Transcription
New StudentRegistrationPacket
Norristown Area School DistrictStudent Registration Packet and InstructionsRegistrations are done by appointment only and take place at Norristown Area School District Administration Building, 401N. Whitehall Road, Norristown, PA 19401.The following documents are REQUIRED to be presented by the legal parent/guardian at the time of registration:NOTE: Failure to have all required documents at time of registration will result in your appointment having to be rescheduled.1. Completed Student Registration Packet2. Students birth certificate (may use passport or baptismal certificate if necessary)3. Students latest vaccination/shot records4. Students last report card and/or transcript from previous school5. Legal parent/guardian valid photo ID: driver’s license, state issued photo ID, government issued photo ID, passport6. Three (3) proofs of your address. Proof of address MUST be current and dated within 30 days of date of registration. Seeproof of address guidelines below.7. Property Owner Verification Sheet (if you do not OWN your residence)The following documents need to be provided if applicable to your child:1. Special Education documents2. Legal documents pertaining to custody, placement, foster care, adoption, etc.PROOF OF ADDRESSANDAny one (1) of the following:a. Current rental lease (and completed Property Owner Verification)b. Current mortgage statementc. Deedd. HUD Settlement SheetAny two (2) of the following:a. Renters/Home Owners Insuranceb. Utility Bill: electric/water/sewer/gas/oilc. cable/internet bill, paystubd. home or cellular phone billIMMUNIZATION REQUIREMENTSIn accordance with Pennsylvania State Law, it is required that all school children in the Commonwealth of Pennsylvania are to beprotected against serious communicable disease and immunized as follows:Diphtheria-Tetanus (DT, TD, Dtap) - four (4) or more doses properly spaced with dose #4 to be given ON or AFTER 4 th birthdayPolio – three (3) or more doses proper spacedMeasles, Rubella, Mumps (MMR) – two (2) doses with dose #1 to be given ON or AFTER the 1 st birthdayHepatitis B – three (3) doses properly spaced with dose #2 given 28 days AFTER dose #1 and dose #3 given 8 weeks after dose #2(and no early than 6 months of age)Tuberculin Test – as indicated by the TB screening questionnaire which can be found in registration packetVaricella – two (2) doses with dose #1 give ON or AFTER the 1 st birthday. Immunity from vaccine or proof of disease fromhealthcare provider.***FOR STUDENTS ENTERING 7TH GRADE ONLY***Tetanus Diphtheria Acellular PertussisVaccine (Tdap)Meningococcal Conjugate Vaccine(MCV)One (1) doseOne (1) doseIf 5 years have passed since the lastTetanus immunizationIf not given previouslyThese immunizations may be completed by your family healthcare provider or the Montgomery County Health Department (610-2785145). (Servico en Espanol: 1-800-344-7432). (TTY-Deaf Access: 1-800-243-7889). There is no charge for these immunizationsat the Montgomery County Health Department, but you must call for an appointment and take all immunization records with youto the appointment.The only exceptions to this law are those children who provide proof based on religious objections or for medical reasons. Accordingto the law, the required immunizations must be completed prior to entrance into school. Children will not be registered for schooluntil proof of immunization is provided.Appointments can be made by either visiting any Norristown Area School District school or by going on-line towww.nasd.k12.pa.us/registration.Rev. 4/24/2018
Residency Verification/Tuition Payment ResponsibilityNorristown Area School District is proud to offer a high quality education to the students of ourresidents. We as a school district have a very active residency verification program which isused to protect our community resources. The program includes, but is not limited to, completedocumentation verification, independent investigation by school officials as well as lawenforcement officials, and surveillance.Norristown Area School District will prosecute, to the fullest extent of the law, any individualproviding false information in the student’s registration forms for the purpose of enrolling astudent that is not a resident of our district.If the student registered is found to be a non-resident, the individual registering the student willbe financially responsible for all tuition costs. Depending on the educational program of thestudent the tuition liability ranges from 13,500 to 57,000 annually. The individual thatregistered the student will be responsible for this tuition ************************************I certify that I have