registration requirements - edl · registration requirements ... the student will not be promoted...

LEFLORE COUNTY SCHOOL DISTRICT

STUDENT REGISTRATION

Registration Requirements

Kindergarten Registration Requirements for 2017-2018 school year! In order to attend kindergarten, children must be 5 years old on or before September 1, 2017.

What to Bring: 1. Student’s certified birth certificate (copies will not be accepted) 2.Student’s social security card (copies will not be accepted) 3.Student’s Mississippi Immunization Form 121 4.Proof of Residency Two current (July) utility bills 5.A completed registration packet

K-12 Admission What to bring: 1. Mortgage document, filed homestead exemption, or property deed. If leasing, original home or apartment lease 2. Two (2) current (July) utility bills (electric, water, gas, land phone). Bills addressed to a PO Box will not be accepted. Cell phone bills will not be accepted; 3. Certified birth certificate (no copies) 4. Social security card (no copies) 5. Certificate of health compliance issued by the Mississippi Department of Health or a local physician. 6. D-TAP (7th Grade Only) 7. A completed registration packet Students New to Leflore County School District in grades K-12 What to Bring: 1. Mortgage document, filed homestead exemption, or property deed. If leasing, original home or apartment lease; 2. Two (2) current (July) utility bills (electric, water, gas, land phone). Bills addressed to a PO Box will not be accepted. Cell phone bills will not be accepted; 3. Certified birth certificate (no copies); 4. Social security card (no copies); 5. Certificate of health compliance (immunization form 121) issued by the Mississippi Department of Health or a local physician; 6. Address of previous school attended; 7. Withdrawal information from the previous school attended; 8. A copy of last report card; 9. A completed registration packet from below.



STUDENTS LIVING WITH PARENT(S) OR GUARDIAN(S) The parent(s) or legal guardian(s) of a student seeking to enroll must provide the Leflore County School District

with at least two of the items numbered 1 through 10 below as verification of their address, except that a

document with a post office box as an address will not be accepted.

1. Filed Homestead Exemption Application form

2. Mortgage documents or property deed

3. Apartment or home lease

4. Utility bills

5. Driver's license

6. Voter precinct identification

7. Automobile registration

8. Affidavit and/or personal visit by a designated school district official and will still require two (2) of the

items numbered 1 through 10.

9. Any other documentation that will objectively and unequivocally establish that the parent or guardian

resides within the school district

10. Certified copy of filed petition for guardianship if pending and final decree when granted

HOMELESS CHILDREN When a child is determined to be homeless as defined by the Stewart B. McKinney Act 42 USC Section 11431

(1), 11432 (e) and 11302 (a), the Leflore County School District shall consider and take enrollment action that is

in the best interest of the child pursuant to 42 USC 11432 (e) (3).

STUDENTS LIVING WITH ADULTS OTHER THAN PARENTS OR LEGAL GUARDIANS: 1. The non-parent(s) claiming district residency must meet the criteria of subparagraph (a) (1) through (10)

above, required of a parent or legal guardian.

2. The district resident must provide the school with an affidavit (see last page of this policy) stating his or her

relationship to the student, and that the student will be living at his/her abode full time, and provide

documentation fully explaining the reason(s) (other than school attendance zone or district preference) for this

arrangement. The superintendent or his/her designee will make the necessary factual determinations as

required under this policy. Examples of situations where "in loco parentis" authority of an adult will be

recognized to establish residency of the minor include but are not limited to the following:

a. Death or serious illness of the child's parent(s) or guardian(s);

b. Abandonment of the child;

c. Child abuse or neglect;

d. Unstable family relationships or undesirable conditions in the home of the child's parents or

guardians having a detrimental effect on the child;

e. Students enrolled in recognized exchange programs residing with host families.

3. Whenever appropriate the person who has assumed responsibility for the care and custody of the child shall

be encouraged to obtain legal guardianship of the child.

The school district may require additional documentation and verification at any time.

At the minimum, the Leflore County School District shall maintain in a file a written instrument

identifying the types of documents used to verify each student's residency and copies of any

relevant guardianship petition or decree.

