Dr. Debra Cr osby, Mr. Jeff Irvin, Superintendent of ......If you live with family or friends, the home owner must provide a notarized letter confirming your living status. Please

QUINLAN INDEPENDENT SCHOOL DISTRICT JOE MARTIN ADMINISTRATION BUILDING

401 EAST RICHMOND QUINLAN, TX 75474

(903) 356-1200 (903) 356-1201 (FAX)

Dr. Debra Crosby, Superintendent of Schools

Welcome to the Quinlan Independent School District! We look forward to another exciting school year.

In order to complete the enrollment process, please bring the completed Registration Packet to your child’s campus with the following documents:

• Student’s Birth Certificate,• Student’s Social Security Card,• Student’s Immunization Record,

• Driver’s License or legal photo ID of parent or legal guardian enrolling the student, and

• Proof of residence in the form of a utility bill, lease agreement or property taxstatement in the name of the parent or legal guardian of the student. If you live with family or friends, the home owner must provide a notarized letter confirming your living status.

Please contact your student’s campus with questions regarding the enrollment process.

Angela House D. C. Cannon Elementary School Principal Grades PK – 2nd 903-356-1300

Mr. Jeff Irvin, Asst. Superintendent of Schools

Jo Lynn HughesA. E. Butler Intermediate School PrincipalGrades 3rd - 5th903-356-1400

Brian KinsworthyThompson Middle School PrincipalGrades 6th - 8th903-356-1500

Amy GriffinFord High School PrincipalGrades 9th - 12th903-356-1600

REGISTRATION FORM SCHOOL YEAR 2016-2017

Registration Date: ___________ Student ID#: ____________ Grade: ____ Bus#: ______ Court Order: __YES __NO (IF YES, PROVIDE COPY OF ORDER)

________________________________________________________________________________________________________________________ FIRST NAME MIDDLE NAME LAST NAME (AS ON BIRTH CERTIFICATE) SUFFIX

__________________________________________________________________________________________________________________________ BIRTHDATE BIRTHPLACE AGE AS OF SEPT. 1st CURRENT AGE SEX

_______________________________ HAS CHILD EVER ATTENDED QISD? ___YES ___NO SOCIAL SECURITY OR STATE ID# (IF YES, WHAT WAS THE LAST SCHOOL YEAR ATTENDED?: __________)

RACE (CIRCLE ONE) AFRICAN AMERICAN CAUCASIAN AMERICAN INDIAN/ALASKA NATIVE ASIAN NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER

HISPANIC ___YES ___NO

________________________________________________________________________________________________________________________ PHYSICAL STREEET ADDRESS (WHERE CHILD LIVES) CITY STATE ZIP

________________________________________________________________________________________________________________________ MAILING ADDRESS (PO OR STREET ADDRESS IF DIFFERENT THAN ABOVE) CITY STATE ZIP

PREVIOUS SCHOOL ATTENDED: ______________________________________________ PREVIOUS SCHOOL PHONE#:________________________

PREVIOUS SCHOOL ADDRESS: _______________________________________________ PREVIOUS SCHOOL FAX#:___________________________

1st

Par

ent/G

uard

ian

☐ Yes ☐ No Parent First Name Parent Last Name Relation to Child Primary Contact?

Parent Street Address Parent City, State, Zip Parent Home Phone

Place of Employment Work Phone Parent Cell Phone Parent Email

2nd

Par

ent/G

uard

ian

☐ Yes ☐ No Parent First Name Parent Last Name Relation to Child Primary Contact?

