WELCOME TO OAK LAWN­HOMETOWN SCHOOL DISTRICT 123!

If you have access to a computer, you can complete this process ON-LINE and SAVE TIME! Visit us at www.d123.org/Enrollment

ITEMS NEEDED TO COMPLETE YOUR STUDENT’S ENROLLMENT

_____ Proof of Residency [Mandatory]

See Oak Lawn­Hometown School District 123 Verification of Residency and Enrollment form for acceptable residency documents, located in this enrollment packet. Residency MUST be established before enrollment is considered complete.

_____ Birth Certificate [Mandatory ORIGINAL Birth Certificate must be presented]

Student will be enrolled with legal name as recorded on Birth Certificate unless court documentation is presented showing legal name change.

_____ *ISBE Student Transfer Form [Mandatory] if transferring from another public school in

Illinois. (Student must be in good standing) This must be submitted before the student’s enrollment is considered complete.

_____ *Office of Catholic Education­Archdiocese of Chicago­Official Elementary School Transfer

Form [Mandatory] if transferring from a Chicagoland area Catholic Elementary School. _____ *If transferring from a private Illinois school or out of state school [Mandatory] must provide

certification, in writing, on school or district letterhead, that the student is not currently serving a suspension or expulsion imposed by the school from which the student is transferring and what grade the student will be entering for the current school year.

_____ **Health Record [Mandatory]

Proof of appropriate health exam and required immunizations – Kdg & 6th Proof of Dental Exam – Kdg, 2nd & 6th Proof of Eye Exam – Kdg

_____ *Previous Term’s report card, current state test results, and/or current IEP _____ All District Forms completely filled in, or process completed via Skyward [Mandatory]

_____Verification of Residency and Enrollment _____Enrollment Form _____Federal Race/Ethnicity Data _____Home Language Survey _____Media Consent _____Acceptable Use Policy _____Student Information Sheet _____Student Emergency Sheet _____*Release of Student Records _____*Registration Receipt Form

If you should have any questions, please contact our district registrar at

(708) 857­5020 or nmottl@d123.org *If applicable **Due before the first day of school Revised 9/20/16

VERIFICATION OF RESIDENCY AND ENROLLMENT Child’s name:_____________________________ DOB:____/____/____ School:___________________

I, _________________________________, live at ____________________________________________, (Name of Adult) (Address) which is located within the boundaries of Oak Lawn-Hometown School District 123.

STEP 1: RESIDENCY VERIFICATION (PART A)

DO YOU: Own your own home Rent Other (Explain) __________________________________ You must provide documentation showing you live at the address listed above. Please provide originals of the following documents. Please black-out account and social security numbers on the documents. If you cannot produce all three documents, contact the Registrar.

All documents must be current and show your name and address.

Category A­ Must provide one (1) document

Category B – Must provide two (2) documents

Real Estate Tax Bill Gas Bill Driver’s License/State ID Signed Lease Electric Bill Bank Statement Mortgage Document or payment book

Water/Sewer Bill Credit Card Statement

Residency Attestation and most current real estate tax bill or mortgage statement

Phone Bill (no cell phones) Cable Bill

Pay Check Stub City Sticker Receipt

Military Housing Letter Vehicle Registration Voter Registration Section 8 Letter Homeowner’s/Renters Insurance

Policy and premium receipt Change of Address confirmation from the US Postal Service

Other* ______________________________________* Please contact the registration staff if you are having trouble collecting all three documents. The district may require a home visit and/or additional documentation to verify residency. Residency MUST be established before enrollment is considered complete.

STEP 1: RESIDENCY VERIFICATION (PART B)

I am unable to provide three (3) of the above documents because: (check all that apply) Our family has not had a permanent residency since ___/___/_____ Last School Attended: ______________________________________________________________ Address of Last Permanent Residence: _________________________________________________

Living in a shelter Living in abandoned apartment or building Sharing housing with others due to loss of housing, economic hardship, etc...

Disaster Victim Unaccompanied youth

Living in a hotel, motel, campground or other similar situation

Temporarily housed, awaiting DCFS foster care placement

Living at a train or bus station, park or in a car Other: ____________________________________ Your child may qualify for additional services. Please ask the registration staff for more information or contact the district’s McKinney-Vento Liaison at 708-423-0150. Please indicate any social service agency you are currently working with: ______________________________________________________________________________________

STEP 2: RELATIONSHIP TO STUDENT

You must provide a certified, original birth certificate. A copy will be made and the original returned to you. If a birth certificate is not available at the time of registration, other proof of the child’s identity and date of birth is required along with a signed affidavit. Check one below: I am the natural or adoptive parent listed on the birth certificate. (Please provide custody agreement if applicable.) I was granted court ordered guardianship. (Please provide a copy of court documentation.) I receive aid on behalf of the child. (Please provide copy of documentation of aid received.) I have assumed and exercise responsibility for the child and provide him/her with a fixed, night time abode. (Please check each of the following to be true and accurate.)

The child is living with me because___________________________________________ I am at least 18 years of age. The child eats and sleeps at my residence on a regular basis.

The child is not living with me for the sole purpose of having access to the educational programs of the school district.

