Sumner School District Student Registration

Checklist

Please complete and return the following documents with this cover sheet.

Verification of Residency Student Registration Form Certificate of Immunization Status Form Health History Form Student Housing Questionnaire Grades 1-8 - Copy of last report card Grades 9-12 - Transcript from previous school

VERIFICATION OF RESIDENCY In order to verify residency within the Sumner School District, ONE current document (dated within the past 30 days) listed below MUST be provided, showing parent/guardian name and address. (Post Office box numbers are not acceptable as residence addresses). Escrow papers, mortgage book or statement, or homeowner’s association fees statement Lease Agreement/Rental contract and current rent receipt Letter on apartment complex or mobile home

park letterhead, signed by the landlord, statingthat parent/guardian lives at the stated address

Phone bill (land line, not cellular) at the statedaddress

Residence insurance statement

Parent/Guardian (Please Print):

Student Name (Please Print):

I declare the above-named student resides at the address shown on one of the documents indicated above, and attached to this enrollment packet. I will notify the school within two weeks of residency changes and agree to provide a new proof of residency and updated signed statement at that time. If I move outside of the school district boundaries, I understand an inter-district (Choice Transfer) attendance release must be filed in order to request continued attendance for this student.

Falsification of any information or document required for residency verification, or the use of the address of another person without actually residing there, may result in revocation of student’s

enrollment in the Sumner School District (see Policy 3140.)

Parent/Guardian’s Signature: Date:

FOR SCHOOL USE ONLY The attached document(s) show(s) the name and address of the person(s) enrolling the above named student. If not the parent, the Sumner School District Certification of Temporary Parental Consent agreement is required for guardianship.

Principal or Designee’s Signature: Date

School Name:

Additional Comments:

Garbage bill Gas or electric bill Water bill Cable TV bill Verification of social services

Name of Country

Month/Year

Student Registration Form DO NOT WRITE IN SHADED AREA – FOR OFFICE USE ONLY

Other ID# Grade WA Grad Yr Entry Date Records Requested Y N

Waivered From Overflowed From Teacher

Student Information – Please Print

Student Legal Last Name Student Legal First Name

Student Legal Middle Birthdate (Mth/Day/Yr) Grade Gender Male Female

Has your child ever been registered in the Sumner School District? Yes No If yes, what school

Has your child ever attended school under a different name? If yes, what name(s)

Only check one box per line Language student currently speaks English Spanish Korean Tagalog Ukrainian Russian Other

First language spoken by the student English Spanish Korean Tagalog Ukrainian Russian Other Language student speaks at home English Spanish Korean Tagalog Ukrainian Russian Other

Birth City/State/Country If birth country not United States, please complete the following:

• My child attended a school outside of the United States for months in (10 months equals one school year)

• My child attended school in the United States before enrolling in Sumner School District. Their initial US enrollment date was

Washington State Ethnicity and Race Data Collection School districts in Washington State are required to report student data by ethnicity and race categories to the state’s Office of Superintendent of Public Instruction. The same ethnicity and race categories are used in all Washington school districts. They are set by the federal government, the Washington State Legislature, and the state Superintendent of Public Instruction. We need you to identify your child as either Hispanic/Latino or not Hispanic/Latino and by one or more racial groups. Is your child of Hispanic or Latino origin? Yes - If yes, the state requires information in both section 1 and 2.

No - Not Hispanic-10 - If no, proceed to section 2 and check all that apply. Section 1. Check all that apply.

Mexican/Mexican American/Chicano-30 Central American-75 Other Hispanic/Latino-90

Cuban-55 South American-80

Dominican-60 Latin American-85

Spaniard-65 Puerto Rican-70

Section 2. What race(s) do you consider your child? Check all that apply.

