Revised 03/2020

Huntsville ISD

2020-2021

Student Enrollment Packet

PLEASE NOTE THE DISTRICT WILL NEED THE FOLLOWING DOCUMENTS TO COMPLETE THE REGISTRATION PROCESS:

OFFICIAL BIRTH CERTIFICATE (NOT THE HOSPITAL COPY)

CHILD’S SHOT RECORD

CHILD’S SOCIAL SECURITY CARD

PROOF OF RESIDENCE: CURRENT UTILITY BILL (WATER, GAS OR ELECTRIC), DEED OF TRUST, PROPERTY TAX STATEMENT OR AN UNEXPIRED LEASE AGREEMENT SHOWING THE PHYSICAL ADDRESS. (IF THE UTILITY BILL IS NOT IN THE PARENT/GUARDIAN NAME, THEN THE PERSON LISTED ON THE UTILITY BILL MUST BE PRESENT WITH ID.)

PARENT/GUARDIAN ID OR DL

A POST OFFICE BOX ADDRESS DOES NOT MEET THE CRITERION TO PROVE RESIDENCY

∗ Prekindergarten is free for all students who qualify. Proof of income is required to help determine eligibility. A July pay stub will be required in August to determine if your child qualifies. For students who do not qualify, tuition based Prekindergarten is available.

Form 1

Revised 03/2020

HUNTSVILLE INDEPENDENT SCHOOL DISTRICT 2020-2021 STUDENT ENROLLMENT/INFORMATION SHEET

Birth Date: Grade: Age: Local ID# Social Security No:

ETHNICITY: Hispanic/Latino Not Hispanic/Latino GENDER: Female Male

RACE: American Indian or Alaska Native Asian Black or African American White Native Hawaiian/Other Pacific Islander

Student’s Legal Name: Last First Middle

Address: City: Zip:

Primary Phone: Mailing Address if Different:

As part of entering your contact phone number(s) here, you understand and are giving consent to the district to communicate with you via this number(s) for all notifications including the district’s mass notification system.

� Opt in box: By checking this box you understand and give consent to the mass call out processes Huntsville ISD uses for communication to parents/guardians. Phone numbers allowed for notifications:

1 2 3

Parent/Guardian Information Parent/Guardian #1:

Name Relationship E-mail AddressParent/Guardian #1:

Primary Phone Work/ Work Place Cell Parent/Guardian #2:

Name Relationship E-mail AddressParent/Guardian #2:

Primary Phone Work/Work Place Cell Student Resides With:

Student Protection � There is not a problem at the present time with my child’s mother and/or father picking him/her up at school. � There is a problem with my child’s mother and/or father picking him/her up at school. Custody Papers must be on file in

the school office. Does the school have Court Papers? Yes No N/A

EMERGENCY CONTACTS / AUTHORIZED PERSONS ALLOWED TO PICK UP YOUR CHILD:

Name: Phone: Relationship:

Name: Relationship: Phone: List all brothers and sisters living in the household: Name: Age: Name: Age: Name: Age: Name: Age:

Name of last School/District attended: City: State:

Has student ever attended a Huntsville ISD School? Yes No HISD Campus Attended:

Has your child ever received any of the following services? Dyslexia ESL BIL GT 504 Special Education Speech Other

IT IS THE PARENT'S/GUARDIAN'S RESPONSIBILITY TO NOTIFY THE OFFICE IF ANY OF THIS INFORMATION CHANGES

Parent/Guardian Signature: Date:

Huntsville ISD takes the safety of its students seriously. By listing family members and emergency contacts below you are grantingthem access to be contacted and allowing them to pick up your student. Any individual listed below can be contacted in the event of an emergency including catastrophic events.

Form 2 Huntsville ISD 2020-2021

Revised 03/2020

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

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

Race – choose one or more: _____ American Indian or Alaska Native _____ Asian _____ Black or African American _____ Native Hawaiian or Other Pacific Islander _____ White

Observer signature: Campus and Date:

Texas Education Agency – March 2010

Form 3

Revised 08/28/18

Huntsville Independent School District Home Language Survey 19TAC Chapter 89, Subchapter BB §89.1215

(Home Language Survey applicable ONLY if administered for students enrolling in pre-kindergarten through grade 12)

TO BE COMPLETED BY PARENT OR GUARDIAN FOR STUDENTS ENROLLING IN PREKINDERGARTEN THROUGH GRADE 8 (OR STUDENT IF GRADES 9-12): The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas Public Schools. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below.

Dear Parent or Guardian:

To determine if your child would benefit from the Bilingual and/or English as a Second Language program services, please answer the two questions below.