read and understand the above notice. Additionally, I agree to pay Norristown AreaSchool District its full tuition cost if the student being enrolled is found not to be resident of the district.I understand that Norristown Area School District may contact any or all of the following agencies forstudent’s attendance/residency with the Norristown Area School District. Social Security AdministrationInternal Revenue ServicePublic Welfare DepartmentMontgomery County Housing AuthorityMontgomery County Children and YouthMontgomery County Zoning OfficeMunicipality Tax CollectorsParent/Guardian SignatureDateSworn to and subscribed before me this Day of , 20 ,Commonwealth of County of .Seal:Notary Public Signature
PROPERTY OWNER VERIFICATION(MUST be completed if you do not OWN your residence)Property Address:Lease/Mortgage/Deed Holder(s):Lease expiration date:(if applicable)Property Owner/Manager:Property Owner Phone **********I, , hereby certify to the following:(property owner/manager)1. I am the Property Owner/Manager of the property listed above.2. My telephone number is3. My mailing address is4. In addition to the lease/mortgage/deed holder, the following individuals are alsoresiding at the above property:5. In the event that the child/children and/or parent/legal guardian no longer reside at theaddress listed above, I will immediately notify the Central RegistrationOffice of the Norristown Area School School District.6. I hereby certify that the foregoing statements made by me are true. I am aware that ifany of the foregoing statements made by me are willfully false, I am subject toprosecution.(Signature of Landlord/Property Manager)(Date)(Printed Name of Landlord/Property Manager)
Form R-2NORRISTOWN AREA SCHOOL DISTRICT PARENTAL REGISTRATION STATEMENTStudent Name:Date of Birth: Grade:Parent or Guardian Name:Address:Home Telephone #: Work Telephone #:Pennsylvania School Code §13-1304-A states in part, “Prior to admission to any school entity, the parent,guardian or other person having control or charge of a student shall, upon registration, provide a swornstatement or affirmation stating whether the pupil was previously or is presently suspended or expelledfrom any public or private school of this Commonwealth or any other state for an action or offenseinvolving a weapon, alcohol or drugs, or for the willful infliction of injury to another person or for any actof violence committed on school property.”Please complete the following:I hereby swear or affirm that my child was was not previously suspended orexpelled, or is is not presently suspended or expelled from any public or privateschool of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs,or for the willful infliction of injury to another person or for any act of violence committed on schoolproperty. I make this statement subject to the penalties of 24 P.S. §13-1304-A(b) and 18 Pa C.S.A. §4904,relating to unsworn falsification to authorities, and the facts contained herein are true and correct to the bestof my knowledge, information and belief.If this student has been or is presently suspended or expelled from another school, please complete:Name of the School(s) from which student was suspended or expelled:Dates of suspension(s) or expulsion(s):Reason for suspension/expulsion (optional):(Signature of Parent or Guardian)DateSworn to an subscribed before me this day of 20Commonwealth of County(Signature of Notary Public or Justice of the Peace)HSV/1-13
NORRISTOWN AREA SCHOOL DISTRICT401 N. Whitehall RdNorristown, PA 19403CENSUS INFORMATIONIn order that our census may be complete as required by state law (Section 1351 of the Public School Code) and tonotify the proper assessors of your residency in the bounds of the Norristown Area School District (Section 680b ofthe Public School Code), please enter the information requested below. Your cooperation in completing therequested information is greatly appreciated, and there will be no need for a census taker to visit your residence.Current AddressStreet Name:Apartment No: Zip Code:( )Norristown Borough ( )West Norriton Township( )East Norriton TownshipPhone Number: (Previous AddressStreet Name:Apartment No: Zip Code:Borough or Township)ALL ADULTS that live at your current addressName:Date of Birth: Race:Sex: ( )Male ( )FemaleMarital Status: ( )Single ( )MarriedSchool/Employer:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleMarital Status: ( )Single ( )MarriedSchool/Employer:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleMarital Status: ( )Single ( )MarriedSchool/Employer:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleMarital Status: ( )Single ( )MarriedSchool/Employer:ALL CHILDREN that live at your current addressName:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:Name:Date of Birth: Race:Sex: ( )Male ( )FemaleSchool:
