Davis ES 23-24

New StudentReturning Student

Student First Name*

Student Middle Name*

Student Last Name*

Grade Level for 23-24 School Year*

Legal Name

Home Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Child's S.S. Number*

Cell Phone*

Please enter a valid phone number.Format: (000) 000-0000.

YesNo

Student Date of Birth*

Date

Age*

MaleFemale

Birthplace City*

Birthplace State*

Physical Home Address*

Physical Home Address City*

Physical Home Address Zip*

Mailing Address(If different)

Name of county in which you reside*

Legal names of student's natural parents:

Mother*

Father*

If student's parents are divorced or separated please indicate who has custody

Natural FatherStep FatherGuardian

E-Mail of Male parent/guardian with whom student resides*

example@example.com

Name of Male parent/guardian with whom student resides*

Work Phone Number of Male parent/guardian with whom student resides

Please enter a valid phone number.Format: (000) 000-0000.

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Occupation of Male parent/guardian with whom student resides*

Place of Work of Male parent/guardian with whom student resides*

Natural MotherStep MotherGuardian

E-Mail of Female parent/guardian with whom student resides*

example@example.com

Name of Female parent/guardian with whom student resides*

Work Phone Number Female parent/guardian with whom student resides

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone Number Female parent/guardian with whom student resides*

Please enter a valid phone number.Format: (000) 000-0000.

Occupation of Female parent/guardian with whom student resides*

Place of Work of Female parent/guardian with whom student resides*

Emergency Contact #1: Name*

Emergency Contact #1: Relationship*

Emergency Contact #1: Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #1: Cell Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #2: Name*

Emergency Contact #2: Relationship*

Emergency Contact #2: Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #2: Cell Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

YesNo

If yes, what bus number (if known)

Bus Driver's name (if known)

If yes, directions to home for bus driver

Person(s) allowed to pick up my child at school (Please use a comma to separate names)*

Name & grade levels of siblings attending this school

*New Student Only* Last School attended (other than Davis)*

*New Student Only* Last Grade level*

*New Student Only* Last date enrolled*

Date

*New Student Only* School's Full Mailing Address*

YesNo

Upload Child's CDIB Citizenship card here: (Only for New Students or if not on file)

YesNo

SpanishAmerican Sign LanguageNative AmericanOther

Physician/Clinic Name*

Physician/Clinic City*

Physician/Clinic Phone*

Format: (000) 000-0000.

Does child have any special needs, health problems, or known allergies (If yes please specify)*

Does child have an IEP? (If yes please specify)*

Permission is given for my child to attend any school related field tripPermission is give to DPS to use photographs of my child for publicity purposes in newspapers, television, yearbook and the DPS website.I am aware that my child will be receiving the rules and regulations approved by the Davis Public School Board of Education, in the handbook and will abide by them as stated.

Signature of Parent*

Upload your student's Official Birth Certificate here: (New Students Only)*

Upload your student's Immunization record here: (New Students Only)*

Upload your student's social security card: (New Students Only)*

Date*

AUTHORIZATION FOR MEDICAL CARE OF A MINOR

The undersigned parent or guardian has legal custody of the child named below. As such, he/she grants to the listed custodian - into whose care the child has been entrusted - permission to authorize the following: x-ray examination, anesthetic, medical/surgical/dental diagnosis or treatment and hospital care for the child. All procedures must be recommended by a physician, surgeon or dentist licensed by the state of Oklahoma.

This consent - given in advance of a specific event - encourages the custodian to seck needed treat- ment for the child in the absence of a parent or guardian. It is effective until withdrawn in writing.

Name of custodian (s)*

Signature of parent or legal guardian*

Special medical information regarding child (allergies, current medication, medical condition: i.e. asthma, epilepsy. diabetes, etc.)*

Because of the legal implications involving teachers and others who administer medication to children, it is required that this form be completed by the parent and/or physician regarding ANY MEDICATION that needs to be administered during school hours. It is understood this creates no responsibility or obligation on the part of the school faculty and staff but is done only as a service to the parent or child.