The provisions of this policy do not apply to students who reside outside the school district, but who

have legally transferred into the school district. Any court ordered procedure shall take precedent

over any procedure contained herein.



TRANSFER STUDENTS 1. No student is to be enrolled in this school district until any and all questions regarding residence

or immunizations have been resolved.

2. Students suspended or expelled from another school or school district may not be allowed to

enroll.

3. No pupil shall be permanently enrolled in a school in this school district who formerly was

enrolled in another school within the state or outside the state until the cumulative record of said

pupil shall have been received from the school from which he transferred. Should such record

have become lost or destroyed, then it shall be the duty of the superintendent or principal of the

school where the pupil last attended school to initiate a new record.

4. Unless a transfer student is tested in the manner provided in paragraph 5 below, the student will

be permanently enrolled and placed in a grade or class on the basis of an official transcript of

credits from the last school attended.

5. All students seeking to transfer from any school, public, private or home school, within or

outside of the boundaries of the State of Mississippi, to the Leflore County School District shall

be required to take a standardized test to determine the grade and class to which the pupil shall

be assigned at the time of pupil transfer.

The administrative head of the school shall administer the test or tests to such pupil or pupils as

shall apply for transfer to such public school. Such test or tests shall be administered within

thirty days after the filing of each such application for transfer.

Notice of the giving of such test shall be given the applicant not less than five days prior to the

date of the administration of such test.

No transfer of a pupil shall be affected until the test has been given and the pupil is assigned to

the grade and class for which the test shows he is best suited. No pupil shall be assigned to a

grade and class more than three (3) grades above or below the grade or class that the pupil

would have been assigned to had the pupil remained in the school from which the transfer is

being made. Pending the administration of the test herein provided for and its grading and an

assignment based thereon the superintendent of the Leflore County School District or the

attendance center principal to which the pupil seeks admission may assign the pupil temporarily

to a grade and class comparable to that in which the pupil would have been had the pupil

continued in the school from which the transfer was being made.

If any student is transferred or reassigned within the Leflore County School District by an order

of the board of trustees of this school district as designated by law of the State of Mississippi

and not at his own request, the requirement of that pupil's taking the standardized test shall be

waived. Likewise, if a pupil shall transfer from one school district to another school district in the

manner provided and required by the laws of the State of Mississippi, the requirement of such

pupil taking the standardized test shall be waived.

6. Any legal guardianship formed for the purpose of establishing residency for school district

attendance purposes shall not be recognized by this school board.

Note: (See also Policy JBCD Transfers and Withdrawals of Students)



Notification of Literacy-Based Promotion

Act (for 3rd Grade Students only)

1. In compliance with the "Literacy Based Promotion Act," it is the intent of the District

to improve the reading skills of kindergarten through third grade students so that

every Student completing the third grade is able to read at or above grade level.

2. Each Student's progress shall be determined by the Student's proficiency in

reading.

3. Immediately upon the determination of a reading deficiency, and subsequently with

each quarterly progress report until the deficiency is remediated, the District shall

notify the Student's parent/legal guardian of the deficiency in accordance with

procedures outlined in this policy. If a Student's reading deficiency is not remedied

by the end of the third grade year, the Student will not be promoted to the fourth

grade.

4. Social promotion is prohibited. A Student may not be assigned a grade level based

solely on the Student's age or any other factors that constitute social promotion.

5. Beginning in the 2014-2015 school year, if a Student's reading deficiency is not

remedied by the end of the third grade, the Student shall not be promoted to fourth

grade. The District will provide written notification to the parent/legal guardian of

any third grade student who is retained that the student has not met the proficiency

level required for promotion and, if applicable, the reasons the student is not

eligible for a good cause exemption. Any third grade student who is retained shall

be provided with a high-performing teacher.

By signing below, I am aware that my child, ____________________________________

must meet the aforementioned requirements according to SB 2347 Literacy-Based Promotion

Act before he/she will be promoted.