If either of your responses indicates the use of a language other than English, then the school district must conduct an assessment to determine how well your child communicates in English. This assessment information will be used to determine if Bilingual and/or English as a Second Language program services are appropriate and to inform instructional and program placement recommendations. If you have questions about the purpose and use of the Home Language Survey, or you would like assistance in completing the form, please contact your school/district personnel.

For more information on the process that must be followed, please visit the website: https://projects.esc20.net/upload/page/0084/docs/EL%20Identification_ReclassificationFlowchart%202018.pdf.

This survey shall be kept in each student’s permanent folder.

STUDENT NAME: (Last) (First) (Middle)

DATE OF BIRTH: ID #:

ADDRESS:

TELEPHONE: CAMPUS:

NOTE: PLEASE INDICATE ONLY ONE LANGUAGE PER RESPONSE.

1. What language is spoken in your home most of the time? _____________________________________________

2. What language does your child speak most of the time? ______________________________________________

Parent Signature Date

Signature of Student if Grades 9-12 Date

NOTE: If you believe you made an error when completing this Home Language Survey, you may request a correction, in writing, only if: 1) your child has not yet been assessed for English proficiency; and 2) your written correction request is made within two calendar weeks of your child’s enrollment date. Texas Education Agency 2018-2019

HISDassignedStudentID: Form 4

HuntsvilleISDConfidentialStudent

ResidencyQuestionnaireTheinformationonthisformisrequiredtomeetthelawknownastheMcKinney-VentoAct42U.S.C.11434a(2),whichisalsoknownasTitleX,PartC,oftheNoChildLeftBehindAct.Theanswersyougivewillhelptheschooldetermineservicesthestudentmaybeeligiblefor.

Part1StudentName: Studentbirthdate: Studentgrade:

Gender: o Male o Female Lastdistrictattended: Lastschoolattended: Schoolenrollinginnow:

CurrentAddress(includingcity,state,zip): Telephone: Cellphone:

Nameofpersonwithwhomthestudentresides: o Parento Onhis/herowno FosterCare(Courtorderor2085

formpresent)

o LegalGuardian*(courtgranted)o Caregiver(friends,relatives,

etc.)o Other:

1. Isyouraddressatemporarylivingarrangement?2. Isthistemporaryarrangementduetolossofhousingoreconomichardship?

o Yeso Yes

o Noo No

IfyouansweredYEStoeitherquestion,pleasecompletePart2and3.IfyouansweredNOtoboth,youmaystophereandsignbelow.

Part2Pleasecheckoneboxthatdescribeswherethestudentisliving:

PleaselistyourotherchildreninHuntsvilleISDwhoresidewithyouandinthesamelivingsituationdescribedabove.Pleaseusebackifmoreroomisneeded.

Firstandlastname StudentID DateofBirth

SignatureofParent/Guardian/Caregiver/Unaccompaniedyouth: Date:

StudentdoesNOTqualifyashomeless:FilethisSRQonyourcampus.Date:_____________________

o

o StudentisinFosterCarePlacement:Give SRQ to HL and filea copyonyourcampus.

DISTRICTUSEONLYIcertifytheabove-namedstudentqualifiesforapplicableservicesundertheprovisionoftheMcKinney-VentoAct,theUSDAChildNutritionPrograms._______________________________________________________ _________________

HuntsvilleISDHomeless Liaison Date

o Studentlivesinahouseownedorrentedbyparentorlegalguardian.(PEIMS Status=0)o Studentlivesinashelterortransitionalhousing (PEIMS Homeless Status=5)o StudentlivesinthehomeofafriendorrelativebecauseIlostmyhousing(examples:fire,flood,lostjob,lostincome,divorce,domesticviolence,kickedoutbyparents,parentinthemilitaryandwasdeployed,parent(s)injail,etc).Thisistemporarybecausethereisnootheroptionavailablefinancially. (PEIMS Homeless Status=2)

o Inatent,storageunit,car,van,abandonedbuilding,atacampground,intheparkorotherunshelteredlocation (PEIMSHomeless Status =3)

o Inahotelormotel(PEIMS Homeless Status=4)o The student sleeps here because of natural disaster: flood, tornado, wildfire, hurricane-Name________________________.

