Grades 1-8: Registration Form

Student Health Information Continued
Please list other important health or behavior information:
What type of medical insurance do you have? *

None Medi-Cal Healthy Families Kaiser Private Other
If there is any change in your child’s health which affects her/his ability to participate in physical education, or if she/he is given regular medication (Ed. Codes 49423, 51241), it is the parents’ responsibility. All forms can be obtained from the School Health Office.

* These conditions require a Health Care Plan. Note: Any of the above conditions may require a Health Care Plan. This information is kept in the student’s health record. I give permission for the nurse to share this information with school staff if necessary.
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date

ACKNOWLEDGEMENT OF PARENT RIGHTS AND RESPONSIBILITIES
State law requires that parents or guardians be notified of their rights and responsibilities pertaining to their child’s education. The Parent Notice of Rights and Responsibilities document is posted on the Knights Ferry Elementary School website, (available in hard copy by request). Signing this form acknowledges that you have read and understood the Parent or Guardian Rights and Responsibilities notification. Also, please indicate below whether your child is on a continuing medication program and select the appropriate response regarding personal information.
Students Name *

First Name Last Name
School *
Grade *
Choose Grade Level
Is student is on a continuing medication program:

Yes No
If YES, you have my permission to contact student’s physician:

By selecting this option you are agreeing with the above statement
Please list all medications and dosages:
Physician’s Name:
Physician's Phone:

Area Code Phone Number
If you do not choose to provide permission to allow your child’s personal information to be released, which may include their photo, name, age, or birthdate, please select the appropriate box. *Note that this will prohibit the District from providing this information to any newspapers reporting on Knights Ferry School events, interested schools, Parent-Teacher Club events or Facebook page, interested employers, and similar parties. If you choose not to allow the District to release this information but would like to make an exception for the school yearbook, you may do so by selecting the box stating this exception.
District Consent *

I consent to allowing the District to release personal information regarding my child. I do not consent to allowing the District to release personal information regarding my child.
Check if an exception may be made to include student information and photos in the yearbook.
I hereby acknowledge receipt of information regarding my rights, responsibilities, and protections.
Signature of Parent of Guardian: *

Clear
Date *

Month Day Year
Date

Home Language Survey

English
Type a question

Type option 1
The California Education Code requires schools to determine the language(s) spoken at home by each student. This information is essential in
order for schools to provide meaningful instruction for all students.
Your cooperation in helping us meet this important requirement is requested. Please answer the following questions and have your
son/daughter return this form to his/her teacher. Thank you for your help.
Date:

Month Day Year
Date
Student Name:

First Name Last Name
School:
Teacher:
Grade:
Age:
Which language did your son or daughter learn when he or she first began to talk?
What language does your son or daughter most frequently use at home?
What language do you use most frequently to speak to your son or daughter?
Name the language most often spoken by the adults at home:
Signature of Parent or Guardian:

Clear
Date:

Month Day Year
Date

Spanish
El código de educación de California requiere que las escuelas para determinar el idioma o idiomas hablados en el hogar por cada
estudiante. Esta información es esencial para que las escuelas a proporcionar instrucción significativa para todos los estudiantes.
Se solicita su colaboración en ayudarnos a cumplir con este requisito importante. Por favor contesta las siguientes preguntas y tener a su
hijo/hija devolver este formulario a su maestro. Gracias por tu ayuda.
Type a question

Type option 1
Date:

Month Day Year
Date
Name of Student:

Apellido Segundo
Escuela:
Maestro:
Grado:
Edad:
¿1El idioma que su hijo o hija aprender cuando él o ella empezó a hablar?
¿Qué lenguaje ¿su hijo o hija con más frecuencia utiliza en casa?
¿Qué lengua utiliza con más frecuencia para hablar con su hijo o hija?
Nombre de la lengua hablada más a menudo por los adultos en el hogar:
Firma del padre o tutor:

Clear

Internet Responsibility Contract
Knights Ferry School District now has access to the Internet - a collection of thousands of interconnected computer networks around the world that allows almost instantaneous sharing of information.

