THESE PEOPLE HAVE PERMISSION TO CHECK MY CHILD OUT OF SCHOOL

(In accordance to school system check-out procedures)

1. ________________________________Relation___________________________Phone__________________

2. ________________________________Relation___________________________Phone__________________

3. ________________________________Relation___________________________Phone__________________

ALABAMA APPLICATION FOR STUDENT ENROLLMENT

Must be completed by Parent/Legal Guardian DATE______________________________________ SCHOOL ______________________________

GRADE___________________________________

LAST NAME _____________________ FIRST NAME ____________________________ MIDDLE NAME__________

DATE OF BIRTH _________________ SEX-Circle One: MALE FEMALE HOME PHONE________________

PHYSICAL ADDRESS _______________________________ CITY ________________________ ZIP CODE___________

MAILING ADDRESS _______________________________ CITY ________________________ ZIP CODE___________

STUDENT LIVES WITH — Circle One PARENTS MOTHER FATHER GUARDIAN : RELATION_____________

*SOCIAL SECURITY NUMBER (voluntary) _____________________________

PARENT(S) / GUARDIAN (verification shall be in accordance with local school board policy)

MOTHER/GUARDIAN _______________________________ Address __________________________

Email Address ________________________________________ Cell Phone ____________________________

EMPLOYER _____________________________________________ Work Phone __________________________

FATHER/GUARDIAN ________________________________ Address ___________________________

Email Address ____________________________________ Cell Phone _________________________

EMPLOYER ______________________________________ Work Phone ___________________

SPECIAL INFORMATION ABOUT CUSTODY___________________________________________________________

____________________________________________________________________________________________ EMERGENCY CONTACT: (PLEASE LIST NUMBERS OTHER THAN YOUR OWN)

EMERGENCY #1 EMERGENCY #2

CONTACT _______________________________________ CONTACT_____________________________

NAME AND ADDRESS OF LAST SCHOOL ATTENDED:_____________________________________________________

______________________________________________________________________________________________

PARENT SIGNATURE_____________________________________________________________________________

*Disclosure of your child's social security number MN) Is voluntary. If you elect not to provide a SSN, a temporary Identification number will be generated and

utilized Instead. Your child's SSN Is being requested for use in conjunction with enrollment in school as provided in Ala. Admin. Code §290-3-1.02(2)(b)(2), it

will be used as a means of identification in the statewide student management system. January 2015

ALABAMA STATE DEPARTMENT OF EDUCATION

EMPLOYMENT SURVEY

SCHOOL SYSTEM: Limestone County SCHOOL YEAR:___________________________

SCHOOL: C r e e k s i d e E l e m e n t a r y GRADE______:___________________________

Dear Parents or Guardians;

Please, complete the following survey. The results of this survey will be used to determine if you are possibly

eligible for the Migrant Education Program.

Student Name:

Name of Parent or Guardian:

Address:

Telephone Number:_____________________________________________________

1. Have you moved during the last 3 years to work or to seek work even

if it was for a short period of time? YES NO

2. Are you or your spouse working or have you worked, in an activity

directly related to some of the following? Please, check all applicable:

The production or process of harvests, milk products, poultry farms, poultry plants or cattle farms

Fruit farms

The cultivation of cutting of trees

Work in nurseries or sod farms

Worm farms

Catching or processing seafood (shrimp, oysters, crabs, fish, etc…)

3. From what city, state or country did you come from?

4. What type of work did you or your spouse do before coming here?

Blackboard (automated calling system) Student Information Sheet

Parents,

The district utilizes a company that provides notification services for emergency broadcasts and parental outreach for K-12 Education.

The system is programmed to call up to 5 phone numbers of parents, grandparents, neighbors, etc for a variety of reasons that impact the safety and academic performance of your students. Blackboard will be used to complement our emergency preparedness procedures and to inform parents of upcoming school events such as statewide testing.

This system will not replace current modes of school communication. Principals and teachers are still accessible for live visits. Acquisition of the Blackboard system is intended to reinforce the district's commitment to remain personally connected to parents.

Please list up to 5 numbers (only direct numbers for the people you list) to be called in case of emergency or general announcements. Blackboard allows two types of phone calls: general information calls and emergency calls. Only the first telephone number listed below will be called for general information. General information calls may include but are not limited to athletic events, PTO meetings, awards day, school closings (when time permits), etc. All numbers will be called in case of an emergency. Emergency calls may include but are not limited to evacuations, emergency weather-related school closings and other situations when time is limited.