Norristown Area School District Records Request FormCentral Registration401 North Whitehall RoadNorristown, PA 19403Phone: 610-630-5016Student Name Birthdate GradePrevious District:Phone #Previous School:Fax #This student has enrolled in the Norristown Area School District. Please forward the following records:Academic Records-Progress ReportMedical RecordsDiscipline RecordsESL Testing / ReportsPSAT/SAT ScoresPaul Fly ElementaryWhitehall ElementaryCole Manor Elementary2920 Potshop Road399 North Whitehall Rd2350 Springview Rd.Gotwals Elementary1 E. Oak St.Norristown, PA 19403Norristown, PA 19403Norristown, PA 19401Norristown, PA 19401Phone: 610-630-0380Phone: 610-630-6000Phone: 610-275-5525Phone: 610-275-1077Hancock ElementaryMarshall Street ElementaryStewart Middle SchoolEast Norriton Middle SchoolArch St & Summit St1525 W. Marshall St.1315 W. Marshall St.330 Roland Dr.Norristown, PA 19401Norristown, PA 19403Norristown, PA 19401Norristown, PA 19401Phone: 610-275-5522Phone: 610-630-8550Phone: 610-275-6870Phone: 610-275-6520Eisenhower Science andNorristown Area High SchoolRoosevelt Campus of the NAHSRay S. MusselmanTechnology Leadership Academy1900 Eagle Dr.1161 Markley St.Learning Center1601 Markley St.Norristown, PA 19403Norristown, PA 194011020 Sandy Hill RoadNorristown, PA 19401Phone: 610-630-5090Phone: 610-275-9720Norristown, PA 19401Phone: 610-277-8720Phone: 484-270-2140PARENTAL AUTHORIZATION FOR RELEASE OF RECORDSI hereby authorize the release of all school records for the above named child. This informationis to be sent to the school listed above.Date:Parent/Guardian SignatureRegistrar
HOME LANGUAGE SURVEYALL newly registering students regardless of race, nationality, or language origin MUST complete thisform. Federal law requires that all Local Education Agencies (LEAs) utilize a non-biased procedure foridentifying which students are potential English Learners (ELs) in order to provide appropriate languageinstruction educational programs and services. Given this responsibility, LEAs have the right to ask for theinformation contained on this and other forms associated with the identification process.Student Information (Parents/Guardians should complete this section):Child’s first name:Child’s family name:HOME LANGUAGE SURVEYChild’s Date of Birth:ALLnewly registering students regardless of race, nationality, or language origin MUST complete this(Month/Day/Year)form. Federal law requires that all Local Education Agencies (LEAs) utilize a non-biased procedure foridentifying which students are potential English Learners (ELs) in order to provide appropriate languageQuestions forParents or programsGuardians and services. Given this responsibility, LEAs have the right to ask for theinstructioneducationalinformation contained on this and other forms associated with the identification process.1. Is a language other than English spoken in the child’s home?NoYes (language)Student Information (Parents/Guardians should complete this section):2. Does your child communicate in a language other than English?NoYes (language)Child’sfirst3. Whatis name:the language that your child first learned to speak?Child’sfamilyname:documents translated into another language? No Yes(language)4. Do yourequireChild’sDaterequireof Birth:5. Do youan interpreter? No Yes (language)(Month/Day/Year)Questions for Parents or Guardians1. Is a language other than English spoken in the child’s home?2. Does your child communicate in a language other than English?NoNoYes (language)Yes (language)3. What is the language that your child first learned to speak?Parent/Guardian Signature:Interpreter ProvidedNoDate:YesRevised 12/2018
Para español, favor de veral reverso de ésta página.Would your children benefit from . . .Wouldlike . . .Then please take time to fill out the form below and return it to the school office. If you’ve moved intothe area within the past three years, you may qualify for these services (and many more) providedfree of charge by the Pennsylvania Migrant Education Program. Answering these questions willhelp our staff determine whether or not you meet the program requirements and give them a chanceto contact you.Name of Parent/Guardian(s):Name(s) & Age(s) of Child(ren):Telephone:Address:1. Have you moved into the Norristown Area School District within the past three years?YesNo If yes, when?2. Where did you move from? City State3. Since moving, what types of agricultural jobs have you (or your other family members)applied or looked for (for example: planting, picking, cutting, or packing vegetables, fruit,meat, eggs, trees; caring for farm animals; milking cows; etc.)? Please list them.Any questions about this form can be directed toMaria Williams at (610) 805-6118
