doses of vaccine DO NOT need to be reviewed for grades 8 through 12. See footnotes for specific information for each vaccine. Children who are enrolling in grade-less classes should meet the immunization requirements of the grades for which they are age equivalent. by the Advisory Committee for Immunization Practices (ACIP).

NOTES: Children in a prekindergarten setting should be age-appropriately immunized. The number of doses depends on the schedule recommended

2015-16 School Year New York State Immunization Requirements for School Entrance/Attendance1 1. Demonstrated serologic evidence of measles, mumps, rubella, hepatitis B, varicella or polio (for all three serotypes) antibodies is acceptable proof of immunity to these diseases. Diagnosis by a physician, physician assistant or nurse practitioner that a child has had varicella disease is acceptable proof of immunity to varicella. 2. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15 through 18 months, and 4 years of age or older. The fourth dose may be received as early as age 12 months, provided at least 6 months have elapsed since the third dose. However, the fourth dose of DTaP need not be repeated if it was administered at least 4 months after the third dose of DTaP. The final dose in the series must be received on or after the fourth birthday and at least 6 months after the previous dose. b. If the fourth dose of DTaP was administered at age 4 years or older, the fifth (booster) dose of DTaP vaccine is not necessary. c. For children born prior to 1/1/2005, doses of DT and Td meet the immunization requirement for diphtheria toxoid-containing vaccine. d. Children ages 7 through 10 years who are not fully immunized with the childhood DTaP vaccine series should receive Tdap vaccine as the first dose in the catch-up series; if additional doses are needed, use Td vaccine. A Tdap vaccine (or incorrectly administered DTaP vaccine) received at 7 years or age or older will meet the 6th grade Tdap requirement. e. For previously unvaccinated children 7 years of age and older, the immunization requirement is 3 doses. Tdap should be given for the first dose, followed by two doses of Td in accordance with the ACIP recommended immunization schedule for persons 0-18 years of age: an initial Tdap followed 4 weeks later by a Td, and 6 months later by another Td.

3. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. (Minimum age: 7 years) a. Students 11 years of age or older entering grades 6 through 12 are required to have one dose of Tdap. A dose received at 7 years of age or older will meet this requirement. b. Students who are 10 years old in grade 6 are in compliance until they turn 11 years of age.

4. Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks) a. Children starting the series on time should receive a series of IPV at ages 2, 4, 6 through 18 months, and 4 years of age or older. The final dose in the series must be received on or after the fourth birthday and at least 6 months after the previous dose. b. For students who received their fourth dose before August 7, 2010, 4 doses separated by at least 4 weeks is sufficient. c. If the third dose of polio vaccine was received at age 4 years or older and at least 6 months after the previous dose, the fourth dose of polio vaccine is not necessary.

6. Hepatitis B vaccine a. Dose 1 may be given at birth or anytime thereafter. Dose 2 must be received at least 4 weeks (28 days) after dose 1. Dose 3 must be at least 8 weeks after dose 2 AND at least 16 weeks after dose 1 AND no earlier than 24 weeks of age. b. Two doses of adult hepatitis B vaccine (Recombivax) received at least 4 months apart at age 11 through 15 years will meet the requirement.

7. Varicella (chickenpox) vaccine. (Minimum age: 12 months) a. The first dose of varicella vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. Two doses of varicella vaccine are required for students in grades kindergarten, 1, 6 and 7. c. One dose of varicella vaccine is required for prekindergarten and grades 2 through 5 and 8 through 12.

8. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive Hib vaccine at 2 months, 4 months, 6 months and 12 through 59 months of age. b. If 2 doses of vaccine were received before 12 months of age, only 3 doses are required with dose 3 at 12 through 15 months of age and at least 8 weeks after dose 2. c. If dose 1 was received at ages 12 through 14 months of age, only 2 doses are required with dose 2 at least 8 weeks after dose 1. d. If dose 1 was received at 15 months of age or older, only 1 dose is required. e. Hib vaccine is not required for children 5 years of age or older.

9. Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks) a. Children starting the series on time should receive PCV vaccine at ages 2 months, 4 months, 6 months and 12 through 59 months of age. The final dose must be received at 12 through 59 months of age. b. Unvaccinated children 7 through 11 months of age are required to receive 2 doses, at least 4 weeks apart, followed by a third dose at age 12 through 15 months. c. Unvaccinated children 12 through 23 months of age are required to receive 2 doses of vaccine at least 8 weeks apart. d. If one dose of vaccine was received at 24 months of age or older, no further doses are required. e. For further information, refer to the PCV chart available in the School Survey Instruction Booklet at: www.health.ny.gov/prevention/immunization/schools

For further information contact:

5. Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months) a. The first dose of MMR vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. Students in grades kindergarten through 12 must have received 2 doses of measles-containing vaccine, 2 doses of mumps-containing vaccine and at least 1 dose of rubella-containing vaccine. c. One dose of MMR is required for prekindergarten.

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New York State Department of Health/Bureau of Immunization health.ny.gov/immunization

New York State Department of Health Bureau of Immunization Room 649, Corning Tower ESP Albany, NY 12237 (518) 473-4437 New York City Department of Health and Mental Hygiene Program Support Unit, Bureau of Immunization, 42-09 28th Street, 5th floor Long Island City, NY 11101 (347) 396-2433

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