___________________________________________ __________________________

Parent’s or Legal Guardian’s Signature Date



Residency Registration & Documentation

Checklist

Name of Student: _____________________________________

Name of Parent/Court Appointed Guardian: _______________________________________

Address: __________________________________________________________________

Street Apartment # City State Zip Code

1. I certify that the information given above on this form is a true and correct statement of

my legal residence. Should my legal residence change while the above student is

enrolled in the above cited school district, I will promptly notify the appropriate officials

of this district. I understand that a pupil is not legally enrolled until this form is

completed and signed by the parent or court appointed guardian with whom the

student may be living. I understand that a pupil admitted under false information is not

legally enrolled and is subject to penalty.

2. I hereby certify that the student named on this registration form has not been expelled

or suspended from another school. If the student has been expelled or suspended,

please write the name of the school, date of the expulsion or suspension, and the

reason for such expulsion or suspension in the space provided below.

Date expelled/suspended:

School: ___________________________________________________________________

Reason(s):

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Parent’s signature: _____________________________________________ Date: ________

Phone Number: _________________________________



Acceptable Use of Internet Policy

Leflore County School District Acceptable Use Policy Please read the following information carefully:

Internet access is available to students and staff in the Leflore County School District (LCSD). Our

goal in providing this service is to further the mission of the LCSD: to provide a quality formal

education to enable its students to achieve academic success and become productive, contributing

members of society. Internet access is to be used for educational purposes.

Pupil guidelines for Internet use:

Pupils are responsible for good behavior on the Internet, just as they are in a classroom or a school

corridor. General school rules apply. Access is a privilege, not a right, and that access requires

responsibility.

Individual users of the Internet are responsible for their behavior and communications over the

network. Users will comply with school standards and honor the agreements they have signed.

Computer storage areas will be treated in a similar manner as school lockers. Staff may review files

and communications to insure that users are using the system responsibly. Users should not expect

that stored files would be private.

During school, teachers will guide pupils toward appropriate materials. Families bear responsibility for

providing such guidance as they must exercise with other information sources, such as television,

telephones, movies, radio, and other potentially offensive media.

The following are not permitted:

1. Sending or displaying offensive or inappropriate messages or pictures

2. Using obscene or inappropriate language

3. Harassing, insulting or attacking others

4. Damaging computers, computer systems or computer networks or changing computer settings

5. Violating copyright laws

6. Using others' passwords or teacher’s logins

7. Trespassing in others' folders, work or files

8. Intentionally wasting resources

9. Using network for commercial purposes

10. Installing ANY software on LCSD computers

11. Downloading ANY files without a teacher’s permission

12. Revealing personal addresses, phone numbers or student names

13. Participating in chat sessions not supervised by a teacher

Students are to notify an adult immediately if they encounter materials which violate the rules of

appropriate use.

Students are to be prepared to be held accountable for their actions and for disciplinary

consequences if the Acceptable Use Policy is violated



Parent Internet Network Access Agreement

IMPORTANT NOTICE TO PARENTS

Due to the nature of the Internet, it is neither practical nor possible for the school district to enforce

compliance with user rules at all times. Accordingly, parents and students must recognize that

students will be required to make independent decisions and use good judgment in their use of the

Internet. Therefore, parents must participate in the decision whether to allow their children access to

the Internet and must communicate their own expectations to their children regarding its appropriate

educational use.

As a parent/guardian of this student, I have read the board-adopted policies on Internet Use by

Students, the administrative procedures, and the Internet Network Access Agreement.

I understand that Internet access is designed for educational purposes and that the

school/district will attempt to discourage access to objectionable material and

communications that are intended to exploit, harass or abuse students. However, I

recognize it is impossible for the Leflore County School District to restrict access to all

objectionable material, and I will not hold the school or school district responsible for

materials acquired or contacts made on the Internet.