STEP 3: AFFIRMATION AND WARNING (Must be completed in the presence of district employee)

Please read the following statements and initial each. _____I affirm that the information presented in this verification form, in connection with any investigation of my residency or the residency and custody of the student, is true, complete and accurate. _____I understand that knowingly or willfully providing false information to a school district regarding the residency of a child for the purpose of enabling that child to attend any school in that district without the payment of nonresident tuition is a Class C Misdemeanor. _____I understand that knowingly enrolling or attempting to enroll a child in the school of a school district on a tuition-free basis when I know the child to be a nonresident of the school district, unless the nonresident child has a lawful right to attend, is a Class C Misdemeanor and I will be liable for payment of tuition, fees and all other applicable fees. ___/___/____ _______________________________________ _________________________________

Signature of Adult Enrolling Student Print Name of Adult Enrolling Student

FOR OFFICE USE ONLY

___/___/____ _________________________________ _________________________________ Signature of Enrollment Personnel Print name of Enrollment Personnel Date of Verification: ___/___/____ Signature of Registrar: _________________________________

ENROLLMENT FORM FOR OFFICIAL SCHOOL RECORDS Date: __________________ Home School:_______________________________ Grade: __________

STUDENT’S NAME **It is essential for record keeping purposes that the District 123 Schools have your

child’s full LEGAL name and that this name be used on all school records** Full Legal Name: ______________________________________________________________________

(Last) (First) (Middle) Address: ________________________ City: ___________________ State: IL Zip: ___________ Telephone: _____________________________________ Gender: ________ Male _________ Female

(Area Code) Phone Number Date of Birth: _______________________ Birth Certificate# ___________________________

Hospital Name: ____________________________________________________ Father’s Name: ______________________ _________________ ____________ ________________

(Last) (First) (Middle) (Legal Guardian (y/n) Mother’s Name:______________________ _________________ ____________ ________________

(Last) (First) (Middle) (Legal Guardian (y/n) Last School Pupil Attended: ____________________________________________________________

Address: ________________________ City: ___________________ State: IL Zip: ___________ DOES YOUR CHILD HAVE AN IEP? YES NO (if yes, please provide a copy at the time of enrollment) Please List Siblings under the age of 15: Brother: ______________________ Age___________ Sister: ____________________ Age:________ Brother: ______________________ Age___________ Sister: ____________________ Age:________ Brother: ______________________ Age___________ Sister: ____________________ Age:________ Brother: ______________________ Age___________ Sister: ____________________ Age:________ Parent Signature: ___________________________________________________________

HOME LANGUAGE SURVEY

ENGLISH The state requires the district to collect a Home Language Survey for every new student. This information is used to count the students whose families speak a language other than English at home. It also helps to identify the students who need to be assessed for English language proficiency. Please answer the questions below and return this survey to your child’s school.

1. Is a language other than English spoken in your home? Yes _____ No _____ What language? ________________

2. Does your child speak a language other than English? Yes _____ No _____ What language?________________

If the answer to either question is yes, the law requires the school to assess your child’s English language proficiency.

Parent Signature: Date:

SPANISH

El estado requiere que el distrito colecte una Encuesta del Idioma en el Hogar para cada estudiante nuevo. Esta información se usa para contar a los estudiantes cuyas familias hablan en el hogar un idioma que no es el inglés. También ayuda a identificar a los estudiantes que necesitan ser evaluados para la fluidez en el idioma inglés. Por favor, conteste las preguntas a continuación y devuelva esta encuesta a la escuela de su niño.

1. ¿Habla alguien en su hogar un idioma que no es el inglés? Sí _____ ¿Cuál? _______________________ No _____

2. ¿Habla su niño(a) un idioma que no es el inglés? Sí _____ ¿Cuál? ________________________ No _____

Si la respuesta a cualquiera de las preguntas es sí, la ley requiere que la escuela evalúe la fluidez de su niño en el idioma inglés.

Firma del Padre/ Madre o Tutor:

Fecha:

LITHUANIAN

Valstijos reikalavimu apygardoje vykdomas kiekvieno naujo mokinio namuose vartojamos kalbos tyrimas. Ši informacija naudojama suskaičiuoti mokinius, kurių šeimos namuose kalba kitokia, ne anglų kalba. Taip pat šis tyrimas padeda išskirti mokinius, kurių anglų kalbos įgūdžius reikia įvertinti. Atsakykite į žemiau pateiktus klausimus ir grąžinkite anketą į savo vaiko mokyklą.

1. Ar kas nors jūsų namuose kalba kita, ne anglų kalba? Taip _____ Kokia kalba? ____________________ Ne _____

2. Ar jūsų vaikas kalba kita, ne anglų kalba? Taip _____ Kokia kalba? ________________________ Ne _____

Jei atsakymas į vieną iš šių klausimų yra taip, pagal įstatymų reikalavimus mokykla turi įvertinti jūsų vaiko anglų kalbos įgūdžius.

Tėvo arba globėjo parašas:

Data:

HOME LANGUAGE SURVEY POLISH

Stan wymaga od dystryktu zbieranie Ankiet o języku domowym od każdego nowego ucznia. Te informacje są używane aby policzyć uczniów, których rodziny mówią w domu językiem innym niż angielski. Pozwalają także na zidentyfikowanie uczniów, którzy powinni być ocenieni pod względem biegłości w języku angielskim.

Proszę odpowiedzieć na poniższe pytania i zwrócić tą ankietę do szkoły Twojego dziecka.

1. Czy ktokolwiek w domu mówi w języku innym niż angielski? Tak _____ Jaki to język? ______________ Nie _____

2. Czy Twoje dziecko mówi w języku innym niż angielski? Tak _____ Jaki to język? __________________ Nie _____

Jeśli odpowiedź na któreś z pytań brzmi „tak”, prawo wymaga od szkoły oceny biegłości w języku angielskim Twojego dziecka.

