FY22-23 Student Registration Packet

AUTHORIZATION FOR RELEASE OF RECORDS & INFORMATION
I,Parent/Guardian Name* , hereby authorize release of Records/Transcript/Evaluation* regarding my child, Student's Name* DOB: Date of Birth*
From:Previous School/Agency*   to the Thomasville City Schools for the following purpose(s):
Check all that apply: Education Programming   Psychiatric Evaluation   Medical   Psychological-Educational Evaluation   Other   Attendance

I understand that I am freely giving my consent to this release of information. I also understand that I have a right to inspect and review all records.
The above information is correct and complete to the best of my knowledge.
Parent/Guardian Signature *

Clear
Date

Month Day Year
Date

Pre-K Registration Form
School/Site Name:

Harper Elementary Jerger Elementary Scott Elementary
Child's Name(Exactly as it appears on the birth certificate) *

First Name Middle Name Last Name Suffix(i.e. Jr, Sr, II, III)
Child's Social Security Number: *
D.O.B. *

Month Day Year
Date Of Birth
Sex: *

Male Female
Home Address (Do not enter PO Box Info): *

Home Address

City

County State

Zip Code
Home Phone
Please enter a valid phone number.
If the Student is transferring from another Pre-K, please provide the following:
Previous School Name:
Last Date in Attendance:

Month Day Year
Date
Parent/Guardian Information
Parent/Guardian #1 *

First Name Middle Initial Last Name
Home Address (IF DIFFERENT FROM CHILD)

Street Address

Street Address Line 2

City State

Zip Code
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email:
example@example.com
Place of Employment:
Work Phone:
Please enter a valid phone number.
Work Address

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian #2

First Name Middle Initial Last Name
Home Address (IF DIFFERENT FROM CHILD)

Street Address

Street Address Line 2

City State

Zip Code
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email:
example@example.com
Place of Employment:
Work Number
Please enter a valid phone number.
Work Address

Street Address

Street Address Line 2

City State

Zip Code
Emergency Contact Information(Persons to contact in the event that either parent/guardian cannot be contacted)
Emergency Contact #1
Name
Relationship
Cell Phone
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Email
example@example.com
Emergency Contact #2
Name
Relationship
Cell Phone
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Email
example@example.com
I verify the above information to be correct, and I understand that completion of this form does not guarentee placement in a Pre-K class. If my child is placed in Georgia's Pre-K Program, I agree that my child will attend the program for the required number of hours and days as prescribed by the Georgia Department of Early Care and Learning and outlined by the center where my child is enrolled. I understand that failure to comply with these attendance requirements could result in disenrollment. I understand that I cannot register my child without appropriate age documentation.
Signature Parent/Guardian: *

Clear
Date

Month Day Year
Date

Pre-K Registration Form
Child Maintenance
Child's Living Arrangements:

Both Parents Mother Father Other
Child's Legal Guardian:

Both Parents Mother Father Other
The child may be released to the person(s) signing this agreement or to the following:
Name #1
Address
Relationship
Cell Phone
Please enter a valid phone number.
Name #2
Address
Relationship
Cell Phone
Please enter a valid phone number.
Name #3
Address
Relationship
Cell Phone
Please enter a valid phone number.
Name #4
Address
Relationship
Cell Phone
Please enter a valid phone number.
Child's Physician or Clinic's Name(Child's Primary Health Source):
Date of last full health screening:

Month Day Year
Date
Phone Number
Please enter a valid phone number.
My child has the following special need(s):
The following special accommodation(s) may be required to most effectively meet my child's needs while at this center:
My child is currently on medication(s) prescribed for long-term continuous use and/or has the following pre-existing allergies, illness, or health concerns:

Pre-K Registration Form
General Release

I verify the above information to be correct and true. I hearby grant permission for the information provided in the preceding Registration Form to be distributed to Pre-K providers, the Department of Early Care and Learning (DECAL), and certian agencies or those entities contracted by Pre-K providers or DECAL which shall include, but not be limited to, the Georgia Department of Education, and colleges/universities.
Signature (Parent/Guardian) *