Students and staff will have access to college and university libraries, information and news from a variety of sources and research institutions, software of all types, electronic mail and discussion groups on a wide variety of topics, and much more.

Knights Ferry School District strongly believes in the educational value of such electronic services and recognizes the potential of such to support our curriculum and student learning in our district. Our goal in providing this service is to promote educational
excellence by facilitating resource sharing, innovation, and communication. We also want to take every precaution to protect students and staff from any misuses or abuses of this world-wide service. With access to computers and people all over the world also comes the potential availability of material that may not be considered to
be of educational value in the context of the school setting. There may be some material or individual communications which are not suitable for school-age children.

In that agreement, the student and his/her parent/guardian shall agree not to hold the district or any district staff responsible for the
failure of any technology protection measures, violations of copyright restrictions, or user mistakes or negligence. They shall also
agree to indemnify and hold harmless the district and district personnel for any damages or costs incurred.

Students must agree to responsible use of the system under the rules for use listed below
1. I will not use the Internet unless a school administrator, teacher, aide, or secretary is present in the room and has FIRST given permission.
2. The student in whose name an online services account is issued is responsible for its proper use at all times. Students shall keep personal account numbers and passwords private and shall only use the account to which they have been assigned.
3. Students shall use the district’s system safely, responsibly, and primarily for educational purposes.
4. Students shall not access, post, submit, publish, or display harmful or inappropriate matter that is threatening, obscene,
  disruptive, or sexually explicit, or that could be construed as harassment or disparagement of others based on their
  race/ethnicity, national origin, sex, gender, sexual orientation, age, disability, religion, or political beliefs.
  
  Harmful matter includes matter, taken as a whole, which to the average person, applying contemporary statewide standards,appeals to the prurient interest and is matter which depicts or describes, in a patently offensive way, sexual conduct and which lacks serious literary, artistic, political, or scientific value for minors.
5. Unless otherwise instructed by school personnel, students shall not disclose, use, or disseminate personal identification information about themselves or others when using email, chat rooms, or other forms of direct electronic communication. Students also shall be cautioned not to disclose such information by other means to individuals contacted through the Internet
  without the permission of their parents/guardian.
  
  Personal information includes the student’s name, address, telephone number, Social Security number, or other personally
  identifiable information. Students shall not use the system to encourage the use of drugs, alcohol, or tobacco, nor shall they promote unethical
  practices or any activity prohibited by law, Board policy, or administrative regulations.
6. Students shall not use the system to engage in commercial or other for-profit activities.
7. Students shall not use the system to threaten, intimidate, harass, or ridicule other students
8. Copyrighted material shall be posted online only in accordance with applicable copyright laws. Any materials utilized for research projects should be given proper credit as with any other printed source of information.
9. Students shall not intentionally upload, download, or create computer viruses and/or maliciously attempt to harm or destroy
  district equipment or materials or manipulate the data of any other user, including so-called “hacking”.
10. Students shall not attempt to interfere with other users’ ability to send or receive email nor shall they attempt to read, delete,
  copy, modify, or use another individual’s identity. Students shall report any security problem or misuse of the services to the teacher or Superintendent/Principal.
A Student MUST BE PREPARED to be held accountable for his/her actions and for the loss of privileges if the rules listed on the reverse side of this form are violated.

The district reserves the right to monitor use of the district’s systems for improper use without advance notice or consent. Students shall be informed that computer files and electronic communications, including email, are not private and may be accessed by the district for the purpose of ensuring proper use.

Whenever a student is found to have violated Board policy, administrative regulation, or the district’s Acceptable Use Agreement, the Superintendent/Principal or designee may cancel or limit a student’s user privileges or increase supervision of the student’s use of the district’s technological resources, as appropriate. Inappropriate use also may result in disciplinary action and/or legal action in accordance with law and Board policy.

