9TH-12TH GRADE REGISTRATION FORMS

(NON-RESIDENT)

If you are applying as a non-resident student the following information will be required. You must be the parent or legal guardian to register a child.

Completed Enrollment Packet Copy of Current Transcript

Copy of Standardized Test Scores

Copy of Discipline Record (If the child doesn’t have a referral, please have the assistant principal contact the

Admissions Administrator at CHS at 770-834-7726.)

Attendance Record

Special Programs: Current paperwork for students in special programs (i.e. gifted, special education, SST, 504,

etc.)

Minimum Requirements for NON-RESIDENT students to be considered for enrollment at Carrollton High School:

• Minimum grade average of 78% in all classes • Good attendance with no more than 10 days of unexcused absences • No office referrals • No probation officer

If your child is accepted as a non-resident or enrolling as a resident student, the following information will be required.

Child’s Birth Certificate

Current Georgia Immunization Form #3231 (You must have this at time of enrollment. This form can be obtained

from a healthcare provider or the county health department)

Eye, Ear, & Dental Screening, Georgia Form #3300 (This can be obtained from the health department for a fee)

Social Security Card

Report Card/ Transcript from the previous school or withdrawal form (You must have this at time of enrollment)

Photo ID of Parent

Custody Papers (if not the birth parent)

For Resident Enrollment: Proof of Residency (Current bill such as water, electricity, lease dated within three months. Cell

phone bill, bank statements, etc. will not be accepted)

ENROLLMENT CHECKLIST

NON-RESIDENT CHECKLIST:

RESIDENT CHECKLIST:

FORMS

ATTENDANCE CARD

CRIMINAL BACKGROUND

BUS FORM

PROOF OF RESIDENCY (Current Bill- water/electric, or car tag). TYPE:

BIRTH CERTIFICATE

SOCIAL SECURITY CARD

PHOTO ID OR PARENT/GUARDIAN

CURRENT GA IMMUNIZATION FORM

EYE, EAR, DENTAL SCREENING

JOINT CUSTODY SOLE CUSTODY ORIGINAL PARENT SINGLE CUSTODY

SCHOOL RECORDS FROM PREVIOUS SCHOOL (If student does not have records, parents will complete a

“records request” form)

PREVIOUS SCHOOL:

SCHOOL PHONE #:

CONTACT SPOKEN TO:

HAS STUDENT BEEN IN THE SST PROCESS:

DISCIPLINE RECORD

STUDENTS INTEREST AND HOBBIES:

STUDENT RECEIVED TOUR OF SCHOOL: YES NO

STUDENT/STAFF WHO CONDUCTED TOUR:

STUDENTS/PARENTS ARE AWARE OF: Scheduling, Attendance Procedures, Parking Lot, Behavior,

Extracurricular Opportunities.

NOTES (for office use only):

SCHOOL PERSONNEL CHECKLIST

TO BE COMPLETED BY SCHOOL PERSONNEL:

CARROLLTON CITY SCHOOLS Non-Resident Application Registration Form Please print and complete one form for each child in the household that is being enrolled.

SECTION 1: Student Information

Student’s Legal Name _______________________________________________________________________________ (Last) (First) (Middle) (Preferred)

Physical Address ________________________________________ City _____________ State _____ Zip __________ Student or Parent Cell Phone _____________ Student Email ____________________________________ Grade ________ Date of Birth __________________ SSN __________________ Gender ⬜ Female ⬜ Male

Race (Check all that apply) ⬜ American Indian or Alaska Native ⬜ Black or African American ⬜ Asian ⬜ Native Hawaiian or Other Pacific Islander ⬜ White Is this student of Hispanic/Latino ethnicity? ⬜ Yes ⬜ No Current County of Residence: _______________ In which language would you prefer to receive school information? _______________________________

SECTION 2: Enrollment History

Previous School 1: _________________________________________________________________________________ School Name City/State Dates Attended Previous School 2: _________________________________________________________________________________ School Name City/State Dates Attended Previous School 3: _________________________________________________________________________________ School Name City/State Dates Attended If student is in high school, what is the appropriate date the student entered 9th grade for the first time? _________________________