African American/Black-200 American Indian or Alaskan Native Do grandparent(s) or parent(s) have a tribal affiliation? Yes No

White-300 Alaska Native-405 Quinault-454

Asian Chehalis-410 Samish-457

Asian Indian-505 Laotian-545 Colville-413 Sauk-Suiattle-460

Cambodian-507 Malaysian-550 Cowlitz-416 Shoalwater-463

Chinese-510 Pakistani-555 Hoh-418 Skokomish-466

Filipino-520 Singaporean-560 Jamestown-421 Snoqualmie-469

Hmong-525 Taiwanese-565 Kalispel-424 Spokane-472

Indonesian-530 Thai-570 Lower Elwha-427 Squaxin Island-475

Japanese-535 Vietnamese-575 Lummi-430 Stillaguamish-478

Korean-540 Other Asian-599 Makah-433 Suquamish-481

Native Hawaiian or Other Pacific Islander Muckleshoot-436 Swinomish-484

Native Hawaiian-605 Micronesian-632 Nisqually-439 Tulalip-487

Fijian-615 Samoan-635 Nooksack-442 Yakama-490

Guamanian or Chamorro-620 Tongan-640 Port Gamble S’Klallam-445 Other WA Indian-495

Mariana Islander-625 Other Pacific Islander-699 Puyallup-448 Other American Indian/Alaska Native-499 Melanesian-630 Quileute-451

Page 1 of 3

SUMNER SCHOOL DISTRICT A GREAT PLACE TO LEARN

Other Children Attending School in Sumner

Household #1 Information Parent/Guardian #1 Last Name First Name

Relationship to Student Father Mother Guardian Foster Other

Home Phone ( ) Work Phone ( ) Ext: Cell Phone ( ) Please check if unlisted

Primary contact phone number (check one) home cell work e-mail

Street Address Apt# City, State, ZIP Code

Mailing Address/PO Box City, State, ZIP Code (Complete if different than street address)

Parent/Guardian #2

Last Name First Name

Relationship to Student Father Stepfather Mother Stepmother Guardian Foster Other

Work Phone ( ) Ext: Cell Phone ( ) e-mail

Household #2 Information Parent/Guardian #1

Last Name First Name

Relationship to Student Father Mother Guardian Foster Other

Home Phone ( ) Work Phone ( ) Ext: Cell Phone ( ) Please check if unlisted

Primary contact phone number (check one) home cell work e-mail

Street Address Apt# City, State, ZIP Code

Mailing Address/PO Box City, State, ZIP Code (Complete if different than street address)

Parent/Guardian #2

Last Name First Name

Relationship to Student Father Stepfather Mother Stepmother Guardian Foster Other

Work Phone ( ) Ext: Cell Phone ( ) e-mail

Emergency Contacts - One Name per Line

Name (other than guardian) Relationship to Student

Phone number ( ) home cell work

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Name (other than guardian) Relationship to Student

Phone number ( ) home cell work

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Name (other than guardian) Relationship to Student

Phone number ( ) home cell work

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Name (other than guardian) Relationship to Student

Phone number ( ) home cell work

Page 2 of 3

Legal Last Name Legal First Name School Grade

Legal Last Name Legal First Name School Grade

Legal Last Name Legal First Name School Grade

Legal Last Name Legal First Name School Grade

Student History Name of school student last attended District City State

Has your child ever been retained? Yes No If yes, at what grade level(s)?

Has your child ever received services in any of the following programs? Check all applicable programs.

Special Education (Including Speech) 504 Accommodations Highly Capable ELL Title 1 Services LAP Services Migrant Services

Name of school where services were received Date

Have you moved in the last two years to find agricultural work? Yes No

Does your child have any past, current, or pending disciplinary actions or any history of violent behavior? Yes No Date

Is your child presently on suspension or expulsion from another school? Yes No If yes, reason

Is there a joint-custody or parenting plan in effect? Yes No If yes, a certified copy of the most recent plan must be on file with the school for enforcement.

