16-17 Enrollment Form Returning Student MS-HS Packet

Formulaire d’inscription revenant MS/HS élève
2016-2017
Présent à l’école _____________________________ Année ____________
Information de l’élève
Nom de l’élève __________________________ _________________________ _____________________ _________
Nom de famille
Prénom
moyen complète
Suffixe
Nom de parent primaire __________________________ Numéro de téléphone fixe: _______________________
Numéro de téléphone Mobile: ________________________
Nom de parent secondaire ________________________ Numéro de téléphone fixe: _______________________
Numéro de téléphone Mobile: ________________________
Addresse__________________________________________________________________________________________________________________
Addresse
ville
Etat
Zip
Contact d’Urgence
Nom ______________________________ Relation ______________ Numéro de téléphone ________________
Nom ______________________________ Relation ______________ Numéro de téléphone ________________
Ecole de Waterloo quartier Anti-intimidation gage
2016-2017
Je suis d'accord de travailler pour arrêter l'intimidation dans notre école et la communauté.
La définition du harcèlement et de l'intimidation dans la loi est: Tout acte électronique, écrite , verbale ou physique ou conduite envers
un élève qui est basé sur un trait ou une caractéristique réelle ou perçue de l'élève et qui crée un environnement scolaire objectivement
hostile qui répond une ou plusieurs des conditions suivantes : place l'élève dans la crainte raisonnable ou des dommages à la personne ou
aux biens de l'élève ; A un effet sensiblement négatif sur la santé physique ou mentale de l'élève; A pour effet de sensiblement interférer
avec le rendement scolaire de l'élève; et / ou a pour effet de sensiblement interférer avec la capacité de participer à ou au profit de l'élève
des services, des activités ou des privilèges offerts par une école .
Les comportements d'intimidation peuvent se composer d'un enfant à l’autre, un groupe d'enfants se liguer contre un enfant solitaire, ou un
groupe d'enfants destinés à un autre groupe. Comportements ordinaires attribuées à l'intimidation comprennent dénigrement, insultes,
rumeurs, des ragots, des menaces, menaçante, le harcèlement, l'intimidation, l'isolement social / exclusion, et des agressions physiques

Nous croyons qu'aucun élève mérite d'être intimidé et que chaque élève indépendamment de la couleur de l'âge , la religion, l'origine
nationale , la race , la religion , l'état matrimonial , le sexe , l'orientation sexuelle , l'identité sexuelle , attributs physiques , de l'ascendance de
la capacité physique ou mentale , la préférence de parti politique , les convictions politiques , le statut socio-économique, ou la situation de
famille a le droit de se sentir en sécurité , sécurisé et respecter.
J’accepte de:
Traiter d'autres élèves et le personnel avec gentillesse et respect.
Connaitre et respecter les politiques anti-intimidations de mon école (Politique 103.1).
Soutenir les élèves qui ont été victimes par le comportement de l'intimidation.
 Dites non à la verbale, physique et site d’intimidation (ayez de la position)
Prévenez un parent, un enseignant ou un administrateur de l’école. Si/quand je vois un comportement d’intimidation se produire
 Etre un bon modèle pour les autres élèves.
Etre responsable de mes choix, des actions et des mots

Signature de l’élève
Date
Signature de parent
Date
Accord de l'activité physique, Niveau 6 à 12
2016-2017
En 2008 , l'Assemblée législative de l'Iowa a adopté «La Loi sur la santé des enfants », exigeant que tous les élèves de 6-12 pratiquer une
activité physique pendant au moins 120 minutes par semaine dans laquelle il y a au moins cinq jours d'école . En raison de la programmation
de l'étudiant, il y aura des semaines que votre étudiant ne peut satisfaire à cette exigence par classe d'éducation physique seul. Par conséquent ,
chaque étudiant doit remplir cet accord . La loi exige également que nous contrôlons comment les élèves répondent à cette exigence .
Nom de l’élève
Année
Les activités scolaires que l'élève sera impliqué au cours de l'année Scolaire 2016-2017
Course du pays
Footballe
Volleyballe
Golf
Bowling
Basketballe
Softballe
Athlétisme
Marching Band
Natation
Show Choir
Tennis
Wrestling
Soccer
Cheerleading
Baseballe
Dance Team
Activités non scolaires que l'élève sera impliqué au cours de l'année scolaire 2016-2017
Signature de l’élève
Signature de parent
Date
Attendance Procedures
2016-2017
One of the most important things you can do to help your children succeed is to make sure that they are in school, on time and ready to learn
Tardy Procedure:
Children who arrive late must report to the office for a tardy slip. Tardiness is recorded and monitored for all students. Students who are on Voluntary
Transfer status may have the transfer revoked if tardiness becomes a concern.