Parent Street Address Parent City, State, Zip Parent Home Phone

Place of Employment Work Phone Parent Cell Phone Parent Email

************************************************************************************************************************ FAMILY DETAILS

Are the Natural Parents Living Together? ___Yes ___No ____Separated? ____Divorced? With whom does the child live? _____Mother _____Father _______Grandparent ____Other(IF Other, Define: _______________________) Does a court order state who is allowed to pick up the child? ___Yes ___No IF YES, WHO IS LISTED: ___________________________________

Brother/Sister 1: __________________________________ Age/Grade: ____/____ School: _________________________________________




What Language is spoken in your home most of the time?: ________________________________________________________________________ What Language does your child speak most of the time?: _________________________________________________________________________ Is your child a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard on Active duty? ☐ Yes ☐ No Is your child a dependent of a member of the TX National Guard (Army, Air Guard, or State Guard)? ☐ Yes ☐ No Is your child a dependent of a reserve force in the US military (Army, Navy, Air Force, Marine Corps, Coast Guard)? ☐ Yes ☐ No

Is your child a PRE-KINDERGARTEN STUDENT who is a dependent of: 1) an active duty uniformed member of the Army, Navy, Air Force, Marine Corps, or Coast Guard, 2) activated/mobilized uniformed member of the TX National Guard (Army, Air Guard, or State Guard), or 3)

Grade Began in US School? _________________

activated/mobilized members of the Reserve components of the Army, Navy, Marine Corps, Air Force, or Coast Guard; who are currently on active duty or who were injured or killed while serving on active duty? ☐ Yes ☐ No Is the child currently in the conservatorship of the Department of Family and Protective Services? ☐ Yes ☐ No Is the child a PRE-KINDERGARTEN STUDENT who was PREVIOUSLY in the conservatorship of the Department of Family and Protective Services following an adversary hearing held as provided by Section 262.201, Family Code? ☐ Yes ☐ No

Will your child be picked up from school? _____Yes ____No IF YES, BY WHOM? __________________________________________ Will your child use bus transportation to/from school? _____Yes _____ No Please give DETAILED DIRECTIONS to your home from school. Use road numbers, street names, division names and landmarks. Give area neighbors if possible. _______________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ************************************************************************************************************************

SPECIAL PROGRAMS INFORMATION Was your child involved with the Gifted and Talented program at his/her previous school? ____Yes ____No Did your child attend any Special Education Programs? _____Yes ____No Did your child attend any ESL classes? _____Yes _____No Was your child on a 504 plan? _____Yes _____No ************************************************************************************************************************

EMERGENCY CONTACT INFORMATION If you cannot be reached in the event of an emergency, please list individuals the district may contact. Please also list if the individual is allowed to pick up your child during school hours (ID is required at the time of pick up and individuals NOT LISTED will not be allowed to pick up your child).

☐YES

☐NO

☐Parent/Guardian

☐Grandparent

☐Other

Name Home# Cell# Work# Pickup? Relationship

☐YES

☐NO

☐Parent/Guardian

☐Grandparent

☐Other


☐YES

☐NO

☐Parent/Guardian

☐Grandparent

☐Other


☐YES

☐NO

☐Parent/Guardian

☐Grandparent

☐Other


Doctor Preference: _________________ Doctor’s Phone#: _________________ Hospital Preference: _________________________ ************************************************************************************************************

TO THE PARENT Presenting false information or false records for identification is a criminal offence under penal code 37.10. Enrolling the child under false documents/information makes the person liable for tuition. The information supplied on this form (front and back) is needed as a permanent school record of your child and will be used by the school personnel. It is the responsibility of the parent/guardian to update the information as necessary. This is to certify the information on this form is correct. I, the undersigned, do hereby authorize officials of the school to contact directly the person(s) named on this form, and do authorize the above named physician to render such treatment as may be deemed necessary in an emergency, for the health of my child. In the event the physician, other person(s) named on this form, or parents cannot be contacted, the school officials are hereby authorized to take whatever action is necessary in their judgment, for the health of the aforesaid child. I will not hold the school district financially responsible for the emergency care and/or transportation for said child.