Use of the District’s computer system is a privilege, not a right. Network administrators may review communications to maintain
system integrity and insure that students are using the system responsibly. Anyone can read what you write. Consequences for
violating the behavior standards outlined above include:
- loss of technology privileges from 1 month to 1 year, depending on the severity
- repayment of any damages caused to equipment.
- suspension/expulsion
Staff shall provide age-appropriate instruction regarding safe and appropriate behavior on social networking sites, chat rooms, and other Internet services. Such instruction shall include, but not limited to, the dangers of posting personal information online, misrepresentation by online predators, how to report inappropriate or offensive content or threats, behaviors that constitute
cyberbullying, and how to respond when subjected to cyberbullying.

Student use of district computers to access social networking sites is prohibited.

In order to use the Internet, students and parents must sign the agreement to indicate understanding of the conditions of responsibility
and return this form to their child’s teacher.

PARENT OR GUARDIAN

District computers with Internet access have a technology protection measure that blocks or filters Internet access to visual depictions that are obscene, child pornography, or harmful to minors and that the operation or such measures is enforced.

As the parent or guardian of this student, I have read this contract and understand that it is designated for educational purposes. I
understand that it is impossible for the school to restrict access to all controversial materials, and I will not hold the school responsible
for materials acquired on the Internet. I also agree to report any misuse of the information system to the school. Misuse can come in many forms, but can be viewed as any messages sent or received that indicate or suggests pornography, unethical or illegal solicitation, racism, sexism, inappropriate language, and other issues described in this document.

I understand that my child is responsible for his or her behavior, and agree to the consequences set up by Knights Ferry School.
Parent or Guardian Name:
Signature:

Clear
Date:

Month Day Year
Date
STUDENT:
Student Name:
Signature (K-2 don’t need to sign):

Clear
Date:

Month Day Year
Date
This form will be kept on file until the end of the school year

Student-School-Parent Contract
Each student should be helped to reach his/her highest potential for intellectual growth. To achieve this, the student, staff and parent must work together by recognizing and agreeing upon the responsibilities of each in the learning process.

As a student, I will be responsible for:
1. Attending school each day class is in session.
2. Arriving at school on time and prepared to work.
3. Doing all assignments to the best of my ability.
4. Completing all homework assignments on time and to the best of my ability.
5. Asking questions to stay informed about school assignments.
6. Communicating with my parents about school assignments.
7. Showing respect and cooperating with all members of the school community.
8. Asking the instructor for help when needed.
Student Signature:

Clear
Date:

Month Day Year
Date
As a parent, I will be responsible for:
1. Seeing my child is at school and on time every day.
2. Knowing how my child is doing in school by attending conferences, looking at schoolwork, checking to see assignments are completed, and talking with my child and his/her teacher.
3. Working with my child to set household routines that provide structure and limits, so that schoolwork takes first place over everything else.
4. Showing respect and cooperating with all members of the school community.
Parents Signature:

Clear
Date:

Month Day Year
Date
The Knights Ferry School Staff will be responsible for:
1. Providing high-quality curriculum and instruction in the subject areas determined
  by the Knights Ferry School District Board.
2. Providing meaningful instruction so students have a clear understanding of what is expected.
3. Providing opportunities for communication with parents concerning their child’s progress.
4. Providing a safe and positive environment.
5. Showing respect and cooperating with all members of the school community.
Staff Member Signature:

Clear
Date:

Month Day Year
Date

Student insurance for Sports Grades 5 through 8 Only
In order to participate in the sports program (flag football, volleyball, soccer, basketball, softball, track) your child must have insurance coverage. If your child does not have insurance coverage, please contact the school office if you need to purchase student insurance.