I understand that a variety of inappropriate and offensive materials are available over

the Internet and that it may be possible for my child to access these materials if he/she

chooses to behave irresponsibly. I also understand that it is possible for undesirable or

ill-intended individuals to communicate with my child over the Internet, that there is no

practical means for the school/district to prevent this from happening, and that my child

must take responsibility to avoid such communications if they are initiated. While I

authorize the staff to monitor any communications to or from my child on the Internet, I

recognize that it is not possible for the school to monitor all such communications. I

have determined that the benefits of my child having access to the Internet outweigh

potential risks.

I understand that any conduct by the herein named student that is in conflict with these

responsibilities is inappropriate, and such behavior may result in termination of access

and possible disciplinary action.

I have reviewed these responsibilities with my child, and I hereby grant permission to

the school/district to provide Internet network access.

I agree to compensate the school/district for any expenses or costs it incurs as a result

of my child’s violation of Internet policies or administrative procedures

Parent/Guardian Name(s) _________________________________________________________

(Please Print)

Parent/Guardian Signature(s) ______________________________________________________



Student Internet Access Agreement

I accept the responsibility to abide by the Leflore County School District’s board-approved policy on

Internet Network Access and by procedures as stated below in this Agreement. I understand that the

use of the Internet and access to it is a privilege and not a right. I agree:

To use the Internet network for appropriate educational purposes and research;

To use the Internet network only with permission of designated school staff;

To be considerate of other users on the network and to use appropriate language for

the school environment;

To not intentionally degrade or disrupt Internet network services or equipment. This

includes but is not limited to tampering with computer hardware or software,

vandalizing data, invoking computer viruses, attempting to gain access to restricted or

unauthorized network services, or violating copyright laws;

To report immediately any security problems or breeches of these responsibilities to

appropriate staff;

To comply with all rules and expectations included in the policies included under

Internet Use by Students (Policy IJ-R) and with administrative procedures and

guidelines; and,

To not divulge personal information such as addresses and telephone numbers over

the Internet.

I understand that I have no right to privacy when I use the school/district Internet network(s), and I

consent to the monitoring of my communications over the Internet by school/district staff.

I also understand that any conduct that is in conflict with these responsibilities is inappropriate and

may result in termination of Internet access and possible disciplinary action.

Name: _______________________________ School: __________________________________

(Please Print)

Home Address: ________________________________________________________________

Student Signature: ____________________________________ Date: __________________

NOTE: This form is to be used in conjunction with the following policies: (EI) Computer Software

Usage, (IJ) Technology and Instruction / Electronic Information Resources, IJ-E (1) Internet Network

Access Agreement, IJ-E (2) Internet Parental Consent Agreement, (IJA-E) Internet Etiquette, (IJA-P)

Internet Administrative Procedures



My child participates in (Please circle)

OT/PT Inclusion Speech Self-

Contained 504 Plans Gifted/Honors EL



Student’s Checklist

Registration Form

Book Card

Residency Documentation (2 proofs)

Administration of Medicine at School Form

Asthma Action Plan (AAP) if applicable

Birth Certificate

Social Security Card

Immunization Record

Home Language Survey

Photo-In District Travel Consent Form

Parent-Student-Teacher-Principal Compact

Parent-Student- Handbook Agreement

Acceptable Use Policy-Signed Agreements

SB 2347 Literacy Based Promotion Act Agreement (3rd Grade Students Only)

Athletic Participation Form (if applicable)

7th Graders- Updated Immunization (T-dap)

Student’s Name: ___________________________________________ Grade Level: _____________________

Parent’s Name: ____________________________________________ Contact Number: _________________

School’s Name: ____________________________________________________________________________

District Personnel’s Signature: _____________________________________ Date: _____________________



DEPARTMENT OF ATHLETICS

STUDENT PARTICIPATION CLEARANCE FORM

I hereby give consent for my child, _________________________________________to participate in

the __________________________________ School District’s athletic and activities programs during

the_____________________ school year. I agree to abide by the rules and regulations of my school

district and its governing body, the Mississippi High School Activities Association.

I hereby authorize and give permission for emergency medical treatment to be rendered for and on

behalf of my child, ____________________________________, for any injury received while

participating in any supervised school activity. This authorization includes, but is not limited to, any

treatment deemed necessary by certified personnel, physicians, hospital emergency room physicians

and hospitals.