Podpis rodzica lub opiekuna:

Data:

ARABIC الطالب الذين تفرض الوالية على المنطقة جمع مسح حول اللغة المستخدمة في المنزل لكل طالب جديد. تستخدم ھذه المعلومات في إحصاء

تتحدث عائالتھم لغة تختلف عن اللغة اإلنجليزية داخل المنزل. وتساعد ھذه المعلومات أيضا في تحديد الطالب الذين ھم بحاجة ألن يتم تقييمھم من ناحية إتقانھم للغة اإلنجليزية.

1 .ھل يتم التحدث بلغة تختلف عن اللغة اإلنجليزية في منزلك؟ نعم _____ ال _____ أي لغة؟ _________________ 2 .ھل يتحدث ابنك/ابنتك لغة غير اللغة اإلنجليزية؟ نعم _____ ال _____ أي لغة؟ ________________________

توقيع الوالد/الوصي القانوني التاريخ

ROMANIAN Statul cere ca districtul să colecteze informaţii printr-un Sondaj privind limba vorbită acasă pentru fiecare student nou.

Aceste informaţii sunt folosite pentru a determina numărul studenţilor ale căror familii vorbesc acasă altă limbă decât engleza. De asemenea, acestea ajută la identificarea studenţilor ale căror competenţe de limba engleză trebuie să fie evaluate. Vă rugăm să răspundeţi la întrebările de mai jos şi să returnaţi acest sondaj şcolii copilului dumneavoastră.

1. În casa dumneavoastră se vorbeşte altă limbă decât engleza? Da _____ Nu _____ Ce limbă? ___________________ 2. Copilul dumneavoastră vorbeşte altă limbă decât engleza? Da _____ Nu _____ Ce limbă? _____________________

În cazul în care răspunsul la oricare din întrebări este da, legea cere ca şcoala să evalueze competenţele de limba engleză ale copilului dumneavoastră.

Semnătura părintelui/ tutorelui

Data:

U.S. DEPARTMENT OF EDUCATION RACE AND ETHNICITY DATA STANDARDS

DATA COLLECTION FORM

INSTRUCTIONS: This form is to be filled out by the student's parents or guardians, and both questions must be answered. PART A asks about the student's ethnicity and PART B asks about the student's race. lf you decline to respond to either question, the school district is required to provide the missing information by observer identification.

Student Name: ___________________________________________ School: ______________________

PART A: Is this student Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of race.)

Choose only one:

No, not Hispanic/Latino

Yes, Hispanic/Latino

The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to the question below by marking one or more boxes to indicate what you consider this student's race to be.

PART B: What is this student's race? Choose one or more:

American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including Central America, and who maintains affiliation or community attachment)

Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,

the Philippine Islands, Thailand, and Vietnam)

Black or African American (A person having origins in any of the black racial groups of Africa)

Native Hawaiian or Other Pacilic Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or Pacific Islands.)

White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)

Note: Data collected on this form must be maintained by the school district for three years. However, when there is litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the completion of the action.

Illinois State Board of Education, Division of Data Analysis and Progress Reporting January 2015

STUDENT ACCESS TO ELECTRONIC NETWORKS AND ONLINE RESOURCES Yes, I have read “Student Access to Electronic Networks and Online Resources” and hereby request that my child be allowed to access the District 123 electronic network and associated online resources.

Oak Lawn-Hometown School District 123 (“D123”) is actively integrating 21st Century educational technology tools into the curriculum through a suite of secure online applications including Google Apps for Education. This permission form describes the tools and student responsibilities for using these services. Using these tools, students can collaboratively create, edit and share files and websites for school related projects and communicate via email with other students and teachers. Online applications like Google Apps for Education are available at home, the library, or anywhere with Internet access. Examples of student use include: showcasing class projects, building an electronic portfolio of school learning experiences, and working in small groups on presentations to share with others. The Common Core State Standards for grades K-12 stress the importance of a technology-infused learning environment and ask students to demonstrate mastery in the following areas:

Proficiency in the use of computers & applications, as well as an understanding of the concepts underlying hardware, software, and connectivity.

Responsible use of technology & an understanding of ethics & safety issues in using electronic media at home, in school, and in society.

The ability to use technology for research, critical thinking, problem solving, decision making, communication, collaboration, creativity and innovation.

All users of the District's electronic networks, including use of the Internet and Google Apps for Education, must comply with Board Policy 6:135, Acceptable Use of Electronic Networks , Board Policy 6:220, Bring Your Own Technology (BYOT) Program; Responsible Use and Conduct , and their implementing regulations. School staff will monitor student use of the network and Apps when students are at school. Parents are responsible for monitoring their child's use of Apps when accessing programs from home. Students are responsible for their own behavior at all times. Though electronic technology tools and use of technology is an important component of the learning environment, a student's use of D123's electronic network is a privilege, not a right, and inappropriate use will result in restriction or cancellation of those privileges. Elementary and middle school students must have written permission from their parent(s) or legal guardian(s) to gain access to D123's electronic networks and online applications, including but not limited to Google Apps for Education via their D123 account. While access is designed for educational purposes and D123 has taken precautions to eliminate access to inappropriate materials, it is impossible for D123 to restrict access to all inappropriate materials. District 123 cannot and does not guarantee the security of electronic materials located outside the D123 network. If any parent or guardian has concerns about his or her child's use, restrictions may also be placed on the student's account. Although detrimental to the instructional program, a parent may review and request the deletion of the child's personal information and revoke consent for further collection or use, upon written notice to either the Chief Information Officer, their child's building principal, or the Superintendent. School District 123 is responsible for protecting and safeguarding the confidentiality of student information. District 123 has contracted with Google to provide access to Google Apps for Education to its users (students and staff) in a closed and secure environment that is not accessible by anyone outside of District 123. Google Apps has detailed privacy policy and security measures, which District 123 has reviewed and is satisfied that they appropriately protect the users' privacy. Additionally, under the contract with School District 123, Google must comply with the Family Educational Rights and Privacy Act (FERPA) and Children's Online Privacy Protection Act (COPPA.). See http://bit.ly/d123gafe for Google Apps for Education terms and conditions.