____________________________________________________________________________________________________________ Parent/Guardian’s Signature Printed Name Date ************************************************************************************************************

OFFICE USE ONLY __Birth Certificate ___Social Security Card ___Immunization Record ___Proof of Residency __Transcript of Grades

__Withdrawal Form ___Home Lang Form(PK, K) ___Family Survey __Residency Questionnaire __Enrolling DL

__Scanned Packet _________1st Day present with QISD at ADA Hour (for current year)ASSIGNED TEACHER:______________________________________

The information on this form is required to meet the law known as the McKinney-Vento Act 42 U.S.C. 11434a(2), which is also known as Title X, Part C, of the No Child Left Behind Act. The answers you give will help the school determine the services the student may be eligible to receive.

Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d).

Name of Student: ________________________________________________________ Gender: Male Female Last First Middle

Birth Date: ______________ Grade: ______________ Social Security #: ____________________________ (or student identification number)

Check the box that best describes with whom the student resides. (Please note: legal guardianship may be granted only by a court; students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend school. The school cannot require proof of guardianship for enrollment or continued attendance.)

Parent (s) Legal Guardian(s) Caregiver(s) who are not legal guardians (Examples: friends, relatives, parents of friends, etc.)

Other _________________________________________________________________________________________

Name of person with whom student resides: _____________________________________________________________

Address: ___________________________________________________________________________________________

City: _______________________________________________________ Zip: __________________________________

Home Phone #: _________________ Cell Phone #: ________________Other Emergency #:________________________

Last District Attended: ______________________________ Last School Attended: ______________________________

Please check only one box that best describes where the student is presently living: In a home that the student’s parent or a legal guardian owns or rents (PEIMS Code 0)

In a place that does NOT have windows, doors, running water, heat, electricity, or is overcrowded (PEIMS Code 3)

Staying with a friend or relative because of loss of housing, economic hardship, or a similar reason (PEIMS Code 2)

In a shelter (PIEMS Code 1) (Examples include: family shelter, domestic violence shelter, children/youth shelter, FEMA housing.)

In an unsheltered location such as a tent, car, truck, van, abandoned building, on the street, campground, park,

bus/train station or other similar place. (PEIMS Code 3)

In a hotel or motel because of loss of housing or economic hardship (PEIMS Code 4) (Examples include: eviction,

foreclosure, cannot get deposits for permanent home, flood, fire, hurricane)

In a transitional housing program (PEIMS Code 1) (Housing that is available as part of a program for a specific length of time only

and is partly or completely paid for by a church, a nonprofit organization, governmental agency or another organization.)

Are the student’s living arrangements the result of a natural disaster? YES NO.

Quinlan ISD - Student Residency Questionnaire

*Is this a permanent or temporary arrangement?*Is this a voluntary arrangement? Yes No

If you weren't living with a friend or relative, would you rent buy other (describe) ___________________________

If the living arrangements are the result of a natural disaster, please mark the type of disaster below and provide the requested information:

Hurricane: Name of Hurricane: ____________________ Flood Tornado Wildfire Other: Please describe:

_______________________________________________________________________________

If the living arrangements are the result of a natural disaster please list the date and the city, state and county the natural disaster took place:

Date: ___________ City, State, County: _____________________________________________________________

None of the above describes the main reasons for my present living situation. Briefly explain the contributing factors:

____________________________________________________________________________________________________________________________________________________________________________________________________

Please provide the following information for school-age siblings (brothers and/or sisters) of the student:

Name Grade Level School District

____________________________________________________________ ___________________________ Signature of Parent/Legal Guardian/Caregiver/Unaccompanied Student Date **********************************************************************************************

QISD McKinney-Vento Liaison Use Only All Homeless Students must fall into one of the three following Unaccompanied Youth categories. Please select the appropriate code.

3 = Homeless Student is in the physical custody of a parent or legal guardian (student is not unaccompanied) for the entire school year.

4= Homeless Student is not in in the physical custody of a parent or legal guardian (homeless student is unaccompanied at any time during the school year.

I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act.

_________________________________________________________ ______________________________________

McKinney-Vento Liaison Signature Date

DISTRICT STAFF: Please send form to District Homeless Liaison IF PEIMS CODE IS NOT 0.