Is there a restraining order against anyone pertaining to your student? Yes No If yes, most recent certified legal papers must be on file with the school for enforcement. Restraining order is against Mother Father Other

Childcare Does student attend childcare? Before school Afterschool Before and afterschool

Provider’s name Phone Number ( )

Street Address City, State, ZIP Code

Release of Information The Family Educational Rights and Privacy Act (FERPA), a Federal law, requires that the Sumner School District, with certain exceptions, obtain written consent prior to the disclosure of personally identifiable information from your child’s education records. However, it is permissible to disclose designated information without written consent, unless the District has been advised otherwise. 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, such as newspapers and other media, without a parent’s prior written consent.

Sumner School District likes to celebrate the achievements of our students and staff. Throughout the year, the Communications Department and district staff may take photographs of students and school activities. These photographs may appear in various District materials, including the District’s website (www.sumnersd.org), newsletters, brochures, district calendar, etc. The District may include directory information about your child in school publications including: listing their name on a playbill, showing your student’s role in a drama production, in the annual yearbook, on Honor Roll or other recognition lists, in graduation programs, and on athletic team rosters.

FERPA - Please do NOT release my student’s Directory Information to outside organizations.

Photo Release - Please do NOT publish my student’s photo in the yearbook, or any district publication. NOTE: Your student’s photo will be excluded from yearbooks, any district publication and or media.

Two federal laws require the District to provide military recruiters, upon request, with three directory information categories: names, addresses and telephone listings unless parents have advised the high school that they do not want their student’s information disclosed without their prior written consent.

Please do NOT release my student’s Directory Information to the Armed Forces.

Please do NOT release my student’s Directory Information to institutions of higher education.

Verification of Residency – Sumner School District requires residency verification at time of enrollment. Please provide one of the following as proof of residency.

Utility Bill – gas, water or electric. This bill must include the parent/guardian name, the address and be less than 30 days old. Purchase Papers for home Lease/Rental Agreement Affidavit of Residence with a Sponsor or Landlord —sponsor/landlord must also provide proof of residency as outlined above.

Verification of Information The information on this form is true and accurate as of this date. I understand that falsification of information to achieve enrollment or assignment may be cause for revocation of the student’s enrollment or assignment to a school in the Sumner School District.

Parent/Guardian Signature Date

Equal Opportunity Employer The Sumner School District complies with all applicable federal and state rules and regulations and does not discriminate on the basis of race, creed, color, national origin, families with children, sex, marital status, sexual orientation, age, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability. This holds true for all district employment opportunities. Inquiries regarding compliance and/or grievance procedures should be directed to the school district’s Equal Opportunity Officer and/or Section 504/ADA coordinator, telephone 253 891-6000. RCW 49.60.010.

B/10/201-A January 2016 Page 3 of 3

Certificate of Immunization Status (CIS) For Kindergarten-12th Grade / Child Care Entry

Please print. See back for instructions on how to fill out this form or get it printed from the Washington Immunization Information System.

Child’s Last Name: First Name: Middle Initial: Birthdate (MM/DD/YY): Sex:

____________________________________________________________________________________________________________________________________________________

I give permission to my child’s school to share immunization information with the Immunization Information System to help the school maintain my child’s school record.

______________________________________________________________ Parent/Guardian Signature Required Date

I certify that the information provided on this form is correct and verifiable.

______________________________________________________________ Parent/Guardian Signature Required Date

♦ Required for School and Child Care/Preschool Date MM/DD/YY

Date MM/DD/YY

Date MM/DD/YY

Date MM/DD/YY

Date MM/DD/YY

Date MM/DD/YY

Documentation of Disease Immunity Healthcare provider use only

If the child named in this CIS has a history of Varicella (Chickenpox) or can show immunity by blood test (titer) it MUST be verified by a healthcare provider

I certify that the child named on this CIS has:

a verified history of Varicella (Chickenpox).

laboratory evidence of immunity (titer) to disease(s) marked below. Lab report(s)

for titers MUST also be attached.