If you are interested in allowing your child to participate in the school sports program, please provide the information requested below. Thank you.
Date:

Month Day Year
Date
Students Name:

First Name Last Name
Insurance Company:
Policy Number:
Emergency Contact Number:

Area Code Phone Number
I Give My Permission For My Child:
Child's Name
To Participate In:
(Name of sport OR all sports)
Parent/Guardian Signature:

Clear
Date:

Month Day Year
Date

School Driver Certification Form
Driver Type (Select One)

Employee Parent Volunteer
Name:

First Name Last Name
Date of Birth:

Month Day Year
Date
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number:

Area Code Phone Number
Drive's Licence Number:
Vehicle
Registered Owner of Vehicle:

First Name Last Name
Vehicle Year:
Vehicle Make:
Vehicle Licence Plate Number:
Registration Expiration:

Month Day Year
Date
Registered Owner Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Vehicle Seating Capacity (Number of Seat-belts):
NOTE: Maximum passengers in the vehicle not to exceed 7, including the driver.
Insurance Information
Insurance Company Name:
Policy Number:
Policy Expiration Date:

Month Day Year
Date
Liability Limits of Policy:
(The minimum acceptable limit for privately-owned vehicles is $100,000 per occurrence. If you transport students often, it is recommended that your coverage be $300,000 per occurrence.)
Insurance Agent Name:
Agent Telephone Number:

Area Code Phone Number
VERIFICATION OF DMV DRIVING RECORD
An annual DMV print-out of your driving record must be on file in the school
office if you anticipate transporting students on school field trips. To obtain this
information you may either, drop by your local DMV office or go online at
www.dmv.ca.gov. Click on the “Online Services” tab at the top of the page,
choose the very first item listed, “Driver Record.” Follow the directions on the
page, the fee for this online service is $2.00. If you go into a DMV office the cost is $5.00.

I certify that the information given above is true and correct. I understand that if an accident occurs, my insurance coverage shall bear primary responsibility for any losses or claims for damages.
Driver Applicant Signature:

Clear
Date:

Month Day Year
Date

Permission to Allow Students to be Dismissed to an Off-Campus Location (Optional)
I wish to allow my child,

Student First Name Student Last Name
To Be Dismissed After-School To:

walk directly home after school walk down Dean Street and directly to the Knights Ferry Tennis Court to wait to be picked up bya parent, guardian or other person designated by me.
In granting this permission I understand & agree that:
- My child will be subject to school discipline policies until s/he is picked up. Child must be picked up no later than 3:00 PM.
- Violation of school rules while waiting off-campus may result in my child being directed to return to the main campus to wait for his/her ride, among other consequences.
- Repeated violations of school rules may result in the revocation of my child’s off-campus dismissal privileges.
Parent/Guardian Signature:

Clear
Date:

Month Day Year
Date

Mobile Phone Contract (Optional)
My Child,

Student First Name Student Last Name
has my permission to have in his/her possession a mobile phone. I understand that he/she may not have their phone on them. I understand that it must be turned in to the teacher each day at the beginning of the school day and that it will be given back at the conclusion of the school day. I understand that the phone must be turned off at all times during school hours. If at any time your child is found with the phone on or in his/her immediate possession during school hours it will be confiscated by school personnel and kept in the office until a parent comes to pick it up. In addition a student who violates this policy may be prohibited from possessing a mobile communication device at school and/or may be subject to further discipline.
Student Signature:

Clear
Date:

Month Day Year
Date
Parent/Guardian Signature:

Clear
Date:

Month Day Year
Date
Should be Empty:

Registration Grades 1-8

Emergency Contact Information 01

Emergency Contact Information 02

Emergency Contact Information 03

Data Request For 2019-2020

Student Health Information

Student Health Information Continued

ACKNOWLEDGEMENT OF PARENT RIGHTS AND RESPONSIBILITIES

Home Language Survey

Internet Responsibility Contract

Student-School-Parent Contract

Student insurance for Sports Grades 5 through 8 Only

School Driver Certification Form

Vehicle

Insurance Information

Permission to Allow Students to be Dismissed to an Off-Campus Location (Optional)

Mobile Phone Contract (Optional)