FAMILY SURVEY

District: Quinlan ISD Campus:

Student Name: Age: Grade Level: Dear Parents,

In order to better serve your children, Quinlan ISD is helping the State of Texas identify students who may qualify to receive additional educational services. The information provided below will be kept confidential. Please answer the following question and return this form to your child’s school.

Within the past 3 years have you moved from one city or state to another so that you or your family could work or look for work in agriculture or fishing? ☐ NO (STOP here and return survey to your child’s school.)

☐ YES (Please check all that apply below and fill out the information requested at the bottom of this form.)

Working with fruits, vegetables, soybeans, sunflower, cotton, wheat, grain, sugar beets, agricultural farms or ranches, fields & vineyards ☐

Working in a cannery

☐

Working in a dairy farm

☐

Working in a fishery

☐

Working in a slaughter house

☐

Other similar work, please explain: Working on a poultry farm

☐

Working in a plant nursery, orchard, tree growing or harvesting

☐

Please complete the following information: (Please Print) Best time to contact you: ___________________ Parent/Guardian Name: Home Address/Apt No. City: Zip Code:

Telephone Number: Mailing Address: City: Zip Code: Home: _____________________ Cell/Work:_______________

For School Use Only: School Personnel, please fax forms with YES answered to Kathleen Witte at 903-356-1235. Mrs. Witte will then fax to Region 10 ESC at 972-348-1413.

Quinlan ISD Care Services Health Inventory

Teacher/Grade Level Campus Date Form Completed

Dear Parent,

Please complete this form and return it to the office/school nurse. The information will enable the school nurse and staff to have a better understanding of the health of your child.


Sex Date of Birth Birth weight

Please list any medication allergies: __________________________________________________________________________________________

________________________________________________________________________________________________________________________

Please list any food allergies: _______________________________________________________________________________________________

________________________________________________________________________________________________________________________

Please check any of the following signs and symptoms you have recently observed: ☐ Frequent headaches ☐ Frequent sore throats ☐ Frequent sinus problems ☐ Frequent stomachaches ☐ Frequent nosebleeds ☐ Environmental allergies ☐ Frequent earaches ☐ Vomiting ☐ Fainting

Have you consulted a doctor regarding the symptoms you’ve observed? ☐ YES ☐ NO

Medical History: Please check all that apply to your child. ☐ Asthma Age: _______ ☐ Heart Disease Age: _______ ☐ Kidney Disorder Age: _______ ☐ Serious Injury Age: _______ ☐ Hearing Loss Age: _______ ☐ Vision Loss Age:_______ ☐ Glasses ☐ YES ☐ NO ☐ Chickenpox Month: ___ Year: _____ ☐ Fractures Age: _______ ☐ Allergies Age: _______ ☐ Seizures Age: _______ ☐ Diabetes Age: _______

Please give additional information on the above marked conditions: _______________________________________________________________

________________________________________________________________________________________________________________________

Current Medications: ______________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Is he/she under the treatment of a doctor at this time? ☐ YES ☐ NO If yes, for what condition(s): ________________________________________________________________________________________________

Name of physician/clinic: __________________________________________________________________________________________________





***If your child has any serious condition that might impact his/her school activities, please notify the school nurse.

Has your child attended Quinlan ISD before? ☐ YES ☐ NO If yes, Year attended: _____________ Grade Level: _______________

_______________________________________________________________________________________________________________________ Parent Signature Date

REQUEST FOR FOOD ALLERGY INFORMATION

The District must request, at the time of enrollment, that the parent or guardian of each student attending a school in the District disclose the student’s food allergies. Additional information regarding food allergies, including maintaining records related to a student’s food allergies, can be found at FD and FL.

This form allows you to disclose whether your child has a food allergy or severe food allergy that you believe should be disclosed to the District in order to enable the District to take necessary precautions for your child’s safety.

“Severe food allergy” means a dangerous or life-threatening reaction of the human body to a food-borne allergen introduced by inhalation, ingestion, or skin contact that requires immediate medical attention.