AUTHORIZATION FOR STUDENT ACCESS TO ELECTRONIC NETWORKS

AND ONLINE RESOURCES

I, as parent/guardian of the student listed below: (1) understand that access is designed for educational purposes and that, although the District has taken precautions to eliminate controversial material, it is impossible for the District to restrict access to all controversial and inappropriate materials; (2) agree to hold harmless the District, its employees, agents, or Board members, for any losses, claims, damages, causes of action, or injuries of any kind that result from materials or software accessed by my child via the District's networks; (3) understand that my child must follow Board Policy 6:235, Access to Electronic Networks, and its administrative procedures; (4) understand that the District and/or its agents may access and monitor at any time, without prior notice or consent, my child's use of the District's networks, including but not limited to District equipment and devices, the Internet, e­mail services, and any materials stored on, transmitted through, or received by my child using the District's networks; (5) understand that if my child violates Board policy, administrative procedures, or this Authorization, my child's access privileges may be restricted or revoked and disciplinary action, up to and including out­of­school suspension and expulsion, and/or appropriate legal action may be taken; (6) accept full responsibility for supervision if and when my child's use is not in a school setting; and (7) have discussed the terms of this Authorization with my child. (8) understand this signed Authorization for Student Access to Electronic Networks and Online Resources will be in effect as long as your child is in attendance in a District 123 school, unless written notification to the contrary is received by the principal. In addition, I understand that education files/records stored in Google Apps for Education may be accessible to someone other than my student and Oak Lawn­Hometown School District 123 by virtue of this online environment. I understand and authorize that: (1) my child may be given a D123 Google Apps for Education account, (2) my student may access online resources under the supervision and direction of D123 staff; . (3) my student's education work/files/records may be stored by Google; (4) by participating in Google Apps for Education, information about my child will be collected and stored electronically; (5) I may ask for my child's Google Apps for Education account to be removed at any time in writing; and (6) my signature below authorizes the collection of my child's personal information as set forth above. I, the student, understand that: (1) I must comply with Board Policy 6:235, Access to Electronic Networks, its administrative procedures, and all school rules when using the District's networks; (2) the District and/or its agents may access and monitor my use of the District's networks, including the Internet, my school email, and downloaded material, without prior notice to me, (3) should I commit any violation, my access privileges may be restricted or revoked, and school disciplinary action, up to and including out­of­school suspension and expulsion, and/or appropriate legal action may be taken, (4) my signature below releases the School District and its Board members, employees, and agents from any claims and damages arising from my use of, or inability to use the Internet.

Parent/Guardian Signature:

Date:

Student Signature: Date:

Print Student Name:

MEDIA/INFORMATION RELEASE FORM Media release for school related events Yes My child's name/photo may be released to the local media for school-related events such as

sports, clubs, plays, concerts, community projects, etc…I may revoke this consent at any time by notifying the Building Principal.

Check this box if you DO NOT consent. Media release for all events shared with local and social media Yes Oak Lawn-Hometown School District 123 has my permission to take photographs/slide, film,

video and/or audio tape recordings of my child, during classroom instruction, assessment, or other school-related activities. I understand that this media will be produced and used for educational purposes. The media may be used on a school-related website and/or included in a school district or educational foundation related publication, including but not limited to social media. Last names of students will not be used on Internet Projects. I may revoke this consent at any time by notifying the Building Principal.

Check this box if you DO NOT consent. Media release for non­emergency calls Yes I give permission for Oak Lawn-Hometown School District 123 to make non-emergency calls,

texts, or emails using automatic dialing equipment to phone numbers and e-mail addresses listed in Skyward Family Access. This permission will remain in effect throughout my child’s enrollment in School District 123. I may revoke this consent at any time by notifying the Building Principal.

Check this box if you DO NOT consent.

Parent/Guardian Signature:

Date:

Student Signature:

Date:

Print Student Name:

CHROMEBOOK LOAN AND ACCEPTABLE USE AGREEMENT GRADES 3 ­ 8

Yes, I have read the “Chromebook Loan and Acceptable Use Agreement” and will discuss the terms of the Agreement with my child.

Mission Oak Lawn - Hometown School District 123 will continue to provide innovative and engaging learning experiences for students through the use of technology. Each 5th through 8th grade student will be given access to a Google Chromebook both in school and at home as well. Students in 3rd through 4th grade will only have access in school. Access to the digital resources accessible through the use of the Chromebook will allow students to foster the 21st century skills (Communication, Collaboration, Critical Thinking, Creativity) that are necessary for their futures. Introduction Our current One-to-One computing initiative continues to immerse Oak Lawn-Hometown students into a technology-rich instructional environment. Effectively manipulating and employing the power of the technology to help students learn is an integral part of our instructional program. Understanding and adhering to the following terms, guidelines and procedures is necessary for the continued success of the program. Terms of Chromebook Loan The parent/guardian(s) and student are required to satisfy the following terms in order for the student to be issued a Chromebook:

1. Terms of Loan: School District 123 will issue a Chromebook to a student upon: a. Completion of PBIS “Cool Tool” & Student Orientation Training Session (held during school

hours the first week of school) by the student; and b. Submission of signed Chromebook Loan and Acceptable Use Agreement by the

parent/guardian(s) and student either on paper or through Skyward Family Access. 2. Legal title to the device (Chromebook) is with School District 123. A student’s possession and use of the

Chromebook is a privilege and is limited to and conditioned upon full and complete compliance with District 123’s Access to Electronic Networks Policy (6:235) and the Student Access to Electronic Networks and Online Resources Acceptable Use Policy, and this Agreement.