Cell phones, direct lines to you at work, home phone, neighbors, grandparents, etc. are all acceptable.

Make sure you notify the people you have listed to inform them that they will get calls.

Student Name: Grade Level:

Name: Will be used for: Phone number:

1. _______________________ Student Primary

2. ______________________ Emergency Only

3. ________________________ Emergency Only

4. ______________________ Emergency Only

5. ______________________ Emergency Only

* This document does not serve as a student contact listing for the local school

(those with permission to pickup or check-out students).

Ethnicity and Race

Student's Name: _______________________________________ Grade:__________

Parent/Guardian Signature: ______________________________ Date:______________

Please answer BOTH Question 1 AND Question 2

Question 1: Is this student Hispanic/Latino? CHOOSE ONLY ONE ETHNICITY:

NO, not Hispanic/Latino

YES, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

*The above question is about ethnicity, not race. No matter what you selected above, please continue to

answer the following Question 2 by marking one or more boxes to indicate what you consider your

student's race to be.

Question 2. What is the student'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 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,

Somoa, or other Pacific islands

WHITE. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

a BLACK OR AFRICAN AMERICAN. A person having origins in any of the black racial

groups of Africa.

a NATIVE HAWAIIAN OR OTHER PACIFIC !SUNDER. A person having origins in any of the

original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

a WHITE. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Additional Requested Information:

MILITARY

PRESCHOOL

SPECIAL EDUCATION SERVICES

SPECIAL EDUCATION SERVICES

Head Start - Circle One: YES NO First Class Funded Preschool - Circle One: YES NO

Centered Based Child Care – Circle One: YES NO Home Based Child Care – Circle One: YES NO

Home Visitation Program - Circle One: YES NO Other Preschool - Circle One: YES NO

No Preschool – Check if no Preschool Special Education Funded - Circle One: YES NO

Is student connected to an Active Duty Military Parent Circle One YES NO

Is student currently receiving special education services: Circle One: YES NO

LIMESTONE COUNTY SCHOOLS

Kindergarten Registration Form for 2016-2017 School Year

Today’s Date____________ School_____________________________

Age____ Birth Date ___________ *Birth Certificate #______________ **SS#______________ (voluntary)

Student’s Name ___________________________________________________________________________ Last First Middle

Student’s Preferred Name ______________________ Language Spoken at Home _____________________

Gender: M F Is this student Hispanic/Latino Yes No

What is the student’s race? Chooose one or more

American Indian or Alaska Native a person having orgins in any of the original peoples of North and South America (including Central

America), and who maintains tribal affiliation or community attachment Asian a person having orgins 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 orgins in any of the black racial groups of Africa

Native Hawaiian or Other Pacific Islander a person having orgins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific

Islands White a person having orgins in any of the original peoples of Europe, the Middle East, or North Africa

Physical Address________________________________ City_____________ State _____ Zip __________

P.O. Box_____________________________________ City_____________ State _____ Zip __________

Home Telephone _________________________

Emergency #’s: ____________________________ __________________________ _________________ Name Relationship Telephone

____________________________ __________________________ _________________ Name Relationship Telephone

Father’s Name______________________________ Mother’s Name________________________________

Address___________________________________ Address______________________________________ (if different from above) (if different from above)

City/State_________________________________ City/State____________________________________

Place of Employment__________________________ Place of Employment____________________________

Work #________________ Cell #______________ Work #________________ Cell #_________________

Email Address_______________________________ Email Address_________________________________

Student lives with: Father Mother Both Other______________________ Custody Papers

Guardian’s Name (If different from parent)______________________________________________________

Place of Employment____________________________________ Phone #____________________________

People allowed to check-out your child:

_________________________________ ______________________ _____________________ Name Relationship Phone #

_________________________________ ______________________ _____________________ Name Relationship Phone #

_________________________________ ______________________ _____________________ Name Relationship Phone #

_________________________________ ______________________ _____________________ Name Relationship Phone #

*A Birth Certificate is not required for enrollment. Other forms of documentation showing date of birth will carry equal value.