Diphtheria Mumps Other: Hepatitis A Polio __________ Hepatitis B Rubella __________ Hib Tetanus Measles Varicella

Licensed healthcare provider signature Date (MD, DO, ND, PA, ARNP)

Printed Name

● Required Only for Child Care/Preschool

Required Vaccines for School or Child Care Entry

♦ DTaP, DT (Diphtheria, Tetanus, Pertussis)

♦ Tdap (Tetanus, Diphtheria, Pertussis)

♦ Td (Tetanus, Diphtheria)

♦ Hepatitis B 2-dose schedule used between ages 11-15

● Hib ( Haemophilus influenzae type b)

♦ IPV / OPV (Polio)

♦ MMR (Measles, Mumps, Rubella)

● PCV / PPSV (Pneumococcal)

♦ Varicella (Chickenpox) History of disease verified by IIS

Recommended Vaccines (Not Required for School or Child Care Entry)

Flu (Influenza)

Hepatitis A

HPV (Human Papillomavirus)

MCV, MPSV (Meningococcal)

MenB (Meningococcal)

Rotavirus

Office Use Only:

Reviewed by: Date:

Signed Cert. of Exemption on file? Yes No

To print with immunization information filled in: Ask if your healthcare provider’s office enters immunizations into the WA Immunization Information System (Washington’s statewide database). If they do, ask them to print the CIS from the IIS and your child’s immunization information will fill in automatically. You can also print a CIS at home by signing up and logging into MyIR at https://wa.myir.net. If your provider doesn’t use the IIS, email or call the Department of Health to get a copy of your child’s CIS: waiisrecords@doh.wa.gov or 1-866-397-0337.

To fill out the form by hand: #1 Print your child’s name, birthdate, sex, and sign your name where indicated on page one. #2 Vaccine information: Write the date of each vaccine dose received in the date columns (as MM/DD/YY). If your child receives a combination vaccine (one shot that protects against

several diseases), use the Reference Guide below to record each vaccine correctly. For example, record Pediarix under Diphtheria, Tetanus, Pertussis as DTaP, Hepatitis B as Hep B, and Polio as IPV.

#3 History of Varicella Disease: If your child had chickenpox (varicella) disease and not the vaccine, a health care provider must verify chickenpox disease to meet school requirements.

If your healthcare provider can verify that your child had chickenpox, ask your provider to check the box in the Documentation of Disease Immunity section and sign the form. If school staff access the IIS and see verification that your child had chickenpox, they will check the box under Varicella in the vaccines section.

#4 Documentation of Disease Immunity: If your child can show positive immunity by blood test (titer) and has not had the vaccine, have your healthcare provider check the boxes for the appropriate disease in the Documentation of Disease Immunity box, and sign and date the form. You must provide lab reports with this CIS.

Reference guide for vaccine trade tames in alphabetical order For updated list, visit https://fortress.wa.gov/doh/cpir/iweb/homepage/completelistofvaccinenames.pdf Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine Trade Name Vaccine

ActHIB® Hib Fluarix® Flu Havrix® Hep A Menveo® Meningococcal Rotarix® Rotavirus (RV1)

Adacel® Tdap Flucelvax® Flu Hiberix® Hib Pediarix® DTaP + Hep B + IPV RotaTeq® Rotavirus (RV5)

Afluria® Flu FluLaval® Flu HibTITER® Hib PedvaxHIB® Hib Tenivac® Td

Bexsero® MenB FluMist® Flu Ipol® IPV Pentacel® DTaP + Hib + IPV Trumenba® MenB

Boostrix® Tdap Fluvirin® Flu Infanrix® DTaP Pneumovax® PPSV Twinrix® Hep A + Hep B

Cervarix® 2vHPV Fluzone® Flu Kinrix® DTaP + IPV Prevnar® PCV Vaqta® Hep A

Daptacel® DTaP Gardasil® 4vHPV Menactra® MCV or MCV4 ProQuad® MMR + Varicella Varivax® Varicella

Engerix-B® Hep B Gardasil® 9 9vHPV Menomune® MPSV4 Recombivax HB® Hep B

If you have a disability and need this document in another format, please call 1-800-525-0127 (TDD/TTY call 711). DOH 348-013 December 2016

Reference guide for vaccine abbreviations in alphabetical order For updated list, visit https://fortress.wa.gov/doh/cpir/iweb/homepage/completelistofvaccinenames.pdf Abbreviations Full Vaccine