3. The student may be subject to loss of privilege, disciplinary action and/or legal action in the event of intentional damage and/or violation of policies and terms described in this Agreement.

4. The student will receive one of each of the following: a. Chromebook (registered to the D123.org Google domain). b. Chromebook A/C charger (grades 5th through 8th) c. Carrying case with shoulder strap (grades 5th through 8th)

5. The Student ID label attached to the Chromebook and carrying case must remain on them at all times. 6. District 123 reserves the right to modify the Chromebook project or its terms at any time, to no

detrimental financial impact to the student and parent/guardian(s). Damage, Loss, or Theft

1. The student and parent/guardian is responsible for filing a police report within 48 hours if the Chromebook is lost or damaged as a result of a theft or any other type of criminal conduct. Once the

police report has been obtained, the parent/guardian is responsible for notifying building administration and providing a copy of the police report. Failure to report a stolen Chromebook to police within 48 hours will result in the parent/guardian being responsible for the fair market value of the Chromebook unless the Chromebook is subsequently recovered and is undamaged.

2. The student and parent/guardian is responsible for reporting loss to the school technology department if the Chromebook is lost, left unattended in a classroom, or misplaced. If not found, the student and parent/guardian is responsible for paying the fair market value of the Chromebook.

3. The student and parent/guardian will be charged a fee for any damage to the Chromebook beyond normal every-day use, wear, and tear, regardless of whether the student is at fault, to help offset the actual cost of repair or replacement to District 123. District 123 also reserves the right to alter costs associated with damage and repair upon market availability of replacement parts. Examples of fees include, but are not limited to:

Chromebook: $315.00 Motherboard: $175.00

Case: $30.00 Battery: $50.00

Screen replacement: $145.00 Charger: $25.00

Keyboard replacement: $30.00 Hard drive: $40.00

Single key replacement: $5.00 Upper Case: $25.00

4. If the Chromebook is damaged or destroyed because the student committed or facilitated a deliberate act of damage or vandalism, the student and the student’s parent/guardian will be responsible for the actual cost of repair or replacement, whichever is less, and law enforcement may be notified by the school administrator of the damage or destruction of public property.

5. Repeated damage/loss of the Chromebook and/or failing to pay fees for repair/replacement due to damage/loss may result in the student losing the privilege of taking the Chromebook outside of school and becoming a day-only user, or other limitations on the student’s possession and use of a Chromebook.

6. District 123 reserves the right to repossess the Chromebook at any time if the student does not fully comply with all terms of this Agreement.

7. Unpaid fees of students leaving Oak Lawn Hometown School District 123 may be turned over to a collection agency. School District 123 may also file a report of stolen property with the local law enforcement agency if a Chromebook is not returned at the school’s request.

8. District 123 will offer insurance coverage for accidental damage for the Chromebook at the expense of the parent/guardian for families wishing to participate. (grades 5th through 8th)

Repair/Replacement of Chromebook:

1. The parent/guardian(s) and student agree: a. Not to attempt to repair or reconfigure the Chromebook, including but not limited to attempting

to open or tamper with the internal components of the Chromebook. b. Report that the Chromebook has problems, malfunctions, or is otherwise in need of repair to the

building technology department. 2. The Chromebook must be turned over to District 123 staff upon request for maintenance, data and file

backups, application upgrades, profile changes, or other administrative or support actions. 3. District 123 technology staff will determine whether the Chromebook is in functioning condition or if a

loaner (if available) will be issued to the student. Classroom computers and loaner Chromebooks are also covered by all terms and guidelines in this Agreement.

General Use of the Chromebook at School

1. The Chromebook is property of District 123 and should be utilized for educational purposes only. The student must adhere to the Acceptable Use Policy and the Student Handbook, and failure to abide by these rules may result in a disciplinary referral and/or loss of privileges.

2. The Chromebook will only be allowed to sync with District computers and content management accounts

3. The student is REQUIRED to bring the Chromebook to school each day, with a fully charged battery (if applicable).

4. The student may receive a SIR or disciplinary referral from a teacher for repeatedly failing to bring the Chromebook to class or repeatedly not charging the Chromebook battery (if applicable).

5. The Chromebook will be subject to routine monitoring by teachers, administrators and technology staff. The student shall have no expectation of privacy while using District 123 electronic information resources, including but not limited to the contents of computer files or communications undertaken using the Chromebook and/or D123 network. Teachers and/or District 123 administration may conduct an individual search of a student’s Chromebook, files, music, video, e-mail or other related items if there is suspicion that D123 policies, rules, or guidelines have been violated.

6. The student and parent/guardian are responsible for reviewing District 123’s Access to Electronic Networks Policy (6:235) and the Student Access to Electronic Networks and Online Resources Acceptable Use Policy.

7. The student’s Google Apps for Education account has 25GB space for storing educational files. This space must be used for backing up and storing files as directed by the teacher.

8. The student is responsible for not leaving the Chromebook unattended and using it in areas which may lead to damage or theft. The student should not use the Chromebook around sporting activities or events. When using the power cord, the student should not leave the cord in areas that may cause a tripping hazard.

9. The student is not allowed to take the Chromebook on overnight trips or field trips without the express written approval of the teacher and the parent/guardian.

10. District 123 reserves the right to block application downloads, implement security measures, change user permissions, change device settings, or take any other administrative or security steps, as deemed necessary in the District’s sole discretion. Any attempt to modify the Chromebook, including but not limited to changing Internet access settings, will be construed as a violation of the Acceptable Use Policy.