Please list any foods to which your child is allergic or severely allergic, as well as the nature of your child’s allergic reaction to the food.

Food: Nature of allergic reaction to the food:

The District will maintain the confidentiality of the information provided above and may disclose the information to

teachers, school counselors, school nurses, and other appropriate school personnel only within the limitations of the

Family Educational Rights and Privacy Act (FERPA) and District policy. [See FL]

Student Name

Date of Birth Grade Level

Mother’s Name Mother’s Work Phone Mother’s Cell Phone

Father’s Name Father’s Work Phone Father’s Cell Phone

________________________________________________________________________________________________________________________ Parent Signature Date

___________________________ Date Form received by campus

CLINIC EMERGENCY FORM


____/___/_______________________________________________________________________________________________________________ BIRTHDATE CURRENT AGE TEACHER/GRADE

________________________________________________________________________________________________________________________ MAILING ADDRESS CITY STATE ZIP

MOTHER’S NAME MOTHER’S WORK PHONE MOTHER’S CELL PHONE

FATHER’S NAME FATHER’S WORK PHONE FATHER’S CELL PHONE

Please list relatives or nearby neighbors who will assume temporary care of your child if you cannot be reached.

NAME PHONE

NAME PHONE

NAME PHONE

NAME PHONE

HEALTH INFORMATION: List any health conditions such as heart disease, diabetes, severe allergies, medication allergies, food allergies, eye or ear problems, and any chronic problems.

LIST ANY MEDICATIONS STUDENT TAKES ON A DAILY BASIS (TO INCLUDE MEDICATIONS THAT ARE NOT GIVEN AT SCHOOL)

I hereby authorize the release of this confidential information to professional QISD personnel only if appropriate or required. YES ____ NO ____.

I, the undersigned, do hereby authorize officials of Quinlan I. S. D. to contact directly the persons named on this card, and do authorize the named physician to render such treatment as may be deemed necessary in an emergency for the health of said child. In the event the physician, other persons named on this card, or parents cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their judgment, for the health of the aforesaid child.

I will not hold Quinlan I. S. D. financially responsible for the emergency care and/or transportation for aforesaid child.

* Optional: I do hereby consent the release of my child’s shot records and any pertinent medical information to the school nurse. The release willexpire on June 2017. YES _____ NO _____

Parents are responsible for keeping information current.

________________________________________________________________________________________________________________________ Signature of Parent/Guardian

Court Order: __YES __NO

DATE: ____________________

* If I provide cough drops for my child, the nurse/designee may give them. YES _____ NO ______

Upload a copy to the Q-Drive: Enrollment Packet-COMPLETED Folder. Diagnosticians and Special Education Secretary Check Daily for new enrollees.

Student Name Grade Level Emergency Phone No.

Mother’s Name Mother’s Work Phone Mother’s Cell Phone

Father’s Name Father’s Work Phone Father’s Cell Phone

Physical Street Address Physical City Physical Zip Code Home Phone Number

Only fill out the following once if pick-up and drop-off are the same.

Directions for Pick-Up in A.M.

Directions for Drop-Off in P.M.





Please call or send a note if the above information changes.

The transportation department must receive a copy of this form 2 days before service will begin.

__________________________________________________________________________________________________ Signature of Parent/Guardian Date

Send Copy to Donna Pope

Quinlan ISD – TRANSPORTATION FORM

Quinlan Independent School District Student Handbook Authorization Form 2016 – 2017

Student Name Student ID

Street Address, City Phone Number

Campus Email

Parent/Guardian Name Parent/Guardian Signature

Student Handbook and Code of Conduct Acknowledgement My child and I have been offered the option to receive a paper copy of the Student Handbook and Student Code of Conduct for 2016-2017 or to electronically access these documents at www.quinlanisd.net. I have chosen to:

☐

☐

Accept responsibility for accessing the 2016-2017 Student Handbook and Student Code of Conduct by accessing the web address above. Receive a paper copy of the 2016-2017 Student Handbook and Student Code of Conduct.