CAMPUSUSEONLY

Part 3

Presenting a false record or falsifying records is an offense under Section 37.10, Penal Code, and enrollment of the child under false documents subjects the person to liability for tuition and other costs. TEC Sec. 25.002(3)(d)

Revised 03/2018

Form 5

Revised 03/2020

Huntsville Independent School District Military Connected & Foster Care

Student Form 2020-2021

(QUESTIONS IN BOTH SECTIONS 1 AND 2 MUST BE ANSWERED) MILITARY CONNECTED STUDENT: In 2009 The Texas Legislature adopted the Interstate Compact on Educational Opportunity for Military Students – Texas Education Code Chapter 162. This legislation requires schools to recognize and extend certain privileges to students who are military dependents and to assist military dependent students in the transition process of changing schools when their military parents are reassigned and forced to relocate.

Parent Name: Father:

Student Name:

Student ID:

Mother:

Date of Birth:

Grade: Campus:

Please check one box below to indicate if your child is a dependent of a member of: SECTION 1: All students:

� Not a military connected student

� Active Duty: Army, Navy, Air Force, Marine Corps, or Coast Guard [This includes Missing in Action (MIA)]

� Texas National Guard (Army, Air Guard, or State Guard)

� Reserve Duty: Army, Navy, Air Force, Marine Corps, or Coast Guard

Pre-Kindergarten students ONLY:

� Active duty uniformed member of the United States Army, Navy, Air Force, Marine Corps, or Coast Guard, or activated/mobilized uniformed member of the Texas National Guard (Army, Air Guard, or State Guard), or activated/mobilized members of the Reserve components of the Army, Navy, Marine Corps, Air Force, or Coast Guard; who are currently on active duty or who were injured or killed while serving on active duty

SECTION 2: All students-Foster Care Information: (In compliance with TEC §25.007) Please check one box below to indicate the Foster Care status of your child:

� Student is not currently in the conservatorship of the Department of Family and Protective Services

� Student is currently in the conservatorship of the Department of Family and Protective Services (Need a copy of DFPS Form 2085)

Pre-Kindergarten students ONLY: � Pre-Kindergarten student was previously in the conservatorship of the Department of Family and

Protective Services following an adversary hearing held as provided by Section 262.201, Family Code.

Form 6

Huntsville Independent School District Standing Order Medication Permission

2020-2021

Huntsville Independent School District (HISD) values the health, safety and comfort of your student. It is a known fact that a healthy student performs better in school. To assist our students when they have minor injuries or medical needs Huntsville ISD School Clinics have Physician approved medications (standing orders) for treatment of these medical issues. These medications will not be administered unless this Parental/Guardian permission letter is signed and returned to the nurse. The exception being emergency medications listed. If your child has had a known reaction to any of these medications please notify the nurse at your child’s school clinic.

Complaint/Injury Treatment

Minor Cuts, Scrapes or Scratches Cleansed Hibiclens and Water

Dental Pain Anbesol or Orajel

Minor Eye Discomfort Artificial Tears or Ophthalmic Saline Solution

Fever Blisters/Cold Sores Carmex or Blistex

Mouth Ulcers/Braces Orabase, Proxigel, or Cankaid

Sore throat/Cough Chloraseptic Spray

Stomach Complaints Tums

Rash Aveeno Cream or Calmoseptine Ointment

Burns or Sunburn Aloe Vera, Lanacane, Solarcaine Spray or Unburn Gel

Muscular Ache or Soreness Myoflex, Generic (non-salicylate) Muscle Cream, or Bio Freeze Gel

Insect Sting Sting-kill or Sting Relief Pads or Swabs

Emergency Medications: Fever If oral temp over 103 and unable to contact/locate

parent, give Tylenol per directions

Allergic Reaction (Severe) Benadryl Liquid per directions

Anaphylaxis EpiPen or Ana-Kit per directions and call EMS

Parental/Guardian Permission for Standing Order Medication at School: I hereby give my permission for my son/daughter to take the medications as ordered above during the school day if needed.

______________________________________ ___________ ____________ Student Name (printed) Student ID Campus

______________________________________ ________________________________ Parent/Guardian Signature Date

Revised 03/2020

Huntsville ISD Health Inventory 2020-2021 Form 7

Revised 03/2020

Date: Student ID:

Student’s Last Name: First: Middle Initial: Grade: School: Teacher: Date of Birth:

Parent/Guardian #1: Relationship:

Phone: Primary: Work/Work Place: Cell:

Parent/Guardian #2: Relationship:

Phone: Primary: Work /Work Place: Cell:

Emergency Contact: Phone: Relationship: __________________________

Emergency Contact: Phone: ________________ Relationship: ___________________________

Doctor’s Name: _____________________________________Doctor’s Phone #:_____________________________________________

Please list any allergies to bees/insects, latex, medication, or environmental: Food Allergy: _____ Yes ____ No Food Type: ___________________________ Doctor’s Note: ______ Yes ______ No Are any of these allergies severe enough to require an Epi-Pen? Yes ______No______ (If an Epi-Pen is required, we must have a written and signed Medication Authorization Form from physician and signed by parent.) Any food allergy must have paperwork from Child Nutrition Department on file in cafeteria. Chronic, Recurring and Special Health Conditions (Please check any of the following that apply). Students with Asthma, Diabetes, Anaphylaxis Allergy & Seizure must annually have an "Action Plan" from a Physician which is given to the school nurse.