11. The student is prohibited from installing or modifying any hardware, software, or peripherals on the Chromebook.

12. The student must observe any hardware/software license agreements entered into by the District for the Chromebook and/or its equipment.

13. The student is expected to notify a staff member if information or a message that is inappropriate, dangerous, threatening or makes the student feel uncomfortable is viewed on the Chromebook.

14. Any attempt to bypass the District 123 filter or change the configuration of the Chromebook will result in disciplinary action and/or loss of privileges.

Chromebook Use at Home (if applicable)

1. The Internet is a powerful learning tool, but it should not be used indiscriminately or without supervision. While the student is at school, D123 staff will make every effort to assure that this resource is used appropriately.

2. The parent/guardian(s) is responsible for monitoring this resource at home (if applicable). It is not advisable for the student to be permitted to engage in long hours of unsupervised time online.

Caring For Your Chromebook

1. For prolonged periods of inactivity, please shut down the computer completely before closing lid. 2. Wait until the Chromebook screen is completely black before closing the lid. 3. Dimming the LCD brightness of your screen and turning off Bluetooth will extend the battery run time. 4. Do not write, draw, paint, place stickers/labels or otherwise deface your Chromebook or case. 5. Take extreme caution with the screen. The screens are very susceptible to damage from excessive

pressure or weight. NEVER PICK UP THE CHROMEBOOK BY THE SCREEN. Always close the lid before moving your Chromebook.

6. Be aware that overloading the carrying case will damage the Chromebook (if applicable). Textbooks, notebooks, binders, and other materials, are not allowed in the Chromebook bags (if applicable).

7. When using the Chromebook, keep it on a flat, solid surface so that air can circulate. For example, using a Chromebook while it is directly on a bed or carpet can cause damage from overheating. The carrying case acts as a lap desk and provides adequate cooling.

8. Liquids, food and other debris can damage the Chromebook. Avoid eating or drinking while using the Chromebook. DO NOT keep food or food wrappers in your Chromebook carrying case.

9. Take care when inserting cords, cables and other removable storage devices to avoid damage to the Chromebook ports. First, plug your power supply into the electrical outlet. Second, plug your power cord into your Chromebook. When disconnecting, reverse this process.

10. Do not expose your Chromebook to extreme temperatures, direct sunlight, or ultraviolet light for extended periods of time (including in a car). Extreme heat or cold may cause damage to the Chromebook. If your Chromebook has been in a very cold environment for a long period of time, let it warm up before using it.

Cleaning Your Chromebook (if applicable)

1. Students are encouraged to perform simple cleaning procedures to the Chromebook as outlined below: 2. Always disconnect the Chromebook from the power outlet before cleaning 3. Clean the screen with a soft, dry anti-static or micro-fiber cloth. Do not use any type of liquid or water to

clean the screen or Chromebook. 4. Wash hands frequently when using the Chromebook to avoid build-up on the touch pad. Grease and dirt

can cause the cursor to “jump around” on the screen. 5. You may clean the touch pad with a lightly dampened (not wet) lint free cloth.

General Security

1. Never leave your Chromebook unsecured. 2. Lock your Chromebook in a designated storage facility or secure locker.

I/we understand that any failure to comply may result in termination of my child’s (i.e., the student identified below) possession, effective immediately, and District 123 may repossess the Chromebook and equipment.

I/we understand that if District 123 officials determine that the Chromebook or equipment has been stolen, lost, or damaged through negligence or misuse, it will be my/our responsibility to pay for the cost of repair or pay for a replacement Chromebook.

I/we understand that failure to return the Chromebook and equipment in a timely manner and/or the continued use of the Chromebook for non­school/educational purposes without written consent of District 123 may be considered unlawful appropriation of the District’s property

Parent/Guardian Signature:

Date:

Student Signature:

Date:

Print Student Name:

TECHNOLOGY INFORMATION SURVEY

What type of technology is in use in the home? (Please check all that apply)

Desktop PC Laptop PC iPad Android Tablet Chromebook Kindle

What type of Internet connection do you have at home?

High Speed Broadband (AT&T/Comcast) Dial-up No Internet Access

Do you have a personal smartphone?

Yes No

Thank you for your time!

Parent/Guardian Signature:

Date:

Print Student Name:

Grade:

Name of School:

STUDENT INFORMATION

New Students: Please fill out completely Existing Students: Please make corrections as needed

Student Legal Name Date of Birth School Grade

Student Address: Include Apt # If Applicable

Primary Phone: Type of Primary Phone: Landline Cellular

Parent/s or Guardian/s who LIVE WITH Student

Name of Parent/Guardian #1

Relationship: Work Phone:

Has Custody? Cell Phone:

Email Address: Additional Phone:

Name of Parent/Guardian #2

Relationship: Work Phone:

Has Custody? Cell Phone:

Email Address: Additional Phone:

Does the student have a parent or guardian who is a member of a branch of the armed forces of the U.S. AND who is deployed to active duty OR expects to be deployed to active duty during the school year?