Dear Mrs. Webb of Davis Elementary School:

I have read and understand the above paragraph and hereby authorize you or a member of your staff to give the medication listed below to the student named on this form. This will be done at my request and you or the staff member will not be held accountable for any effects nor the outcome of administration of the medication, nor shall you be held liable in any manner whatsoever for any act of negligence in giving such medication or for any failure to give such medication.

Student's name*

School*

Medication*

Dosage

Physician's Name*

Phone*

Format: (000) 000-0000.

Time to be administered (clock hour)

Reason for administering medication

Family Educational Rights and Privacy Act (FERPA) Notice for Directory Information

The Family Educational Rights and Privacy Act (FERPA), a Federal law, requires that Davis Public Schools, with certain exceptions, obtain your written consent prior to the disclosure of personally identifiable information from your child's education records. However, Davis Public Schools may disclose appropriately designated "directory information" without written consent, unless you have advised the District to the contrary in accordance with District procedures. The primary purpose of directory information is to allow the Davis Public Schools to include this type of information from your child's education records in certain school publications. Examples include: A program listing your student's part in a band/vocal music production; The annual yearbook; Honor roll or other recognition lists; Graduation programs; Sports activity sheets, such as for wrestling, showing weight and height of team members.

Directory information, which is information that is generally not considered harmful or an invasion of privacy if released, can also be disclosed to outside organizations without a parent's prior written consent. Outside organizations include, but are not limited to, companies that manufacture class rings or publish yearbooks. In addition, two federal laws require local educational agencies (LEAs) receiving assistance under the Elementary and Secondary Education Act of 1965 (ESEA) to provide military recruiters, upon request, with the following information- names, addresses and telephone listings- unless parents have advised the LEA that they do not want their student's information disclosed without their prior written consent.

If you do not want Davis Public Schools to disclose directory information from your child's educational records without your prior written consent, you must notify the District in writing by SEPT 1, 2023. Davis Public Schools has designated the following information as directory information: -Participation in officially recognized activities/sports -Address -Weight and height of members of athletic teams -Telephone listing-Electronic mail address -Photograph -Degrees, honors, and awards -Date and place of birth

(1 ]These laws are: Section 9528 of the Elementary and Secondary Education Act (20 U.S.C.§ 7908) and 10 U.S.C. § 503 (c

I give permission for my students' pictures to be published in newspapers, newsletters,

YesNo

Parent (guardian) Signature*

Verification of Residency in the Davis Public School District

It shall be unlawful for any person to willfully make a false or misleading statement, either verbal or written, to any officer or employee of any school in the Davis school district for the purpose of obtaining enrollment in the Davis school district and/or for the purpose of enrolling in any particular school within the Davis school district. Any willful misstatement on this form shall be a misdemeanor punishable by imprisonment not to exceed one (1) year or a fine not to exceed five hundred dollars ($500) or both such fine and imprisonment.

Parent/Guardian Name*

Relationship to Enrollee(s)*

Am seeking to enroll him/her in Davis Elementary school and I certify under penalties of perjury that I have read and understand the above statement and I further certify, under penalty of perjury, that the above-named school-age child, or children, actually live at

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Signature*

Upload Proof of Residency:*

McKinney- Vento Enrollment Questionnaire

YesNo

Temporarily with another family member or friend until we can locate affordable housingIn an emergency or transitional shelterIn a vehicle, park, campground, or on the streetsIn a house, building, or trailer WITHOUT running water or electricity in a hotel or motelWith an adult that is not a parent or legal guardianAlone or in different locations, without an adult serving as a caregiverWherever I can find a place to stay at night

Please list all children currently living with you who attend Davis Public Schools.*

Signature*

YesNo

What is the dominant language most often spoken by the student?*

What is the language routinely spoken in the home, regardless of the language spoken by the student?*

What language was first learned by the student?*

YesNo

If so, what language?

YesNo

If so, what language?

What was the date the student first enrolled in a school in the United States?*

Date

YesNo

Does your child take any medications that the teacher needs to be aware of? Please list:

YesNo

If yes then what grade?

YesNo

Do you have any additional information that you would like to provide to your child's teacher?*

Thank you for enrolling in Davis Elementary! Please help us make this year successful. This information will be given to your child's teacher.

Davis Elementary Enrollment 23-24