I hereby release the _____________________________ School District and all school personnel for

any and all liability associated with such necessary treatment.

I hereby acknowledge that health and accident insurance is recommended for participation in all

organized sports and activities and further certify that my child is covered under the health and accident

program listed below.

School day insurance: ________________________ Other insurance: _______________________

Policy # _______________________________ Policy # _______________________________

In addition, I assume any expenses for liability not covered by the insurance policy above for injury

received by the above named student while participating in sports and school activities. I accept full

responsibility for medical and hospital expenses and any other related expenses and do hereby hold

harmless the ______________________________ School District and the Board of Trustees, their

agents or assignees, of responsibility for any such injury or expenses and waive any and all claims

which may arise against them. I realize that participation in organized sports and activities involves the

potential for injury, sometimes severe enough to result in total disability, paralysis, or death.

I give the Mississippi High School Activities Association and its assigns, licensees and legal

representatives the irrevocable right to use any picture or image or sound recording of the student in

all forms and media and in all manners, for any lawful purposes. In addition, I consent to the disclosure,

by my child’s/ward’s school, to the MHSAA, upon its request, of all records relevant to his/her eligibility

and participation including, but not limited to, his/her records relating to enrollment and attendance,

academic standing, age, discipline, residence and physical fitness.

The Student Participation Clearance Form is required for all students to participate in MHSAA

athletic and activity programs.

Parent/Legal Guardian ___________________________ Phone # _______________________

Cell #________________________________ Date _________________ (valid 365 from this date)



Home Language Survey

Student’s Name: _________________________________________ Date of Birth: _____________ Sex: ______

Parent/Guardian’s Name: _____________________________________________________________________

Address: ___________________________________________________________________________________

Home Telephone: ________________________________________ Work Telephone: ____________________

School: ______________________________________________ Grade: _____________ Date: _____________

Federal and state laws require the following information be collected about the primary and home language of

every student upon enrollment in the school district. Please completer a survey for each child you are enrolling

in the school district.

1. What language did your child learn when he/she first began to talk? ___________________________

2. What language does your child most frequently speak at home? _______________________________

3. What language is spoken by you and your family most of the time at home? ______________________

If language other than English is indicated for any of the above questions, the school district will test

your child’s English language proficiency to determine eligibility for initial and contributing placement

in an English language development program. You will be notified about the results of this testing.

4. If available, in what language would you prefer to receive information from the school? ____________

5. Has this student attended any U.S. school in any three years of his/her lifetime? __________________

____________________________________________________________________ _____________________

Parent or Guardian’s Name Date

Office Use Only

Student ID # Date Distributed Date Received



Administration of Medicine at School

Procedure for parent to follow if it is essential that a student received medication during time of attendance at

school.

1. Your physician must complete and sign the "Permission for Medication Administration at School" form.

Instructions must be specific and not dependent on school staff judgement.

2. You must sign the "Permission for Medication Administration at School" form and return the form to your

child's school.

3. Provide medicine in container with the original label from the doctor or pharmacist. This label must have

your child's name, the name of the medication, dosage and time of administration, and correct date.

4. To prevent unsupervised access of your child or other students to the medication, you must deliver the

medicine to the school. The quantity acceptable to keep at school may be restricted.

5. Maintain a record of the date and quantity of medicine you provided the school so you will know when to

replenish the medication.

6. Provide the school with new permission if there is a change in medication or change of your child's health

care provider. Permission must be renewed each school year.

7. If your child has asthma, please complete an Asthma Action Plan that can be found at your school.

8. If a parent or guardian cannot be reached, the school staff reserves the right to notify the physician for any

questions regarding medicine or condition of the student.

9. The complete Leflore County School District policy on medicine in school on medicine in school is in the

student's handbook.

Thank you for your cooperation.

__Beverly Quinn___________________ __Tammie Coleman________________________

District School Nurse District School Nurse

___Dr. Ilean Richards______________

Interim Superintendent I have read and understand the policy on medicine administration, I also understand that if my child has

asthma, an Asthma Action Plan must be completed.