Clear
Date

Month Day Year
Date
Photograph/Videotape Release

I hereby grant permission for the Pre-K provider specified below, the Georgia Department of Early Care and Learning (DECAL) and certain agencies or entities contracted by the Pre-K provider or entities contracted by the Pre-K provider or DECAL which shall include, but is not limited to, the Georgia Department of Education, and colleges/universities, to record the participation and appearance of my child, child's name, by photograph and/or videotape in connection with daily Pre-K activities for the purposes of news releases, reporting, and assessing the progress of children and the program. DECAL and its contractors are authorized to exhibit or distribute such photograph(s) and/or videotape in whole or in part without restrictions or limitations for any educational or promotional purpose that DECAL deems appropriate. Such photograph(s) and/or videotape may, for example, appear in printed or visual materials for DECAL and/or on DECAL's web site.
The undersigned hereby jointly and severally releases, acquits, forgives, and discharges the Pre-K provider, DECAL, and other entities contracted by the Pre-K provider or DECAL, from any actions, agreements, claims, controversies, demands, judgements, liabilities, proceedings, and suits, whether arising in equity or in law regarding such participation and appearance by said child.
This shall remain binding upon all successors in the interest and personal representatives of the parties, to the extent permitted by law.
Pre-K Provider Name/Address:
Signature (Parent/Guardian): *

Clear
Date

Month Day Year
Date

Non-Resident Parent Contract

Pre-K through 12
Parental involvement is actively sought by the Thomasville City School District. By enrolling your child in the system, you are promising to provide the necessary support and home environment for a positive educational experience. As a parent/guardian of a Thomasville City Schools student, I support and pledge the following:

1. An early commitment to attendance and punctuality helps develop a sense of responsibility that can transcend a lifetime. Therefore, I pledge to fully support the school's attendance and punctuality policies.
- My child will attend school every day possible.
- My child will be punctual and will not be signed out unnecessarily.
- I will provide timely, written excuses for all absences.
- When possible, I will provide written notification of any impending absences.
2. I understand that a parent's role is critical to the educational process. I pledge to fulfill this responsibility in the following ways:
- My child will complete all assigned forms, including homework.
- I will support the development of positive study habits.
- I will attend all conferences requested by the school.
- I will sign and return all progress reports and report cards if requested.
- I will communicate in a respectful manner with teachers and all school personnel.
3. As a parent, I understand that my child's cooperation and behavior is critical to his/her academic progress. Therefore, I pledge the following:
- I will require my child to show respect for faculty, staff, property and students.
- I will support the school's student code of conduct.
4. I understand that a non-resident student may be removed from Thomasville City Schools for any of the following reasons:
- Unacceptable behavior (as defined by the Code of Conduct)
- Unacceptable attendance (as defined by the Attendance Policy)
- Lack of effort and/or poor academic performance
- Falsification and/or misrepresentation of information during the application process.
Student Name: Student Name Grade:Grade
Parent Signature *

Clear
Date

Month Day Year
Date

Student Internet User Agreement
Student Name: *

First Name Last Name
Grade:
Age:
Parent/Guardian's Name:

First Name Last Name
Home Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone:
Please enter a valid phone number.
Work Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Select School: *

Harper Jerger MPMS Scott SA TCPC THS
Student Signature *

Clear
Date

Month Day Year
Date
Parent Signature:

Clear
Date

Month Day Year
Date

Home Language Survey

State Required
Please select Language:

English Spanish
Dear Parent or Guardian:

In order to provide your child with the best possible education, we need to determine how well he or she speaks and understands English. This survey assists school personnel in deciding whether your child may be a candidate for additional English language support. Final qualification for language support is based on the results of an English language assessment.

Thank You
Student Name: *

First Name Last Name
School: *
Language Background (required information):

Which language does your child best understand and speak?   Answer*
Which language does your child most frequently speak at home?   Answer*
Which language do adults in your home most frequently use when speaking with our child?   Answer*

Language for School Communication:

In which language would you prefer to receive school information?   Answer*
Signature: *

Clear
Date

Month Day Year
Date
Preguntas de la encuesta sobre el idioma en el hogar requerida por el estado

Estimados padres o tutor:

El estado requiere que el distrito escolar realice una Encuesta sobre el idioma en el hogar para cada estudiante recientemente matriculado. Esta información se utiliza para identificar a los estudiantes que podrían necesitar servicios de apoyo en idioma inglés. Los estudiantes cuya lengua materna o primaria no sea el inglés deben realizar un diagnóstico para determinar la elegibilidad como estudiante de inglés.

Responda las preguntas debajo para ayudarnos a determinar si su hijo debe realizar la evaluación diagnóstico de dominio del idioma inglés. Gracias.
Nombre del estudiante (requerido): *
Preguntas de la encuesta sobre el idioma en el hogar (requeridas):

¿Qué idioma habla y entiende mejor su hijo?   Respuesta*
¿Qué idioma habla más frecuentemente su hijo en casa?   Respuesta*
¿Qué idioma usan los adultos en casa con mayor frecuencia cuando hablan con su
hijo?   Respuesta*

Además, el estado requiere que el distrito escolar registre el idioma preferido de la familia para la comunicación escolar. Gracias por completar la pregunta a continuación. (Esta pregunta no es parte de la Encuesta sobre el idioma en el hogar anterior).