**Disclosure of your child’s Social Security Number (SSN) is voluntary. If you elect not to provide a SSN, a temporary identification number will be generated

and utilized instead. Your child’s SSN is being requested for use in conjunction with enrollment in school as provided in Alabama Administrative Code §290-3-

1.02(2)(b)(2). It will be used as a means of indentification in the statewide student management system.

Student’s Brothers/Sisters in School

_____________________________ Grade_______ _____________________________ Grade_______

_____________________________ Grade_______ _____________________________ Grade_______

List any special needs, health problems or medication of which teachers should be aware. (Explain)

________________________________________________________________________________________

________________________________________________________________________________________

Transportation: (please circle) Bus # ______ Car _______ Extended Day ______ Day Care Van ______

Give specific directions to student’s house from school._____________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

If the student is transferring please list the name and address of the last school attended:

________________________________________________________________________________________

________________________________________________________________________________________

Is the student connected to an Active Duty Military family? Yes No

Is the student connected to a Guard or Reserve Military family? Yes No

Is your child currently receiving services from the local school system? Yes No

If yes, which services ________________________________________________________________

Does child have a current Individualized Education Plan (IEP)? Yes No

Has your child attended a:

Early Head Start or Head Start? Yes No

First Class Funded Preschool (Office of School Readiness (OSR) program)? Yes No

Center-based childcare program (daycare-private or church based)? Yes No

Home-based childcare program? Yes No

Home visiting program: Home Instructions for Parents of Preschool Youngsters (HIPPY), Parents as Teachers

(PAT), Nurse Family Partnership (NFP)? Yes No

Another preschool program (Part-time preschool, Mother’s Day Out, Title 1 pre-k, locally funded pre-k, or

other non-listed preschool type)? Yes No

Special Education Funded Preschool Program Yes No

No preschool:Check if no preschool

__________________________________________ Parent Signature

ESCUELAS DEL CONDADO DE LIMESTONE

Formulario de Matrícula de Kindergarten para el año escolar 2016-2017

Fecha de hoy____________ Escuela_____________________________

Edad____ Fecha Nacimiento ___________ *Acta Nacimiento #__________**SS#____________ (voluntario)

Nombre Estudiante_________________________________________________________________________ Apellido Primer Nombre Segundo Nombre

Nombre Preferido del estudiante ________________________ Idioma hablado en el hogar _______________

Género: M F ¿Es el estudiante Hispano/Latino Sí No

¿Cuál es la raza del estudiante? Escoger una o más de una

Indio Americano o Nativo de Alaska una persona que tenga orígenes en cualquiera de los pueblos originales de Norte y Sudamérica

(incluyendo América Central), y que mantiene afiliación tribal o de comunidad

Asiático una persona que tenga orígenes en cualquiera de los pueblos originales del Lejano Oriente, Sureste de Asia o el subcontinente indio, incluyendo,

por ejemplo, Camboya, China, India, Japón, Corea, Malasia, Pakistán, Filipinas, Tailandia y Vietnam Negro o afroamericano una persona que tenga origen en cualquiera de los grupos raciales negros de África

Nativo de Hawái u otras islas del Pacífico una persona que tenga orígenes en cualquiera de los pueblos originarios de Hawái, Guam, Samoa

u otras islas del Pacífico Blanco una persona que tenga origines en cualquiera de los pueblos originales de Europa, el Medio Oriente o África del Norte

Dirección Física___________________________Ciudad___________Estado _____ Código Postal __________

Casilla P.O. _____________________________Ciudad___________Estado _____ Código Postal __________

Teléfono del hogar _________________________

#’s Emergencia: ____________________________ __________________________ _________________ Nombre Parentesco Teléfono

____________________________ __________________________ _________________ Nombre Parentesco Teléfono

Nombre del Padre____________________________ Nombre de la Madre ____________________________

Dirección___________________________________ Dirección _____________________________________ (si es diferente a la anterior) (si es diferente a la anterior)

Ciudad/Estado_______________________________ Ciudad/Estado _________________________________

Lugar de empleo______________________________ Lugar de empleo _______________________________

#Trabajo _______________ #Celular ___________ #Trabajo ______________ #Celular ______________

Correo Electrónico____________________________ Correo Electrónico______________________________

El estudiante vive con: Padre Madre Ambos Otro_________________ Papeles de Custodia

Nombre del Tutor (Si es un nombre diferente al de padre)__________________________________________

Lugar de Empleo____________________________________ #Teléfono ______________________________

Personas autorizadas a sacar a su hijo de la escuela:

_________________________________ ______________________ _____________________ Nombre Parentesco # Teléfono

_________________________________ ______________________ _____________________ Nombre Parentesco # Teléfono

_________________________________ ______________________ _____________________ Nombre Parentesco # Teléfono

_________________________________ ______________________ _____________________ Nombre Parentesco # Teléfono

*Un acta de nacimiento no es requisito para inscripción. Otros formularios de documentación que enseñe la fecha de nacimiento tienen el mismo valor.