Yes No Parent / Guardian WHO DOES NOT LIVE WITH Student

Name of Parent/Guardian who DOES NOT LIVE WITH STUDENT

Relationship: Work Phone:

Has Custody? Cell Phone:

Email Address: Additional Phone:

List 2 or 3 Relatives/Neighbors who will care for student if parent/guardian can not be reached Emergency Contact #1: Cell Phone:

Relationship: Home Phone: Work Phone :

Home Address:

Emergency Contact #2: Cell Phone:

Relationship: Home Phone: Work Phone:

Home Address:

Emergency Contact #3: Cell Phone:

Relationship: Home Phone: Work Phone:

Home Address:

Oak Lawn­Hometown School District 123 is dedicated to ensuring district property tax dollars are spent to educate their neighborhood resident children. Students who live and sleep in residences of District 123 attend school tuition free. However, students found to be non­residents of the district and present false information regarding the student's residency are in violation of the residency policy and may face legal action as well as an annual tuition charge of at least $ 9,961.00 Signature of Parent / Guardian: ____________________________________ Date: _________________

EMERGENCY INFORMATION SHEET -Please make corrections where necessary -

Legal Name of Student Date of Birth Grade School

Student Address: Include Apt# if applicable Student Home Phone:

General Health Concerns/Medications My child has no health/medical concerns My child does not take medication My child takes the following medications or uses the following devices (such as eyeglasses, hearing aids, retainer, etc.) My son / daughter has the following concerns health / medical: Authorization, Release and Indemnity Agreement­to be completed by Parent/Guardian I, the undersigned parent/guardian of the child listed above understand and agree that in the event of illness or injury there is no legal obligation on the part of School District 123, it’s employees, agents or volunteers, to provide or arrange for medical treatment of until I or one of the individuals designated by me on this sheet or the student information sheet can be contacted. Accordingly, I expressly agree to the following instructions: I authorize School District 123 authorities to release my child to any person listed on the student information sheet for any reason. If, in the judgement of School District 123 authorities, emergency medical treatment is needed, I authorize them to contact and exchange information with: Dr:______________________________ Telephone:__________________________ If, in the judgement of School District 123 authorities, emergency medical treatment is needed, I authorize them to transport my child to a hospital as directed by emergency personnel, and to consent to emergency treatment if I cannot be contacted. I agree that my child may be transported in a commercial ambulance or a privately owned automobile, according to the judgement of School District 123 authorities. The School Nurse, in consultation with the Building Principal, will authorize the sharing of this information with staff. I also understand and assume responsibility for the risks that may be associated with my child’s attendance and participation in programs and activities offered or sponsored by School District 123. I further expressly agree to release and hold harmless any liability or responsibility for any and all personal injuries, damages, or expenses of any nature whatsoever which may be incurred as a result of School District 123’s release of my child to the listed individuals and/or provision to or securing of medical treatment for my child. I further expressly agree to indemnify and hold harmless and/or reimburse School District 123 current and former Board Members, employees, agents or volunteers, for any liability, costs, or expenses (including attorneys’ fees and litigation costs) which they may incur as a result of any claims arising from their exercise of judgement and/or following the instructions authorized herein.

Signature of Parent/Guardian: ____________________________________________ Date: ________________

OFFICE USE ONLY Nurse Review: _____________________________________ Health Care Plan Sect 504

CONSENT FOR RELEASE OF STUDENT RECORDS Educational Records

Mental Health and/or Developmental Disability Records

I hearby give my consent to:______________________________________________________________________ (Name of PREVIOUS SCHOOL, Agency or Person)

______________________________________________________________________________________________ (Address, City, State, Zip of previous School, Agency or Person)

To release the information listed below regarding: Student:________________________________________Birth date:____________________Grade:___________ Student’s new address:__________________________________________________________________________ To the following School, Agency, or Person: ________________________________________________________

(Name of NEW SCHOOL, Agency or Person)

______________________________________________________________________________________________ (Address, City, State, Zip of previous School, Agency or Person)

GENERAL EDUCATION RECORDS SPECIAL EDUCATION RECORDS Progress reports IEP’s Attendance Records Reports Multidisciplinary (MOC) Health History/Immunization Records Psychological Evaluations Group Achievement Test Scores Speech/Language Reports Cumulative Record Occupational/Physical Therapy Other:___________________________ Other__________________________ The reason for this release is: Relocation Other (please specify)_____________________________________________ This consent expires one year from the date below. However, we understand that we have the right to revoke this consent in writing at any time. _____________________________________________________________________________________________ Signature of Parent/Guardian Relationship Date Student signature is required if mental health and developmental disability records are being released and the student is 12 years of age or older. _____________________________________________________________________________________________ Signature of Student Date The signature of an adult witness is required if mental health and developmental disability records are being released _____________________________________________________________________________________________ Adult Witness Date

OPTIONAL CHROMEBOOK INSURANCE

GRADE 5 ­ 8 **Insurance coverage will not begin until payment has been received. **

You can purchase insurance through your Skyward Family Access account, or by signing below and returning this form with a check made payable to School District 123 to your child’s advisory/homeroom teacher.

Oak Lawn Hometown School District 123 provides every student in grades fifth through eighth with a touch enabled Chromebook. Your student will have access to this device both during the school day and at home. Allowing all fifth through eighth grade students the ability to take the device home each evening is a natural evolution to our initial 1:1 netbook program. This device is an increasingly essential learning tool in your child's education at District 123.

Chromebook Program at a glance... For Parents... For Students...

1. Sign off on the “Chromebook Loan and Acceptable Use Agreement” BEFORE the first day of school. 2. Help your student come prepared to school each day. Remind your student to charge their Chromebook each evening. 3. Families are ultimately responsible for damage and non­warrantied repairs. 4. Optional insurance is available for $25 during the school year & recommended and will protect your family from incurring costs associated with accidental damage, theft, fire, flood, natural disasters, power surge and vandalism. 5. The internet is a powerful learning tool. We monitor student usage while on our campus. Monitoring this resource while at home remains the responsibility of the parent.