Idioma preferido por los padres para la comunicación escolar:

¿En qué idioma prefiere recibir la información de la escuela?    Respuesta*
Firma: *

Clear
Fecha:

Month Day Year

Thomasville City Schools Chromebook Checkout Contract

Acceptable Use Rules

1. The Chromebook is an educational tool and should be used in that capacity only.

2. The student is responsible for the Chromebook at all times.

3. The Chromebook should not be used to – COPY, DOWNLOAD, UPLOAD, or SHARE COPYRIGHTED MATERIALS without legal permission. This includes reproduction of music files (CDs) and software applications.

4. The student is the only authorized user of your assigned Chromebook. Never share or swap Chromebooks with another student. Keep your password CONFIDENTIAL.

5. Do not EAT or DRINK near your Chromebook.

6. Avoid touching the screen. When cleaning is necessary, use a soft cloth.

7. Do not mark the Chromebook in any way with markers, stickers, etc.

8. Do not remove labels or asset tags.

9. Do not insert foreign objects into openings of the Chromebook.

Internet Use Rules

1. Students agree to adhere to the Thomasville City Schools Internet use policy signed by each student.

2. The Chromebook issued to you is Thomasville City Schools property and all content (software, email, Internet usage) will be monitored AT ALL TIMES. Content found that is related to illegal or unethical activities will be reported to the authorities.

3. School staff has the right at any time to spot check student Chromebooks.

Home Use Rules

1. Students are responsible for the care of their Chromebooks.

2. Do not leave Chromebooks in vehicles. Computers cannot tolerate extremes in temperature.

3. Chromebooks must be recharged before returning to school.

4. If a Chromebook is stolen, the police and the school office must be notified immediately in order for the Chromebook to be traced and disabled.

5. If a Chromebook is lost, the school office must be notified as soon as possible.

6. Parents are responsible for the replacement cost of lost Chromebooks, power cords or damage incurred.

Chromebook Screen	Average $100
Charging Cord	Average $50
Key Replacement	$8 per key replaced
Chromebook Replacement	Average $360

7. Parents/guardians are responsible for monitoring his/her child’s use of the Chromebook at home.

8. School policies continue to apply when using the computer online at home.

Student Name: *

First Name Last Name
Home Address: *
Address, City, State, Zip
Phone Number: *
Please enter a valid phone number.
Parent Name: *

First Name Last Name
Student

I have read and agree to the Thomasville City Schools Chromebook Checkout Contract. I understand my responsibilities as a student. Violation of these policies will be subject to loss of use of the Chromebook as well as other disciplinary consequences as addressed in the Internet Usage Policy.
Printed Student Name: *
Student Signature: *

Clear
Date

Month Day Year
Date
Parent

I have read and agree to the Thomasville City Schools Chromebook Checkout Contract. I understand my responsibilities as a parent/guardian. Violation of these policies will be subject to loss of use of the Chromebook as well as other disciplinary consequences as addressed in the Internet Usage Policy. I am giving consent for my child to bring the Chromebook home.
Printed Parent/Guardian Name: *
Signature: *

Clear
Date: *

Month Day Year
Date
School: *
Grade: *
Homeroom Teacher:

Thomasville City Schools Home WiFi Hotspot Loaner Agreement
To ensure that our students can fully participate in our 1:1 device program both within school and at home, the district will consider providing an Internet access device to households that have demonstrated a need for such a device. Known as wireless hotspots, these devices are provided on loan to the household. They should be used primarily to provide the student(s) in the household with the ability to access on-line curriculum materials and information relevant to their education.

Wireless Hotspot Care

- Only labels or stickers approved and placed onto the hotspot by Thomasville City Schools staff are acceptable.

- Do NOT attempt to try to repair the internal workings of a wireless hotspot yourself.

- If the wi-fi hotspot is not working, please return the device to the Thomasville City Schools board office so that any issues can be resolved.

Turn In

Wireless hotspots and accessories must be returned at the end of each school year at a date and time determined by the Thomasville City Schools. Students who graduate early, transfer, withdraw, or are expelled will return the device and accessories at the time of withdrawal. Failure to return the property in a timely fashion may result in the involvement of law enforcement.

In instances where the student has put his/her own safety or the safety of others at risk (i.e. sexting or bullying), wireless hotspot privileges will be revoked immediately.

I (parent/guardian) have read the Thomasville City Schools Home WiFi Hotspot Loaner Agreement. I understand the technology is provided for educational purposes in keeping with the academic goals of Thomasville City Schools.