Asthma Bladder Problems Mental Health Concerns Development Delays/Problems Diabetes Bowel problems ADHD/ADD Hearing Problems Seizures Stomach Problems Behavioral Problems Vision Problems

Bone or Joint Disorders Eating Disorders/Problems Speech Problems Wears Glasses/Contacts Heart problems

Other Special Conditions/disorders: Special medical procedures required during school: Please elaborate on any health problems you have checked: ____________________________________________________________________________________________________________

Medications taken by your child may cause side effects, allergic reactions, changes in personality and other problems. Please list all medications your child is taking at HOME or at SCHOOL (medications at school require written authorization from parent and/or doctor). Please obtain medication form from school nurse.

Medication Dosage Time(s) Taken At Home At School

Please describe reason your child takes medication listed above:

Equipment or aids used by your child:

***PLEASE UNDERSTAND THAT ANY STUDENT SENT HOME ILL WITH A FEVER CANNOT RETURN TO SCHOOL UNTIL FEVER FREE WITHOUT THE AID OF MEDICATION FOR 24 HOURS .

I give my consent for Hearing, Vision, and Spinal Screenings as required by the Department of State Health Services guidelines.

In the event of an emergency situation and I cannot be reached, I, the undersigned do hereby authorize officials of Huntsville ISD to call the physician or an emergency contact listed on this form to render such treatments as may be deemed necessary for the health and safety of my child. In the event parents or emergency contacts cannot be reached, school officials are hereby authorized to take whatever action is deemed necessary for the health and safety of my child.

I give permission for the school nurse to communicate with my child’s health care provider and to release medical information/records to the appropriate school personnel regarding my child’s medical condition. Yes___ No___

Last School Attended: Ever Attended Huntsville ISD? (check) Yes No

Parent/Guardian Signature: Date:

Form 8

Compulsory Attendance 1201A / 03-2020

Attendance is a key factor in student achievement.  While pre­kindergarten is not required by the State, once a student is enrolled in pre­kindergarten, they must adhere to the state compulsory  attendance  laws.  Senate  Bills  427  and  1112  address  the  number  of  days  a student must attend school each year.  All students, prekindergarten through twelfth grade, must adhere to compulsory attendance laws.

After a child is absent, a parent or doctor’s note will be required when a child returns to school. An individual commits an offense if the individual fails to attend school on ten (10) or more days or parts of days within a six (6) month period or on three (3) or more days or parts of days within a four (4) week period.

As required by law, the districts’ truancy prevention measures include issuing a warning letter after the student has failed to attend school without excuse three times stating that the student’s enrollment may be revoked if he or she obtains more than five unexcused absences in a semester.  The district may impose a behavior improvement plan in lieu of revocation. The continued absence of the student without a doctor’s written excuse or an absence excused by the campus school administrator (TEC. Sec. 25.086 and Sec. 25.087) may result in a referral to truancy court for the student and/or the parent/guardian (Sec. 25.093 & TFC 65.003). 

We encourage your child  to be  in attendance each day.   Additional  information regarding attendance can be found in the Parent­Student Handbook at www.huntsville-isd.org. Your support in this matter is appreciated.

PLEASE SIGN AND RETURN TO YOUR CHILD’S CAMPUS.

I have read the district’s notice regarding compulsory attendance.

Parent/Guardian Signature Date

Student’s Name (printed)

HUNTSVILLE INDEPENDENT SCHOOL DISTRICTCOMPULSORY ATTENDANCE NOTICE

2020­2021

Form 9

Revised 03/2020

Directory Information, Military Recruiters, and Institutions of Higher Education Acknowledgement/Release Form

For more information on Directory Information please refer to Board Policy FL (Legal) and (Local).

Huntsville ISD has designated all the following information about your child as directory information for school use/internal purposes only:

ALL STUDENTS - SCHOOL USE/INTERNAL PURPOSES: * Address* Email address* Degrees, honors, awards received* Dates of attendance* Most recent school attended*Height/weight of athletes

* Name* Telephone number* Photograph* Date and place of birth* Grade level* Major Field of study* Participation in officially recognized activities and sports

Yes___ No___ I agree to allow all the directory information listed above to be released on my child for school use (i.e., student publications, district publications, yearbooks, school/district websites and all social media pages, and other internal district-related or school sponsored purposes). *Designation of “No” will EXCLUDE your child from all of the above, including yearbook publication.