Name Abbreviations Full Vaccine Name Abbreviations Full Vaccine

Name Abbreviations Full Vaccine Name Abbreviations Full Vaccine Name

DT Diphtheria, Tetanus Hep A Hepatitis A MCV / MCV4 Meningococcal Conjugate Vaccine OPV Oral Poliovirus

Vaccine Tdap Tetanus, Diphtheria, acellular Pertussis

DTaP Diphtheria, Tetanus, acellular Pertussis

Hep B Hepatitis B MenB Meningococcal B PCV / PCV7 / PCV13

Pneumococcal Conjugate Vaccine VAR / VZV Varicella

DTP Diphtheria, Tetanus, Pertussis Hib Haemophilus

influenzae type b MPSV / MPSV4 Meningococcal Polysaccharide Vaccine

PPSV / PPV23 Pneumococcal Polysaccharide Vaccine

Flu (IIV) Influenza HPV (2vHPV / 4vHPV / 9vHPV)

Human Papillomavirus MMR Measles, Mumps,

Rubella Rota (RV1 / RV5) Rotavirus

HBIG Hepatitis B Immune Globulin IPV Inactivated

Poliovirus Vaccine MMRV Measles, Mumps, Rubella with Varicella

Td Tetanus, Diphtheria

Instructions for completing the Certificate of Immunization Status (CIS): printing it from the Immunization Information System (IIS) or filling it in by hand.

Parents - Are Your Kids Ready for School?Required Immunizations for School Year 2017-2018

Hepatitis B DTaP/Td/Tdap* (Diphtheria, Tetanus,

Pertussis) Polio*

MMR (Measles, Mumps,

Rubella)

Varicella (Chickenpox)

Kindergarten – 5th Grade

3 doses 5 doses 4 doses 2 doses

2 doses OR

Healthcare provider verified child had

disease

6th – 12th Grade 3 doses

5 doses DTaP

AND

1 dose Tdap

4 doses 2 doses

2 doses OR

Healthcare provider verified child had

disease

*Vaccine doses required may be fewer than listed.

Students must meet minimum intervals and ages to be in compliance with the requirements. Talk to your healthcare provider or school staff if you havequestions about school immunization requirements.

Find information on other recommended vaccines not required for school: www.immunize.org/cdc/schedules/

If you have a disability and need this document in another format, please call 1‐800‐525‐0127 (TDD/TTY call 711). DOH 348-295 December 2015

Parent/Guardian Resource

Instructions: To see which vaccines are required for school, find your child’s grade and look only at that row going across to find the vaccines and number of doses required.

HEALTH HISTORY FORM

Student Full Name: DOB: Male Female Grade: School: Does your child ride the bus? Yes No

HEALTH CONCERNS Have you ever been told by a health care professional that your child has:

ADD ADHD

Allergies: Type Date of Last Reaction: Describe Reaction: Medication required *Yes No Medication Name:

Asthma: Uses inhaler *Yes No Exercise Induced *Yes No

Bowel/Bladder Issues: Type

Diabetes: Dental Issues: Type

Drug/Alcohol Treatment: Year

Emotional Concerns: Depression Anxiety Eating Disorder Other:

Frequent Colds Sore Throats Earache

Headaches: Frequency

Head Injury: Concussion Yes No Date: Lost Consciousness: Yes No

Hearing: Aids Preferential Seating Tubes

Major Illness/Surgery/Hospitalization: Year: Describe:

Neurological Conditions: Nose Bleeds: Other Bleeding Conditions: Other Health Conditions:

Restrictions/Limitations:

P.E. Limitations: For what reason?

Seizure Disorder: Type Last seizure:

Skin Condition: Speech Difficulty Therapy

Stomachache Cramps Tires Easily

Vision Problem: Contacts Glasses Reading Distance Both

LIFE THREATENING CONDITIONS

Does your child have a life threatening health condition? **Yes No Specify:

**If yes, you will be contacted by a District RN to discuss a healthcare plan. Washington State Law requires that a medication, treatment, and/or healthcare plan is in place prior to starting school.