- I agree to return the device as stated above in the “Turn In” Section.

- I agree to pay for a damaged, lost, or unreturned device. (Estimated cost=$100)

- I agree to return the device if internet access for the household is obtained through other means.

- Although the district has sophisticated filters and protections in place, I recognize it is impossible for the school/district to restrict access to all controversial materials and will not hold the school/district responsible for materials acquired on the school network

- I understand that children’s computer activities at home should be supervised.
Student Name: *

First Name Last Name
Parent/Guardian Name: *

First Name Last Name
Parent/Guardian Signature: *

Clear
Date: *

Month Day Year
Date
School: *

GHSA Enrollment Information
TO: STUDENTS ENROLLING INTO THOMASVILLE HIGH SCHOOL

Welcome to Thomasville High School. Please read the following if you desire to participate in our interscholastic activities. You are eligible only if you:

- had a bona fide move and are living within our school attendance zone.

NOTE: A bona fide move is defined as the student moved with the entire parental unit or persons he/she resided with at the former school, and the student and parent(s) or persons residing with the student live in in the service area of the new school. (Note: A move within the same service area does not constitute a bona fide move.)

- attended an accredited school last semester.
- earned at least 2.5 Carnegie units the previous semester.
- have earned Carnegie units that count toward graduation equivalent to years you have been in high school. These are the minimums for entering each grade level: 10th- 5 units, 11th- 11 units & 12th- 17 units.
- have been in high school no more than four consecutive years after your first entry into ninth grade.
- have not attained your 19th birthday prior to May 1st preceding the year of participation.
- have completed a physical examination during the past 12 months.
- were not ineligible at the previous school for academic or behavioral reasons.
- are not a professional athlete in the sport you wish to participate.

Our school’s athletic code and eligibility policies are available upon request.

Recruiting and Undo Influence Waiver Form
Date

Month Day Year
Date
Student Name: *

First Name Last Name
Parent Name: *

First Name Last Name
Parent Contact #: *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Reason for Enrollment: *
My signature below acknowledges my child has NOT been recruited and/or influenced to enroll at Thomasville High School for the purpose of athletic participation.
Parent Signature: *

Clear
Date:

Month Day Year
Date
My signature below acknowledges I was NOT recruited and/or influenced to enroll at Thomasville High School for the purpose of athletic participation.
Student Signature: *

Clear
Date:

Month Day Year
Date
Witness Signature:

Clear
Date:

Month Day Year
Date

Authorization For Release Of School Records
PLEASE SEND INFORMATION AND RECORD TO:

School/Agency:     School/Agency*
Address: Address*
City, State, and Zip Code:   City, State, and Zip Code*
Phone:   Phone*
Fax:   Fax
Registrar's Email:   Registrar's Email
Student's Full Name: *

First Name Middle Name Last Name
Age: *
Birthdate: *

Month Day Year
Date
Grade Level: *
I authorize the listed below to release all school records and information pertaining to the student named above. Please include any Special Education Records where applicable. The following information needs to be included in order for the child’s registration to be complete.

❖ Academic Records

❖ Social Security Card

❖ Copy of Report Card

❖ Certified Birth Certificate

❖ Immunization Records ( Ga Form 3032)

❖ Ear, Eye, and Dental Screening (Ga Form 3300)

❖ Special Education Records (including Psychological Report , IEP, Gifted Records)

❖ Attendance

❖ Discipline

❖ Test Scores

❖ Guardianship Documentation

❖ Withdrawal Form W/ Grades
❖ Choose Student Placement:

Reg. ED. Alt. Sch. Spec. Ed 504 RTI

NOTICE: It is understood that the party to whom this information is released will not release it to a third party.

I understand and agree to the above statement:

Parent or Legal Guardian: *
Parent or Legal Guardian
Date

Month Day Year
Date

Should be Empty:

FY22-23 New Student Registration Packet

MEDICAL HISTORY SURVEY

AUTHORIZATION FOR RELEASE OF RECORDS & INFORMATION

Pre-K Registration Form

Pre-K Registration Form

Pre-K Registration Form

Non-Resident Parent Contract

Student Residency Statement & Needs Assessment Forms

STUDENT NEEDS ASSESSMENT MCKINNEY-VENTO SURVEY

Student Internet User Agreement

THOMASVILLE CITY SCHOOLS CLINIC RECORD

Parent Occupational Survey

Home Language Survey

Thomasville City Schools Chromebook Checkout Contract

Thomasville City Schools Home WiFi Hotspot Loaner Agreement

GHSA Enrollment Information

Recruiting and Undo Influence Waiver Form

Authorization For Release Of School Records