________________________________________________________________________________

Parent/Guardian Signature Date



Leflore County School District

PARENT AUTHORIZATION AND IDEMNITY AGREEMENT

The undersigned parent/s of _____________________________________________ , Child's Name

a minor child, has requested personnel of this school district to administer prescription medicine to

this student. This request has been made for my/our convenience as a substitute for parental

administration of this medicine.

Medications:

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

6. _____________________________________________________________________

7. _____________________________________________________________________

8. ______________________________________________________________________

Reactions to Medication (how it affects the child, etc.) ________________________________ It is understood that the school personnel administering the medicine will not have to have medical or nursing training.

I/We forever release, discharge and covenant to hold harmless the School District, its personnel and Board of Trustees from any and all claims, demands, damages, expenses, loss of services and causes of action belonging to the minor child or to the undersigned arising out of or on account of any injury, sickness, disability, loss or damages of any kind resulting from the administration of the prescription medicine. I understand that I as parent/guardian am responsible, to personally inform the building principal of any changes in dosage(s), medication(s), or prescriptive discontinuations.

The undersigned agree to repay the school district, its personnel or Trustees any sum of money, expenses, or attorney's fees that any of them may be compelled to pay in defense of any action or on account of any such injury to the minor child as a result of the administration of medicine. I have read the foregoing release and indemnity agreement and fully understand it.

Executed the ________________ day of _________________________, 20 ___________ .

Parent or Guardian:_______________________________________________________________

Witness:__________________________________________________________________________



Asthma Information Sheet

Asthma is a serious condition in which there are symptoms of shortness of breath, wheezing, coughing, or

rattling sounds with breathing. Episodes can be caused by various triggers, such as a sudden change in

weather, pollen, dust, smoke, strong perfumes, or air fresheners. These symptoms are due to a sensitivity of

the airways in the respiratory system that causes a difficulty with getting air in and out of the lungs. Severe,

uncontrolled attacks can cause a child to stop breathing.

Ways to better manage your child’s asthma:

1. Always make sure your child has his/her inhaler available, whether he carries it with him or keeps it in

the classroom. Make sure medication has not expired and that it is not empty. Ask doctor to make a

prescription for 2 inhalers-one for school and one for home.

2. There is a medication teacher assigned to each school who can administer a breathing treatment with

proper orders from the doctor. The school nurse oversees the teaching of these procedures and keeps

constant contact with the teacher.

3. Be mindful about your child’s asthma and what triggers cause attacks. Fall, spring, and flu season are

the most prevalent times for asthma attacks. Be aware of weather changes.

4. Keep regular doctor appointments at least twice a year.

5. Take prescription medications only as the doctor orders them.

6. Be aware of when asthma is beginning to get worse. Pay attention to how student feels and how

his/her breathing is. Do not wait until asthma gets too bad to take to the doctor!

7. Have all medical forms completed at school so the teachers and school nurse will be aware of your

child’s condition. In order for us to take the best care of your child, we need to know all about his/her

condition.



School Asthma Action Plan

Name: School:

Grade: Age:

Asthma Severity: Intermittent ( ) Mild Persistent ( ) Moderate Persistent ( )

Severe Persistent ( )

Current Asthma Medication:

1.___________________________________________________

2.___________________________________________________

3.___________________________________________________

4.___________________________________________________

Method of Diagnosis: Historical ( ) Asthma Control Test ( ) Pulmonary Function

Test ( )

Instruction at school:

If wheezing, give _______________________________puffs and notify nurse and/or

parent Pre-medication: give_________________________puffs 15-30 minutes prior to

exertion.

Exercise medications:

__________________________________________________________________

______Recommend that child be allowed to carry and self-administer all asthma

medications.

_____ Recommend that school nurse administer asthma medications and notify

parents.

General Information

Emergency Contact:__________________________________Phone#:_____________

Physician/Health Care Provider:________________________Phone#:______________

Physician Signature:______________________________________________________

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