SECTION 3: PreK Program Attended

Please choose one: ⬜ Did not attend a PreK Program ⬜ GA PreK Lottery (located at a public K-12 school) ⬜ Headstart ⬜ Other Public School ⬜ GA PreK Lottery (located at a private PreK center) ⬜ Private For profit ⬜ Other Publicly Sponsored ⬜ Private - Not for profit (including church-based programs)

SECTION 4: Special Programs

Please check below any programs your student CURRENTLY participates in or PREVIOUSLY participated in:

Currently Participating

Previously Participated

Date Exited (If applicable) Program

Special Education (Primary Disability:______________________________)

Speech-Language Impairment

English to Speakers of Other Languages (ESOL)

Gifted and Talented

Early Intervention Program (EIP) / Remedial Services

Student Support Team (SST)

504 Plan

Other:______________________________

SECTION 5: Non-Residency Information

Has student ever been retained or placed? ⬜ Yes ⬜ No Has student ever been placed in in-school or out-of-school suspension? ⬜ Yes ⬜ No Has student ever been adjudicated? ⬜ Yes ⬜ No How many days was student absent from school last year? __________ Please explain why you wish to enroll in Carrollton City Schools.

_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

How did you hear about us? ⬜ Website ⬜ Ad ⬜ Social Media ⬜ Friend/Family Member ⬜ Radio ⬜ Other:________________

SECTION 6: Home Language

The state requires the District to collect a Home Language Survey for every new student. This information is used to identify students who may need English language instruction. Students whose primary or first language is not English must be screened to determine eligibility. Final qualification for language support is based on the results of an English language assessment. Please answer the questions below to help us identify if your child may need to be assessed for English Language proficiency.

● Which language does your child best understand and speak? _______________________________ ● Which language does your child most frequently speak at home? _______________________________ ● Which language do adults in your home most frequently use when speaking with your child? _____________________

SECTION 7: Immigrant Information ONLY

Country of Birth _________________ Date First Entered U.S.____________ Date First Entered U.S. School (K-12)__________ If Country of Birth is outside the U.S., has student been enrolled in U.S. schools for less than 36 cumulative months? ⬜ Yes ⬜ No Has student attended school(s) outside the U.S. (other than DOD schools) since the first time entering into a U.S. school? ⬜ Yes ⬜ No

SECTION 8: Parent/Guardian Certifications

Please read and initial the following: _____ I am authorized to enroll this student, and understand that in compliance with OCGA 20-2-780 that having enrolled the student, I am the only person who can withdraw the student, unless a court order applies. _____ I have provided the student’s Georgia Certificate of Immunization (Form 3231) OR agree to provide Form 3231 within the thirty days. I understand that if not provided within the time allotted this student shall not be permitted to continue in attendance. _____ I understand that if this student is being provisionally enrolled without all required documentation, this student is being provided educational services based solely on the information I provide. I understand that changes may be made to the services being provided once records are received from previous schools and have been reviewed by appropriate school personnel. This may include, but is not limited to, grade placement, class placement, teacher assigned, type of instructional setting, and any other changes that the school administration deems necessary. _____ In case of an accident or serious illness, I give permission for the school to make the necessary emergency arrangements. _____ Carrollton City Schools reserves the right to place students in classes judged solely by the school system to the be the most appropriate placement. Non-resident students are subject to suspension, expulsion, or revocation of their tuition status if they violate the terms of this contract or violate school system rules. Specific criteria have been established by the Board of Education for non-resident students. This Enrollment Contract may be revoked and the student dismissed in accordance with any and all Carrollton City Schools’ policies and procedures. Students and parents should review the Student Handbook for their school. The parent/guardian is responsible for their child’s transportation to and from school. The superintendent reserves the right to deny admittance to any applicant if accepting the student would not be in the best interest of the Carrollton City School System. I certify that the information provided is correct to the best of my knowledge. I understand that providing false information may prevent my child from being accepted as a non-resident student or could result in mandatory withdrawal. The undersigned agrees to pay tuition fees as designated by the Board of Education. Each school sets the fee schedule. Any exceptions to the fee schedule due to hardship will be considered on an individual basis. Students may be withdrawn if payment is not received. The obligation to pay tuition is unconditional, notwithstanding the subsequent dismissal, expulsion or withdrawal of the student. I have read and understand the contract and agree to the stated conditions.