**Divulgación del Número de Seguro Social de su hijo/a (SSN) es voluntario. Si no quiere proveer el SSN, se utilizará un número temporero como identificación.

Pedimos el número de SSN de su hijo en conjunto con la matricula en la escuela según el Código Administrativo de Alabama §290-3-1.02(2)(b)(2). Se utilizará

como medio de identificación en el sistema de manejo de información de los estudiantes en el todo el estado.

Hermanos/Hermanas del estudiante en la escuela

_____________________________ Año _______ _____________________________ Año _______

_____________________________ Año _______ _____________________________ Año _______

Listar necesidades especiales, problemas de salud o medicamentos los cuales los maestros deben saber.

(Explique)

________________________________________________________________________________________

________________________________________________________________________________________

Transportación: (favor circule) #Autobús ______ Carro ____ Día Extendido _____Van de Guardería ______

Dé instrucciones específicas a la casa del estudiante desde la escuela._________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Si el estudiante es transferido por favor escriba el nombre y la dirección de la última escuela que asistieron:

________________________________________________________________________________________

________________________________________________________________________________________

¿Está el estudiante conectado a una familia el servicio militar activo? Si No

¿Está el estudiante conectado a una familia de la Guardia Nacional o la Reserva Militar? Si No

¿Su hijo/a está recibiendo servicios del sistema escolar local? Si No

Si es así, que servicios ______________________________________________________________

¿El niño/a tiene un Plan de Educación Individualizado (IEP) actual? Si No

¿Ha asistido su hijo/a uno de los siguientes:

¿Programa de Principios Head Start o al Programa de Head Start? Si No

¿Programa pre-escolar financiado por el estado (Oficina de Preparación Escolar (OSR)? Si No

¿Programa basado en centros de (guardería privada o basada en una iglesia) Si No

¿Programa de cuidado infantil basado en el hogar? Si No

¿Programa de visitas a domicilio: Instrucciones para el hogar de padres de niños pre-escolares (HIPPY), Padres

como Maestros (PAT), Colaboración Enfermera y Familia (NFP)? Si No

¿Otro programa pre-escolar (Pre-escolar medio tiempo, programa Mother’s Day Out, Titulo 1-pre-K, pre-K

financiado localmente, u otro tipo de programa pre-escolar no listado aquí? Si No

Programa Preescolar financiado por Educación Especial Si No

No preescolar: Marcar si no preescolar

__________________________________________ Firma de los padres

In addition to practicing the skills above, it is very important that you read to your

child daily.

Kindergarten Readiness Skills

While there is no perfect formula that determines when children are truly ready for

kindergarten, you can use the skills listed below to see how well your child is doing in

acquiring the skills needed for kindergarten. Check the skills that your child has mastered.

Then re-check every few weeks to see what additional skills your child can accomplish.

Young children change so fast — if they can't do something one week, they may be able

to do it a few weeks later. Practice the skills listed below to help your child be better

prepared for kindergarten.

Academic Skills

Identify and name some letters and sounds of the alphabet

Writes first name starting with uppercase letter and all other letters lowercase- ex. Mary not MARY

Recognize all basic colors

Recognize and name basic shapes Sort items by shape, color and size Recognize numbers 1-5 Count to ten

Look at pictures and then tell the story

Social Skills Listen to others without interrupting Pay attention to adult-directed tasks Share with others Follow rules

Respect authority

Manage bathroom needs Stand in line

Take turns

Sit quietly Exhibit self-control

Separate from parents easily

Motor Skills

Use correct pencil grasp when writing or tracing

Cut with scissors using correct scissor grasp

Color within lines using correct grasp

Button shirts, pants, coats, and zip up zippers

LIMESTONE COUNTY SCHOOLS

300 South Jefferson Street Athens, Alabama 35611 Phone (256) 232-5353 Fax: (256) 233-6461

Website: www.lcsk12.org

BOARD MEMBERS Marty Adams

Earl Glaze

Anthony Hilliard Bret McGill Charles Shoulders, Jr.