SECONDARY STUDENTS - MILITARY RECRUITERS: Federal law requires that the District release to military recruiters and institutions of higher education, upon request, your secondary (grades 7-12) directory information, as listed above, unless you have told us that you do not want that information released without your prior written consent.

Yes___ No___ My secondary student’s (grades 7-12) directory information may be released to a military recruiter upon request.

SECONDARY STUDENTS - INSTITUTION OF HIGHER EDUCATION: Federal law requires that the District release to military recruiters and institutions of higher education, upon request, your secondary (grades 7-12) directory information, as listed above, unless you have told us that you do not want that information released without your prior written consent.

Yes___ No___ My secondary student’s (grades 7-12) directory information may be released to an institution of higher education upon request.

ALL STUDENTS - NON-SCHOOL USE/EXTERNAL REQUESTS: According to district policy, district directory information for external (non-district) requests is limited to name and grade, only. The parent or guardian can object to the release of this directory information about their student. If you do not want Huntsville ISD to disclose this limited directory information from your child’s education records without your prior written consent, you must notify the District in writing by September 2, 2020.

Yes___ No___ I agree to allow limited (name and grade, only) directory information to be released for non-school use (i.e., vendors, sales persons and in response to request for records under the Texas Public Information Act.) Per FL (Local) the district restricts directory information for external requests to release name and grade ONLY.

NOTE: Failure to return this form marked and signed indicates your acceptance of releasing directory information. Parents may revoke their permission at any time by notifying the district in writing.

______________________________________ __________________________________ Student’s Name (printed) Student’s School Name

______________________________________ __________________________________ Parent/Guardian’s Name (printed) Parent/Guardian’s Signature Date

Parent/Guardian must sign and return the Directory Information- Acknowledgement /Release Form

if an online enrollment update form is not submitted electronically.

Form 10

Revised 03/2020

Parent/Student Acknowledgement Signature Form

I. Acknowledgement of the Parent/Student Handbook and the Student Code of Conduct:

My child and I have been offered the option to receive a paper copy of or to electronically access the

2020-2021 Parent/Student Handbook and the Student Code of Conduct at www.huntsville-isd.org.

I have chosen to: Request a paper copy of the Student Handbook and the Student Code of Conduct upon publication. Accept responsibility for accessing the Student Handbook and the Student Code of Conduct by visiting

the web address listed above.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 or the Student Code of Conduct I should direct those questions to the campus principal.

II. Huntsville ISD Electronic Communications System:

I understand that my son or daughter will have access to the District’s electronic communications systemwhich includes networked computer services such as electronic mail and the Internet; furthermore, Iunderstand that it is possible for my child to run across areas of adult content although the District takesreasonable steps to preclude access to such materials. I have read the “Responsible Use Guidelines” andwill emphasize to my child the importance of following the Guidelines. In consideration for having accessto the networked system, I hereby release the District, its operators, and institutions with which they areaffiliated from any and all claims and damages of any nature arising from my child’s authorized orunauthorized use of, or inability to use, the system.

STUDENT NAME (PRINT) STUDENT SIGNATURE

STUDENT GRADE STUDENT CAMPUS

ADDRESS CITY/STATE/ZIP CODE

PARENT/GUARDIAN NAME (PRINT) PARENT SIGNATURE

DATE PRIMARY PHONE

HUNTSVILLE ISD’S ELECTRONIC COMMUNICATIONS SYSTEM HAS BEEN ESTABLISHED FOR A LIMITED EDUCATIONAL PURPOSE, NOT INTENDED FORCOMMERCIAL PURPOSES, POLITICAL LOBBYING, OR OTHER PERSONAL USE. THE TERM “EDUCATIONAL PURPOSE” INCLUDES CLASSROOM ACTIVITIES,CAREER DEVELOPMENT, AND LIMITED HIGH-QUALITY ACTIVITIES. PARENTS HAVE THE RIGHT AT ANY TIME TO INVESTIGATE THE CONTENTS OF THEIRCHILD(REN)’S E-MAIL FILES AND THE RIGHT TO REQUEST THE TERMINATION OF THE CHILD(REN)'S USE OF THE SYSTEM.

Parent/Guardian must sign and return the Parent/Student Acknowledgement Signature Form if an online enrollment update form is not submitted electronically.