SECTION 9: Parent/Guardian Signature

My relationship to the student is: ⬜ Parent ⬜ Student (18 Years of Age or Older) ⬜ Grandparent ⬜ Legal Guardian* Relationship to Student ___________________________________ ⬜ Person having lawful Court Order* x Relationship to Student ___________________________________ ⬜ Other* Relationship to Student ___________________________________ (*Please provide court documents establishing guardianship.) Signature ___________________________________ Printed Name ___________________________________ Date _____________ CHS Only: Signature of Student ___________________________________ Printed Name ___________________________________

Date:

School Name:

Address:

Phone:

Contact:

STUDENT INFORMATION: Name: Grade: DOB: SS#: Street Address/ Apt #: City/State/Zip: Parent/Guardian: Phone #: School Leaving: School Entering:

I hereby authorize Carrollton High School to OBTAIN pertinent information concerning the above-named student.

I hereby authorize Carrollton High School to RELEASE pertinent information concerning the above-named student.

TYPE OF MATERIAL: I have examined the records indicated above and agree to have them released to the designated agency.

SIGNATURE OF PARENT/GUARDIAN/STUDENT DATE In compliance with the Family Educational Rights and Privacy Act of 1974, these records will be released to

Parents/Guardians or Students over 18 years of age upon their request. The granting of consent is voluntary on the party

of the parent.

RELEASED BY: DATE: It is not necessary for parents to sign a release when records are being passed from public school to public school. Note

Federal Register, Thursday, June 17, 1976, Part II HEW-Private Right of Parents and Student. Final (Vol.41, #118-

24673).

Carrollton High School 201 Trojan Drive Carrollton, GA 30117 Attn: Records Fax: 770-832-2836 Phone: 770-834-7726 Email: vicky.dudley@ carrolltoncityschools.net

REASON FOR REQUEST: ____Educational Planning ____Medical Treatment ____Other_________________________________________________________

CARROLLTON HIGH SCHOOL RECORDS REQUEST ** DO NOT WITHDRAW**

____Standard Educational Record ____Psychological Report ____Educational Evaluation Reports ____Individual Educational Plan ____Special Education Placement Forms ____Vision/Hearing Tests ____Other___________________________________

____Copy of Birth Certificate ____Immunization Records (Form 3231 and 3300) ____Discipline/Attendance ____Individual Educational Plan ____Program/Services (Gifted, ESOL, SST) ____Testing Labels

School/Agency RELEASING information: School/Agency RECEIVING Information:

Health Assessment Record School Year: _____-_____

This information will be kept confidential.

PART I: STUDENT INFORMATION To be completed by the parent/guardian:

Student Name: School: Grade:

Teacher/Teachers:

Name of Parent/Guardian:

Please list phone numbers where school personnel can contact you or a family member immediately:

Name: Phone:

Name: Phone:

Name: Phone:

Please list siblings who attend Carrollton City Schools:

Name: School:

Name: School:

Name: School:

PART II: MEDICAL HISTORY

All prescription medications and procedures require physician orders.

(over)

o NO KNOWN MEDICAL PROBLEMS OR CONCERNS (If no, please go directly to the bottom of the next page and provide parent/guardian signature.)

To Parent or Guardian: The purpose of this form is to provide the school nurse with additional information regarding your child’s health needs. The school nurse may contact you for further information. The information is essential for the school nurse to meet the health needs of your child.

Please provide all necessary information that may assist in caring for your child while at school.

o Allergies: Please specify allergen and describe symptoms of reaction o Food:(Doctor’s note required to be on file in the cafeteria to make food substitutions)

o Insects: o Environmental: o Medications:

Treatment/medication to be given for an allergic reaction:

o Asthma: Triggers? o He/She uses an inhaler at school. Medication: o He/She uses an inhaler at home. Medication:

o Diabetes: (Requires medication and procedure orders from physician) o Type 1 Diabetic o Type 2 Diabetic

o ADHD/ADD o Requires medication? o To be given at school?

o Bleeding Problems: (such as Hemophilia, Von Willebrand’s, frequent nosebleeds) o Please explain: o Medication?:

o Cancer: o Please explain:

o Cystic Fibrosis: o Please explain:

o Heart Condition: Please explain if there are any activity restrictions or precautions. Medications?