MEDICATION Does your child take any medication? Yes No Name of medication: Purpose: Name of medication: Purpose: Name of medication: Purpose:

Will the medication be needed at school? *Yes No *For medications to be administered at school, by state law, RCW 28A.31.150, written permission from parent and Health Care Provider must be provided. The intent of the state law concerning medication administration at school obligates school districts to obtain written Health Care Provider orders and parental permission for both prescription and over-the- counter medication (i.e. Tylenol, medicated throat lozenges, vitamins).

Is there any other health related information that school staff should know? Washington State Immunization Law 28A.31.118 requires that a Certificate of Immunization be completed for each child attending school or day care center.

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

I understand that the information given above will be shared with appropriate school staff to provide for the health and safety of my child. If either I or an authorized emergency contact person cannot be reached at the time of medical emergency, I authorize and direct school staff to send my child to the most accessible hospital. I understand that I will assume full responsibility for payment of any transport or emergency medical services rendered. Printed Name of Parent/Legal Guardian Signature of Parent/Legal Guardian - Original signature required. Date

SUMNER SCHOOL DISTRICT A GREAT PLACE TO LEARN

ATTN School Staff: Please send this questionnaire to the Sumner- Bonney Lake Family Center – Central Office.

For Central Office Use Only: Date Received: ___________; Initials:__________; Referral to School BPC: ________________

Follow Up Comments: _____________________________________________________________________________________

2017-18

Student Housing Questionnaire

Students may be eligible for additional educational services through Title X, Part C, Federal

McKinney-Vento Assistance Act. Identification of eligible students by districts is required under federal law.

This form is being sent to all parents and legal guardians to complete for that purpose.

.

Questions? Call Tatia Holme, Director of Student Services & McKinney-Vento Liaison at (253) 891-6144,

or Tami Brouillet, McKinney-Vento Coordinator at (253) 891-6537.

Parent/Guardian:

Please answer the questions below and return the form to your child’s school office.

Name of Student: Name of School:

Birth Date: Age: Grade: Sex: Male Female

I (parent/guardian) rent/own my own home or apartment:

Yes

If yes, please skip Section A and proceed to

Section B at the bottom of the form and sign.

No If no, please fill out Section A and B of this form

to help us determine services your child may be

eligible to receive.

Section A: Please check the box that best explains your current living arrangements.

Temporarily sharing the housing of others due to loss of housing, economic hardship or similar

reason

Student is an Unaccompanied Youth: Lives with an adult that is not a parent or legal guardian;

or lives alone without an adult

Currently staying in a hotel/motel due to lack of alternative housing

In a vehicle of any kind, RV Park, campground, or abandoned building

In an emergency or transitional shelter, transitional housing, or other setting designed to provide

temporary living accommodations

Other, please describe: _____________________________________________________

Current Address: ___________________________________________ Phone Number: _______________

Contact Name: Contact Number: ______________

Section B: The undersigned certifies that the information provided above is accurate.

________________________________________________________________________________ Printed name of parent/legal guardian or unaccompanied youth

_______________________________________________________________ _______________ Signature of parent/legal guardian or unaccompanied youth Date

SUM

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Services for Students

Experiencing Homelessness

We may be able to help if you or your family live in any of the

following situations:

• Living with a friend, relative, or someone else

• Staying in a motel or hotel • Living in an emergency or

transitional shelter or a domestic violence shelter

• Staying in sub-standard housing • Living in a car, park, public place,

abandoned building, or a bus/train station

• Living in a campground or an inadequate trailer home

• Abandoned in a hospital • Living in a runaway or homeless

youth shelter

How can we help? • We make sure students are enrolled

in school immediately • Help families and youth get records • Help set up transportation services • Make sure students get all the school

services they need • Help preschoolers who are homeless

enroll in ECEAP, and other preschool programs

• Coordinate with social services and housing agencies to ensure access to education

• Make sure students have a full and equal chance to do well in school

Helping to create educational

opportunities for students living in transition.