Edward Winter

Bradley Young

SUPERINTENDENT OF EDUCATION

Thomas Sisk

April 15, 2016

Dear Parents:

Welcome to the Limestone County School System! We are glad that you have chosen Limestone County

Schools for your child. We are committed to helping each child be successful. For this to happen, it takes both

the parent and the school working together.

To help all students feel comfortable in their new surroundings, we will have a modified "First Week of

School" for kindergarten students to attend. On Wednesday, August rl and Thursday August 4

th only one-half

of the students will attend school and on Friday and Monday, August 5th

and 8th

, the other half of the students

will attend. All students will attend beginning Tuesday, August 9th

. This will allow the teacher time to give

each child the individual attention he or she may need to feel comfortable and have a great first day of school.

The teachers at the local school will contact you concerning the days your child will attend.

Also, to help students be successful, there are some skills which are important that your child works toward

mastering before the start of kindergarten. We encourage you to work with your child during the summer

practicing the skills listed on the enclosed page. The skill practice will provide the best opportunity for a

successful start in kindergarten.

Please contact your local school if you have questions or concerns. Thank you for trusting Limestone County

School System to give your child the best education possible. We are looking forward to working with you

during the 2016-2017 school year as well as the remainder of his or her K-12 school experience.

Tom Sisk

Superintendent of Education

Focused on Quality... Committed to Excellence

Fecha __________

Nombre del menor

Escuela Grado Edad

Revised 03-09

Appendix A

Limestone County Schools

HOME LANGUAGE SURVEY

Date School: CREEKSIDE ELEMENTARY Grade

Child's name Age First Name Middle initial Last Name

Parent or Guardian's name First Name Middle initial Last Name

Address Street City State Zip Code

Phone Number Home Work

1. What is the first language your child learned to speak?

English _________________ Spanish __________

2. What language does your child most often speak at home?

English _________________ Spanish __________

Other

Other

3. What language do you most frequently speak to your child?

English _________________ Spanish __________________ Other ________

Parent or Guardian Signature Date

Escuelas del Condado de Limestone ENCUESTA DEL IDIOMA DEL HOGAR

Primer nombre bum' de Segundo nombre Apellido

Nombre del padre o tutor _______________________________________

Primer nombre lnicial del segundo nombre Arell ido

Direccion Celle Ciudad Estado COdigi PO5U1

Niimero de telefono Hagar Trabajo

1. Cuid es el idioma que su hijo/a aprendio a hablar primero?

Ingl6s ____________ Espaliol __________________ Otro _________

2. Cual es el idioma que su hijo/a habla mas frequentemente en el hogar?

1ngles ____________ Espanol ________________ Otro

3. En quo idioma le habla con mas frecuenria a su hijo/a?

lngles ____________ Espanol Otro

Firma del padre/madre o tutor Fecha

7

Appendix A

Student Residency Questionnaire

School Name: _________________________Student Name:______________________________

For the purpose of identifying homeless children and youth, the Limestone County School

System shall use the McKinney-Vento Act's definition of homeless children and youth. The

act defines homeless children and youth (twenty-one years of age and younger) as:

Children and youth who lack a fixed, regular, and adequate nighttime residence are

considered homeless. Examples: Sharing the housing of other persons due to loss of

housing, economic hardship, or similar reason (sometimes referred to as double-up), living in

motels, hotels, trailer parks, or camping grounds due to lack of alternative adequate

accommodations, living in emergency or transitional shelters, abandoned in hospitals, and

awaiting foster care placement.

Based on the information provided above, please answer the following question:

I consider my child homeless. Yes No

If you answer yes to this question, please complete the Referral for Homeless Student

Services form.

TRANSPORTATION

Name:

Address: ■ ■ • ■ ■ ■ ■ ■ • 1

Teacher: __________________________Grade: __________

Student will ride bus in morning . YES NO Bus # ____

Student will ride bus in afternoon YES NO Bus # ____

Car Rider in Afternoon YES NO

Extended Day YES NO

Peaches & Cream Daycare YES NO

Directions to Home or Name of Subdivision:

I certify that the information above is true and correct.

Parent/Guardian Signature Date