o Juvenile Arthritis/Bone or Joint Problems: Please explain any activity restrictions or limitations.

o Seizures: Describe type of seizures and list any medications ordered for this condition.

o Sickle Cell Anemia: Please provide common symptoms and needs for your child.

o Other Medical Concerns: Please list any medications taken at home

Medical Equipment and Procedures Required at School: Please check if required

Catheter Gastric Tube Feedings Nebulizer Treatments Oxygen Supplement

Tracheostomy Vagal Nerve Stimulator (VNS) Ventilator Wheelchair Walker

Parent/Guardian Signature: Date:

School Nurse Signature: Date:

(Office use only) Student’s ID#:

(Office use only) Date Code: (Please Print) Student’s Full Name: (Last) (First) (Middle) Grade: Gender: Social Security Number: Home Street Address: (Number) (Street Name) (Zip) (Apt#)

Do you request morning bus pick-up? Yes No Morning bus stop location if different from home address:

(Number) (Street Name) (Zip) (Apt#)

Do you request afternoon bus drop-off? Yes No Afternoon bus stop location if different from home address: (Number) (Street Name) (Zip) (Apt#)

These are pick-up and delivery addresses that your child will use unless written changes are sent to the school and signed by the parent/guardian. The parent/guardian is responsible for having the child at the appropriate bus stop in the morning and for being there on time in the afternoon to receive the child. I give permission for the above-named child to be transported by Carrollton City Schools. Parent/Guardian name (print): Signature: Date: Home Phone #: Emergency Phone #:

BUS TRANSPORTATION FORM

This form will give Carrollton City Schools permission to transport your child. To enable your child to ride the bus to and from school, this form must be completed and returned to your child’s school as soon as possible. Please complete one form for each child.

I. RELEASE We, the undersigned (parent/guardian) of , do hereby authorize the academic and

discipline records of this student born on, , to the Carrollton City Schools.

Name of School Address City State Zip

The name and address of the school my/our child last attended was:

Name of School Address City State Zip

The day of 20

Signature of Parent/Guardian

II. DISCLOSURE IS IS NOT currently serving a term of suspension or expulsion from

another school. If the student is currently under suspension or expulsion, please complete the following:

Reason for suspension/expulsion:

Term of suspension/expulsion:

The student Has Has Not been convicted of one or more of the following felonies:

Aggravated sodomy Aggravated sexual battery Aggravated child molestation Aggravated batter Aggravated assault Arson in the first or second degree Battery of a teacher or school employee Carrying or possession of a weapon Escape after conviction of a designated felony Fourth commission of any act which is

committed by an adult would be a felony. Hijacking a motor vehicle Kidnapping or attempted Kidnapping Manufacture, possession, transport or

distribution, of a hoax device or replica of a destructive device (second offense)

Murder or attempted murder

Obstruction of an officer in the detection, disarming, or destruction of a destructive device.

Possession of a pistol or revolver (second of subsequent offense) Possession, manufacture, transport, or distribution of:

a) an explosive, detonator, incendiary, poison gas, bomb, grenade, missile, rocket, or Molotov cocktail. b) any weapon with a bore diameter of more than one half inch. c) a weapon of mass destruction d) a bacteriological or biological weapon

Possession, sale, manufacture, delivery, or trafficking cocaine, illegal drugs, marijuana, or methamphetamine

Racketeering Rape Robbery or armed robbery with or without a firearm Theft of a motor vehicle (second offense)

The date the student was found guilty

The jurisdiction in which the conviction occurred: City County State

The sentence imposed:

I certify that all information provided is true to the best of my knowledge; furthermore, I understand that if my student is currently suspended or expelled from another school district, he/she may not be eligible for enrollment during the term of that suspension or expulsion. I further understand that the Carrollton City Schools may find the student ineligible for enrollment at this time based on the information contained in the records from the prior school’s records. This_____________ day of _____________ 20_________. Parent/Guardian Signature Student Signature

Date of Birth

Name of Student

Name of Student

PARENT/GUARDIAN RELEASE & DISCLOSURE STATEMENT

PARENT/GUARDIAN RELEASE & DISCLOSURE STATEMENT FOR CONDITIONAL ENROLLMENT OF MIDDLE AND HIGH SCHOOL STUDENTS