2022 - 2023 : Early Literacy Program Student Registration

New & Returning Early Literacy Program Student Registration

ELP Enrollment Forms 2022 - 2023
We are thrilled that your family has chosen Rocky Mountain Deaf School’s Early Literacy Program for Toddlers & Families as an early literacy and exploration experience for your child. Our goal is to make this program a fantastic experience for everyone… toddlers, families, and staff alike. We provide a literacy-based program in American Sign Language and English in a rich learning environment that nurtures your child’s exploration, creativity, and growth. Throughout the program, families will be modeled on a variety of early literacy activities and will learn effective strategies for promoting their child’s language and learning. Our program realizes the value of parents connecting and supporting one another as well as the chance to interact with other families with children who are Deaf or Hard of Hearing.

During the program, we will have a lot of experiences, but safety is our number one priority. All of our staff members are well trained and were specifically chosen for their ability to work with young children. To ensure everyone’s safety, we ask that families attend with their child for the first month of the program to support their child and maximize the program’s impact.

The first step is to complete the registration to ensure that your child is under good care and that we have all the information to support your child’s needs in communication, medical, and other areas. Your paperwork must be received in order to be considered for the program.

Please be sure your paperwork is completed and submitted before the due date. After we receive your completed registration packet, you will receive a parent letter with specific details of the Early Literacy Program for Toddlers & Families and our confirmed schedule. If you have any questions or concerns regarding the registration packet, please contact Stephanie Carson at scarson@rmds.co or 720-961-9211.

We are looking forward to a great program and working with you and your child!

General Information:

The program will be held in person on Tuesdays and Thursdays from 8:30 a.m.-11:30 a.m.

First Day of the Program: Tuesday, September 20, 2022.
Last Day of the Program: Thursday, May 18, 2023.

Purpose and Philosophy:

Rocky Mountain Deaf School is founded on the belief that Deaf and Hard of Hearing can and should succeed. In this intellectually stimulating environment, communication is totally accessible throughout the program from every person in the child’s environment. Each student’s potential is maximized as teachers continue to instill in each child the joy of living and learning. With our program, we believe that fun and learning go hand-in-hand. We are committed to supporting each child’s joy of learning by nurturing their emotional, creative, and intellectual needs.

Language Rich Learning Environment:

During the program, we provide a linguistically rich learning environment through the acquisition of American Sign Language and English both inside and outside the program. All staff members are fluent in both American Sign Language and English.

Eligible children:

*Ages 18 months to 3 years old
*Deaf or Hard of Hearing

*Completed all the required paperwork
*Families must be present during the first day of the program
Documents We Need:

In order for your child to be enrolled and accepted in the Early Literacy Program, we must have these items below:

1. Identification Information

*Copy of your child’s Birth Certificate
*Proof of residency-a document that contains name and address (Ex: electric bill)

2. Your child's health forms

**General Health Appraisal Form (to be filled out and signed by your child's doctor)

**Current immunizations document provided by your doctor

3. Your child's most recent Audiogram

**A document provided by your audiologist

4. Copy of IFSP or 33-month assessment reports (If applicable)

5. Parent/Guardian Acknowledgements Checklist

***Every item must be filled out on this form in order to be enrolled in the program***
Date of Enrollment *

Month Day Year
Date
Child's Name *

First Name Last Name
Child's Sex *

Female Male Other
Child's Date of Birth *

Month Day Year
Date
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number *
Home Phone Number: Voice or VP? *
Child's Family Members *

First Name Last Name
*

First Name Last Name
*

First Name Last Name
*

First Name Last Name
*

First Name Last Name
Parent/Guardian #1 *

First Name Last Name
Address (if different from child's) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Home Phone Number: Voice or VP? *
Cell Phone Number *
Text Only? *
Email *
example@example.com
Name of Employment
Address of Employment

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone Number
Work Phone Number: Voice or VP?
Parent/Guardian #2

First Name Last Name
Address (if different from child's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Home Phone Number: Voice or VP?
Cell Phone Number
Text Only?
Email
example@example.com
Name of Employment
Address of Employment

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone Number
Work Phone Number: Voice or VP?
Special Instructions for reaching parent/guardian *

Emergency Contacts

other than parents/guardians
Name #1 *

First Name Last Name
Home Phone Number *
Home Phone Number: Voice or VP? *
Work Phone Number *
Work Phone Number: Voice or VP? *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Relationship to Child *
Name #2 *

First Name Last Name
Home Phone Number *
Home Phone Number: Voice or VP? *
Work Phone Number *
Work Phone Number: Voice or VP? *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Relationship to Child *
Child Pick Up Information

Persons authorized to pick up your child (must show photo ID)
Name #1

First Name Last Name
Home Phone Number
Home Phone Number: Voice or VP?
Work Phone Number
Work Phone Number: Voice or VP?
Name #2

First Name Last Name
Home Phone Number
Home Phone Number: Voice or VP?
Work Phone Number
Work Phone Number: Voice or VP?
Name #3

First Name Last Name
Home Phone Number
Home Phone Number: Voice or VP?
Work Phone Number
Work Phone Number: Voice or VP?