By signing above, we acknowledge our understanding that the Student Handbook contains information that my child and I may need during the school year and that all students will be held accountable for their behavior and will be subject to the disciplinary consequences outlined in the Student Code of Conduct. If I have any questions regarding the handbook or the Code of Conduct, I should direct those questions to the principal.

Instructions to Accessing the Student Handbook and Code of Conduct Go to www.quinlanisd.net. On the left hand side of the screen you will click on “Schools.” Then click “Student Regulations” from the drop down menu. You can then click on the Student Handbook. The Code of Conduct is part of the Student Handbook. Click HERE to go directly to the Student Handbook.

Notice Regarding Directory Information for School-Sponsored Purposes I have read and understand the guidelines for release of student information for school-sponsored purposes (includes honor roll, yearbook, school newspaper, recognition activities, news releases, or athletic programs) and I:

☐ Do give the District permission to use information for school-sponsored purposes. ☐ Do not give the District permission to use information for school-sponsored purposes.

Release of Student Information to Military Recruiters and Institutions of Higher Learning I have read and understand the guidelines for release of student information to military recruiters and institutions of higher learning and I:

☐ Do give the District permission to release my student’s name, address, and telephone number. ☐ Do not give the District permission to release my student’s name, address, and telephone number.

Notice Regarding Directory Information for All Other Purposes Certain information about district students is considered directory information and must be released to anyone who follows the procedures for requesting the information. This objection must be made in writing to the principal within 10 school days of your child’s first day of instruction for this school year. Please review the Directory Information section in the Student Handbook.

☐ I Do give permission to release Directory Information for non-school related purposes. ☐ I Do Not give permission to release Directory Information for non-school related purposes.

http://www.quinlanisd.net/

http://www.quinlanisd.net/

https://drive.google.com/a/quinlanisd.net/file/d/0B-GR3vkg9TqgeVduUUNfOWhuNU9UMWJra1UxZk5UT2lqSGtR/view

Quinlan ISD Corporal Punishment Information

QISD adheres to the following guidelines when administering Corporal Punishment:

1. Parents have the responsibility of submitting a signed statement to the principal each year if they chooseto prohibit the use of corporal punishment with their child. (This form is adequate.)

2. A parent may reinstate permission to use corporal punishment at any time during the school year bysubmitting a signed statement to the principal. (This form is adequate.)

3. Corporal Punishment will be administered in accordance with the law, District policy, and the StudentCode of Conduct (SCOC). [See FO and the SCOC]

4. Corporal punishment will not be administered in anger and will be administered as soon as possible afteran offense.

5. The principal or designee may choose not to use corporal punishment even if the parent has requested itsuse.

6. Any use of corporal punishment will be documented on a District form.

7. The principal or a designee will inform the parent or guardian when corporal punishment is used.

8. Paddles used for administering corporal punishment will not be generally displayed and will be underthe control of the principal or designee.

9. Corporal punishment will be limited to spanking or paddling and will consist of an appropriate numberof strikes based upon the size, age, and the physical, mental, and emotional condition of the student.

10. Before corporal punishment is used, the District may give the student a choice between otherdisciplinary measures and corporal punishment.

This form must be submitted annually and can be revoked by the parent at any time.

I have read the information on the use of corporal punishment in Quinlan ISD. (Please select one of the boxes below.)

☐ I prohibit the use of corporal punishment with my child.

☐ I give my permission for the District to administer corporal punishment to my child in accordance with the law, District policy, and the Student Code of Conduct (SCOC).

Name of Parent/Guardian Signature of Parent/Guardian Date

Student Name Campus Grade

Quinlan ISD – Corporal Punishment Form

Documents

Dr. Debra Cr osby, Mr. Jeff Irvin, Superintendent of ......If you live with family or friends, the home owner must provide a notarized letter confirming your living status. Please