Absence Procedure:
For the safety of your child, it is important that you call or notify the school before 9:15am when an absence occurs (messages can be left on the school’s
answering machine during non-school hours). By notifying the school, you are verifying that you know your child’s whereabouts. Examples of valid reasons
for which a child’s absence from school will not count toward their total absences for the year include:
•
•
•
•
•
•
•
A medical or dental excuse is brought to the office, verifying the reason for absence. Please schedule routine medical and dental appointments
after school hours, when possible
Death or serious illness in the immediate family or household
Suspension from school
Religious holidays requiring absence from school
Prior approval or notification of court appearances or other legal proceedings beyond the control of the family
Other verified emergency, as approved by the building administrator
Other reasons which can be justified from an educational standpoint and which are approved in advance by the building administrator
If your child accumulates four (4) unexcused absences, you will receive a computer-generated letter notifying you of the absences. If absences continue to
accumulate, you and your child may be referred for review to address attendance issues. In accordance with Iowa Law, it is the parents’ responsibility to
ensure their child attends school (Code of Iowa, Chapter 299). Parent/Guardian failure to see to it that their child attends school on a regular basis is a
criminal offense.
The Waterloo Community School District believes the primary purpose of education is to provide an opportunity for students to fully develop the basic
skills needed to function as responsible citizens in a changing world. Students can make academic progress only if they attend school regularly and take
advantage of the educational experiences offered.
I have read, understand, and agree to abide by the attendance rules and procedures.
Student Name ________________________________________________________________
Parent/Guardian Signature:__________________________________________Date:________________________________________
Field Trips/Network and Email account/Student Information/Media Release
YOU ONLY NEED TO FILL THIS OUT TO DENY PARTICIPATION*
2016-2017
The Waterloo Community School District has adopted a policy designed to assure parents and students the full implementation, protection and enjoyment of their rights under
the Family Educational Rights and Privacy Act of 1974 (FERPA).
This law requires the school district to designate as "directory information" any personally identifiable information taken from a student's educational record prior to making it
available to the public. This includes information released to branches of military upon request.
*The school district has designated the following information as directory information: student name, address and telephone number; grade level; activities and sports;
weight and height for athletic teams; degrees and awards received; and photographs and other likeness in still pictures or videotape.
The school district has created Google Apps for Education accounts that includes email for all students in grades 3-12. Additionally, teachers periodically use other online tools
with students as needed to achieve their curricular objectives. The district has adopted a policy which governs the appropriate use of technology resources. This policy is
viewable on our website at www.waterloo.k12.ia.us/TechPolicy/policy.pdf. Paper copies may also be requested by contacting your child’s school.
Please check each box if you DO NOT give permission:
I DO NOT give permission for my student to go on field trips.
I DO NOT give permission for directory information to be released.
I DO NOT give permission for directory information to be released to military branches.
I DO NOT give permission for my student to have a network and email account and access technology resources.
I DO NOT give permission for my student, his/her name, photo and school work to be displayed, included in publications or in media coverage. This includes all printed
media (newspaper, etc.) for sporting events or academic achievement (including honor roll); social media (Facebook, Twitter, etc.); websites maintained by the Waterloo
School District; and teacher performance videos for field experience.
Permission will automatically be granted unless designated above and received within two weeks of enrollment or by the second Friday in September of the current school
year.
Student Name _________________________________________School: ___________________________Date: ___________________
Parent/guardian signature ___________________________________________________________________________
CONDUCT EXPECTATIONS REVIEW FORM
2016-2017
The following policies have been reviewed with me. They are intended to help all of us work together toward a positive, productive
environment in a school of which we can be proud.
1.
Reasonable standards of discipline and the rules of the Waterloo Community School District apply to all students regardless of race,
sex, social or economic status. School areas in which the conduct code can apply include:
a)
The building itself, the school campus and parking lot as established by the school boundaries.
b)
In close proximity to the school campus, close proximity to the school, or away from school grounds or a school event if the
misconduct directly affects the good order of the school district.
c)
While on school operated or chartered buses or while being transported under supervision of school personnel or in close
proximity to the school bus stop.
d)
While attending school-sponsored or school-related activities in which a district school participates.
2.