Parent/Guardian Acknowledgements
By signing below, I confirm that I have received, read, and completed the following documents and procedures, understand their contents, and agree to follow the rules outlined herein. Please review all the information with your student(s) and complete the following: *

Jefferson County Conduct Code Agreement Jefferson County Student Internet Use Agreement FERPA Release Form RMDS Parent/Student Handbook
*The RMDS Student/Parent Handbook, Jeffco Code of Conduct, and Student Internet Use Policy will be available online at www.rmds.co >> Parents >> Documents. A hard copy of any of these documents will be available by request at the front office.
Student Name *

First Name Last Name
Grade *
Which school district do you live in? *
Parent/Guardian Name *

First Name Last Name
Signature *

Clear
Date *

Month Day Year
Date

Jeffco Conduct Code Signature Page
The Jefferson County Public Schools Conduct Code has been prepared to provide you and your student with information relating to your student’s rights and responsibilities. In order for our policies and procedures to have the greatest positive effect, we need your support. Please sign this form and return to the RMDS front office.

Thank you for your cooperation.

I understand that the Conduct Code will be available on-line at: http://www.jeffcopublicschools.org/schools/code_of_conduct for me to access at my convenience. I have internet capability and will access the Code. I have read and discussed the policies and procedures contained therein with my child. I understand that copies of the Code may also be accessed for review in the main office at school.
Child's Name *

First Name Last Name
Grade *
Parent/Guardian Name *

First Name Last Name
Signature *

Clear
Date *

Month Day Year
Date

Jeffco Student Use of the Internet (acceptable use agreement)

JS-E1– Exhibit for District Policy JS Adopted: June 26, 1997 Revised: May 3, 2010
In order to provide for the appropriate use of the Internet in accordance with district policy JS, "Student Use of the Internet", and other applicable district policies, the following "Acceptable Use Agreement" has been developed. (A copy of this agreement will be distributed to students and must be completed and signed by the student and/the student's parent/legal guardian before a student is allowed to access district computing resources.)

Acceptable Use Agreement for Students

All computers having Internet access must be used in a responsible, efficient, ethical, and legal manner. Failure to adhere to district policy JS, "Student Use of the Internet," will result in revocation of access privileges; restitution for costs associated with damages; and, may result in disciplinary action as indicated in the paragraphs below, and/or legal action. I have read and understood district policy JS, "Student Use of the Internet," and agree to abide by its terms. I further understand that violation of district policy JS, "Student Use of the Internet." may result in my loss of Internet access and/or computer use privileges, and school discipline (including suspension or expulsion) being taken against me, legal action being taken against me, and/or restitution by me for costs associated with any damages caused by such violations.
Student Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Student's Signature *

Clear
Parent or Guardian: As the parent or legal guardian of the above student, I give my consent to his/her use of school computers to access the Internet for school-related academic purposes while at school under the terms and conditions set forth above. All students regardless of age must have this contract signed by a parent/guardian in order to access the Internet at school.
Parent/Guardian Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Parent/Guardian's Signature *

Clear

Family Educational Rights and Privacy Act (FERPA)

In accordance with Jeffco’s opt out procedure, RMDS gives parents and guardians the option to exclude their student’s information and electronic images from specific outlets. Check the appropriate boxes below.
RMDS Web Media *

Yes, my student’s electronic images and information can be included on RMDS web media (website, Facebook, Instagram). No, my student’s electronic images and information may not be included on RMDS web media.
RMDS Publications *

Yes, my student’s images and information can be included in the newsletters, event programs, yearbook, and other school publications. No, my student’s images and information may not be included in the newsletters, event programs, yearbook, or other school publications.
Media Publications *

Yes, my student can be interviewed, videotaped, and photographed in connection with a story about Rocky Mountain Deaf School. RMDS may provide the name of my student for the purposes of this news media. Furthermore, neither my student nor I will accept any monetary payments in return for this service and aforementioned rights. No, my student may not be interviewed, videotaped, or photographed in connection with a story about Rocky Mountain Deaf School.
Student Name *

First Name Last Name
Grade *
Parent/Guardian Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Parent/Guardian's Signature *

Clear

Family Directory
Here at Rocky Mountain Deaf School, we strive to create and embody our value of the Family Atmosphere. Whether it be the weekend, fall break, winter break, or summer break, families often find themselves wondering how they might be able to contact their child’s best friend’s guardians/parents or another family that they met at an RMDS event. We recognized this need and have created a family directory that is distributed to families, as a step towards nurturing the family atmosphere that we value.
Please let us know if you would like opt-in or opt-out of the RMDS family directory. Note that we will not include home addresses in the directory. *

Yes, I would like my information to be included in the RMDS family directory. No, I would not like my information to be included in the RMDS family directory.
Student Name *

First Name Last Name
Grade *
Parent/Guardian Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Parent/Guardian's Signature *

Clear
Should be Empty:

New & Returning Early Literacy Program Student Registration

Emergency Contacts

Child Pick Up Information

Child's Medical Information

Program Schedule and Family Preferences:

Parent/Guardian Acknowledgements

Jeffco Conduct Code Signature Page

Jeffco Student Use of the Internet (acceptable use agreement)

Family Educational Rights and Privacy Act (FERPA)

Family Directory