1. Sign off on the “Chromebook Loan and Acceptable Use Agreement” BEFORE the first day of school. 2. Come prepared to class. Charge your Chromebook every night. 3. Treat the Chromebook with care. Liquids, foods and other debris can damage your device. Be very careful with the screen, although it is touch­enabled, be patient and do not apply excessive pressure. Clean hands equals a happy screen and touchpad. 4. Receiving this device is a privilege. It is an essential tool in remaining successful at OLHMS. 5. The internet is a powerful learning tool. Much of the collective knowledge of the world remains at your fingertips. Explore, learn, and create, for both your teachers and yourself.

Chromebook Insurance

Device insurance is currently held with GoCare Warranty Group and managed by School District 123. The optional Chromebook insurance will protect the device against accidental damage, theft, fire, flood, natural disasters, power surge and vandalism. This insurance policy will provide full replacement cost coverage and will protect the item worldwide (on and off school grounds). Additionally, the policy can be transferred to a replacement unit. D123 encourages families to take

part in the insurance program. Without insurance D123 families are fully responsible for the costs associated with the repair/replacement of the device.

Families can sign up for this insurance program by adding the optional “Chromebook Insurance” fee through Skyward

Family Access or by signing below and returning this form with a check made payable to School District 123 to your child’s advisory/homeroom teacher.

Families can enroll anytime up until September 30th. Coverage is for the 2016/2017 school year.

Coverage for 2016/2017 school year ­ $25.00 premium per device

**Due to a high volume of repairs, there will be a $25 deductible for every repair made due to accidental damage, starting for the 2016/2017 school year. No deductibles will be charged for warranty repairs**

Insurance coverage is for the device only. Insurance does not cover the case or the charger.

OPTIONAL CHROMEBOOK INSURANCE GRADE 5 ­ 8

GoCare Warranty Group Chromebook Insurance Coverage

Device insurance is currently held with GoCare Warranty Group and managed by School District 123. Insurance with GoCare Warranty Group will protect the device against ACCIDENTAL DAMAGE, THEFT, FIRE, FLOOD, NATURAL DISASTERS, POWER SURGE and VANDALISM. This insurance policy will provide full replacement cost coverage and will protect the item worldwide (on and off school grounds). The policy is also transferable to a replacement unit.

About GoCare Warranty Group

GoCare Warranty is the preferred mobile/tablet device insurance provider for thousands of clients that include K-12 schools, higher education schools, small and large businesses, government entities and corporations. GoCare has an extensive nationwide reseller network with companies and retailers. GoCareWarranty is backed by a top rated insurer that guarantees performance. GoCare Warranty’s insurance is underwritten by Lyndon Southern Insurance, a Fortegra Financial company. Fortegra Financial Insurance Company is an AM Best rated public company that’s been in business since 1981, with over a half a billion in total assets.

**Due to a high volume of repairs, there will be a $25 deductible for every repair made due to accidental damage, starting for the 2016/2017 school year. No deductibles will be charged for warranty repairs**

Coverage GoCare Warranty Group Insurance $25 premium

2016/2017 School Year **Deductibles**

Manufacturer Defect & Failure $0 Deductible

Accidental Damage Drops and Spills Cracked Screen Liquid Damage

$25 Deductible per repair

Theft, Fire, Flood, & Natural Disasters

$25 Deductible per repair

Chromebook Case (not covered)

N/A $30.00 replacement cost

Chromebook Charger (not covered)

N/A $25.00 replacement cost

Parent/Guardian Signature:

Date:

Print Student Name:

Grade:

Name of School:

Insurance coverage will not begin until payment has been received. If you have any questions, please contact Tammie Lagioia at tlagioia@d123.org.

REGISTRATION RECEIPT FORM

Student Name: ___________________________________ School: __________________ Grade: _____________

Address (Include Apt #.): __________________________________________________Phone:_______________

(An individual form is required for each student.)

FEES FOR GRADES K­8 Fees Paid By

5/31 Fees Paid 6/1­7/31

Fees Paid After 7/31

Instructional Rev 12/15/15

Technology Rev 12/15/15

$ 88.00

$ 63.00

$ 104.00

$ 63.00

$ 135.00

$ 63.00

Total Fees $ 151.00 $ 167.00 $ 198.00

TUITION PRESCHOOL FEES Tuition Preschool Program Tues­Thurs

2 yr 9 mo AM or 3 yr PM Mon­Wed­Fri 3 yr AM or 4 yr PM

Mon thru Fri AM, PM, or AM & PM

Deposit is non­refundable and will be put towards

your May tuition.

$ 130.00

$ 160.00

$ 250.00 (AM or PM) $ 500.00 (AM & PM)

*Lack of Timely Payment of Preschool Tuition will result in student disenrollment* **Your spot is not guaranteed until it is confirmed by a member of the Kolmar staff as space is limited**

OPTIONAL FEES

Optional Ed Foundation Donation* $ 10.00 $ 10.00 $ 10.00

Optional Chromebook Insurance Grades 5 - 8 $ 25.00 $ 25.00 $ 25.00

*The optional fee is a donation to the School District 123 Educational Foundation. The Foundation helps to bridge the gap between the “basics” and the “extras” by raising funds and distributing financial and other resources for the benefit of our students.

Payment Methods:

_____ Cash payments are only accepted in person. DO NOT send cash with your student. Amount Received:___________ Date:_____________ Received by:__________________ _____ Check Payable to Oak Lawn-Hometown School District 123: Check # ________ Please put the student's name and ID # on the section 'memo' on the check _____Online through Skyward Family Access _____Credit Card in Person Authorization Code:______________

I understand that checks returned for insufficient funds will be sent to a collection agency and an additional charge of $ 15.00 will apply.

Signature of Parent /Guardian: _____________________________________________________Date: ___________