Any student who shows disrespect to staff will be subject to disciplinary action, which may include suspension from school and / or
alternate placement. Examples include: not attending detention, failure to give correct name, obscenities, racial slurs, gestures, and
refusing to cooperate.
3.
Any student who brings a weapon to school as defined by Regulation 504.3-R may be recommended to the Executive Director of
Student and At-Risk Services for alternate placement and / or expulsion.
4.
Any student involved with a bomb threat, possession of a chemical device or false alarm will be subject to disciplinary action, which
may include a recommendation to the Executive Director of Student and At-Risk Services for alternate placement and / or expulsion.
5.
Any student under the influence of or possessing, storing, using, selling, supplying or distributing alcohol, drugs and/or controlled
substances will be subject to disciplinary action, which may include recommendation to the Executive Director of Student and At-Risk
Services for alternate placement and / or expulsion and the student will be subject to arrest.
6.
Any student who assaults or fights another student will be subject to disciplinary action which may include, but is not limited to,
recommendation to the Executive Director of Student and At-Risk Services for alternate placement and / or expulsion.
7.
Any kind of student harassment, intimidation, or bullying will result in disciplinary action which may include, but is not limited to,
recommendation to the Executive Director of Student and At-Risk Services for alternate placement and / or expulsion and the student
will be subject to arrest.
8.
Any student, grade (6-12) who continues to disrupt the school environment may be enrolled in an alternative program, and if the
behavior continues, may be recommended to the Executive Director of Student and At-Risk Services for alternate placement and / or
expulsion.
9.
Any student who has been suspended from school or expelled by the Board may be referred to the School Resource Officer or to
local police for trespassing if found on school grounds during the period of the suspension and / or expulsion.
10.
Any student found to have used a photographic (picture or video) cell phone in any district facility is subject to discipline according to
the student conduct code and policy 512.0 Student Use of Handheld Technology Devices, Cellular Telephones, Pagers, and Other
Devices. In addition, social media sharing of inappropriate content (pictures, videos, disparaging language, etc.) is prohibited.
11.
Any student who does not meet the state guidelines of attending school for a minimum of 148 days a year may be retained or lose
credit in a class. If a student in grades 9-12 is scheduled for 5 or fewer classes, he or she may be referred to an alternative education
program.
12.
Any student who leaves the school building during the school day without first securing permission from a school official is recorded
as truant and subject to disciplinary action.
13.
Any student who fails to wear the approved dress code attire is subject to disciplinary action according to the Board approved policy
regulation 504.2-R.
Student Name (Please Print):
Student Signature:
Date:
FAMILY RESIDENTIAL STATUS
Please Complete & Return to the School Counselor/Family Support Worker
This information will remain confidential.
It is used to assist our families and may also be used as supportive data when applying for grants.
The answers to the following questions can help determine the services this student may be eligible to
receive under the McKinney-Vento Act 42 U.S.C. 11435
Please put a check by any information that currently applies to your family .
We temporarily live with family/friends because we can’t afford to live on our own
We choose to live with family/friends for an extended period of time.
We live in a supervised shelter, motel or campground
We live in transitional housing
We live in a public or private place not ordinarily used as a regular sleeping place
We don’t have regular adequate night time shelter
We have children living in runaway shelters or group homes
We have received (or)
We have received (or)
We are receiving (or)
are in danger of receiving an eviction notice
are in danger of receiving) a utility disconnect (gas, water)
have received housing assistance and are paying more that
50% of our income for housing (rent, utilities, etc)
None of this applies to me or my family
We are currently in this situation
What barriers do you find that make receiving services from the schools, medical care, mental health care, etc. more difficult?
Please sign if you have checked any concern above.
Parent(s) / Guardian(s) Name(s)
Current Address
Date
Student Name _________________________
Student Name _________________________
Student Name _________________________
Student Name _________________________
Male☐
Male☐
Male☐
Male☐
Female ☐
Female ☐
Female ☐
Female ☐
Age_____
Age_____
Age_____
Age_____
Thank you for taking the time to fill this out. Your information will help us to
better serve our families and give an accurate picture of our community.
This information will remain confidential.
Should you become homeless, or find yourself in a situation as described
above during this school year, please contact you School Counselor and/or
Family Support Worker.
Thank you for taking the time to fill this out. Your information will help us to
better serve our families and give an accurate picture of our community.
This information will remain confidential.
Should you become homeless, or find yourself in a situation as described
above during this school year, please contact you School Counselor and/or
Family Support Worker.