McKinney-Vento Coordinator

Tami Brouillet 1518 Main Street

Sumner, WA 98390 Phone: 253.891.6537

Fax: 253.891.6530 McKinney-Vento Liaison - Dispute Resolution:

Tatia Holme Sumner School District Phone: 253.891.6144

OSPI – Homeless Education

State Coordinator Melinda Dyer 360.725.6505

Local Food Banks

Food Bank: Sumner Food Bank Phone #: 253.863.3793 Address: 15625 East Main Hours: 1-3pm (Mon., Tues., Wed., Fri.)

5 – 7 pm Thursday evenings Appointments are appreciated! Serves families/individuals once a month

Food Bank: Bonney Lake Food Bank Phone #: 253.863.4043 Address: 410 to B.L. Left at light. Next to Fire Station. Hours: 9:30 – 12:00 Tuesday & Thursday

Friday evenings: 5:00 – 7:00 pm Serves Bonney Lake area families

Free government commodities twice a month

Food Bank: St. Andrews Emmanuel Food Pantry Address: 1402 Valley Ave. , Sumner Hours: Tuesday & Friday 10-11:45 am, Wed. 3-5pm Current ID and proof of address

Free Dinners/Meals

Monday through National Guard Armory Fridays @ 6:00pm 622 4th Avenue SE, Puyallup

253.840.4670 Sundays @ 2:00pm Immanuel Lutheran Church 720 West Main, Puyallup Saturdays @ 11:00am Peace Lutheran Church 214 E Ave., Puyallup Saturdays @ 9:00am Mountain View Lutheran Church Thursdays @ 5:00pm 3505 122nd, Edgewood Wednesdays Christ Episcopal Church Lunch 210 5th St. SW, Puyallup Mon.- Thurs. Daffodil Valley Elementary

5:45 – 6:30 pm 1509 Valley Ave., Sumner Fri. 4:00 – 5:00 pm & 18 & under Free Liberty Ridge Elementary Adults $4.25 12202 209th Ave. Ct. E, Bonney Lk

Other Useful Numbers/Information Sumner/Bonney Lake Family Center.................. 253.891.6535 Sumner School District .......................................... 253.891.6000 State McKinney Coordinator ............................... .360.725.6505 National Center for Homeless Education .......1.800.308.2145 National Runaway Switchboard ........................1.800.621.4000 Lions 4 Kids Clothing Bank…………...………253.447.3844 Other Resources……………………..…………………..211

Community Resources

The McKinney-Vento Act is a federal law that gives students in homeless situations the

right to: • Stay in their school even if they move • Enroll in a new school without regularly

required documentation • Get transportation to school • Receive free breakfast and lunch • Go to pre-school programs • Get all the school services they need • Have disagreements with schools settled

quickly • To go to school while disagreements are

being settled

If you disagree with a decision regarding McKinney-Vento services, you have the

right to appeal our decision: • Submit this form to the school’s office,

homeless liaison, or coordinator within 15 days of the district’s decision (Level I).

• You will be notified in writing within five business days of the homeless liaison’s decision about your complaint.

• You may further appeal in writing to the District Superintendent if you still disagree within 10 business days (Level II);

• Then, if still in disagreement you may notify OSPI (Level III).

Complete details of the Dispute Resolution Process are available through the Sumner School District Homeless Liaison or at OSPI.

Please complete the following questionnaire and return it to your school or call the Sumner School

District McKinney-Vento Coordinator at 253.891.6537

This is a: (please check one)

□ New referral □ Request for dispute resolution □ Request for additional services or change in services

Student Name: Parent Name: Brothers or Sisters: □ Yes □ No Please list names and ages: What school is student currently attending? How long has student been at this school? Where are you currently staying? Contact phone number if available: Do you have any safety concerns for your students or family? Has your child or teen been in any special programs? □ Yes □ No If so, what programs: Is your child/teen participating in after school activities? Does your child/teen need assistance with transportation to/from school?