August 4, 2017Dear Parent or Guardian:We are pleased to inform you that all schools in the Norristown Area School District will becontinuing the provision known as the Community Eligibility Provision (CEP) in the 2017-2018School Year. This program is available to schools/districts who are participating in the NationalSchool Lunch and School Breakfast Programs.All enrolled students of Norristown Area School District are eligible to receive a nutritional breakfastand lunch every day at the school at no charge to your household.No further action is required of you. Your child(ren) will be able to participate in these mealprograms without paying a fee or submitting an application.If we can be of any further assistance, please contact us at the Food Service Department at 610-6305023.Sincerely,Deborah N. MartinDirector of Food ServicesIn accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rightsregulations and policies, the USDA, its Agencies, offices, and employees, and institutionsparticipating in or administering USDA programs are prohibited from discriminating based on race,color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in anyprogram or activity conducted or funded by USDA.Persons with disabilities who require alternative means of communication for program information(e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (Stateor local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speechdisabilities may contact USDA through the Federal Relay Service at (800) 977-8339. Additionally,program information may be made available in languages other than English.To file a program complaint of discrimination, complete the USDA Program DiscriminationComplaint Form, (AD-3027) found online at http://.ascr.usda.gov/complaint filing cust.html, and atany USDA office, or write a letter addressed to USDA and provide in the letter all of the informationrequested in the form. To request a copy of the complaint form, call (866)632-9992.Submit your completed form or letter to USDA by:(1) Mail: U.S. Department of AgricultureOffice of the Assistant Secretary for Civil Rights1400 Independence Avenue, SWWashington, D.C. 20250-9410;(2) Fax: (202) 690-7442; or(3) Email: program.intake@usda.gov.This institution is an equal opportunity provider.
Norristown Area School DistrictHousehold Information Survey2018-19 School YearParent Name(s):Street Address:City:State:Student's Legal Name(As on Birth Certificate)Zip:StudentIDDate of BirthSchool NameGrade1.2.3.4.5.6.7.Look at the chart below and find your household size (number of people living in your home).Household SizeAnnual Income1 21,77523 29,47145 44,86367 60,2558 75,647 7,696Each additionalmemberIs the total yearly income of your household*,less than or equal to the amount listed for yourhousehold size on the chart? (please check one) 37,167 52,559 67,951YESNO*Total yearly income of your household includes the following income sources for all persons living in your home:earnings from work, public assistance (cash assistance, SSI, and SSDI), child support, alimony, pensions, retirementand all other income.
Form M-3NORRISTOWN AREA SCHOOL DISTRICTTUBERCULOSIS SCREENINGDate of Birth / / AgeLast NameFirst NameMiddle InitialCountry of Birth: When did you come to the US?Month YearTraveled outside US? Yes NoIf Yes: Where? When?How Long?Please answer the following questions regarding your childCheck one – Yes or No1. Has your child had a previous skin test for Tuberculosis? Yes NoIf Yes: Date / / Result: Yes No3. Has your child had a known exposure to someone with Tuberculosis? Yes No4. Has your child had a blood test for the AIDS virus? Yes No Yes No2. Has your child taken medicine for Tuberculosis or for a positive skin test?If Yes: Date / /If Yes: Date Given / / Result:5. Has anyone associated with the child spent time living in prison,a residential facility or a homeless shelter?If Yes: Date / /Reviewed by Registrar: Date:
NORRISTOWN AREA SCHOOL DISTRICTHEALTH SERVICESSCHOOL HEALTH SERVICES AND STUDENT HEALTH RECORDSPARENT MEMORANDUM OF UNDERSTANDINGStudent Name: Date of Birth:LastFirstMiddleI understand that the Norristown Area School District Health Services staff will work with my child and Ito insure wellness and good health habits.I understand that the Norristown Area School District provides school health services as required by theSchool Code and Department of Health Regulations which include:Vision Screening (K-12)Hearing Screening (Grades K-3, 7&11; Special Ed as needed)Height and Weight (K-12)Maintenance of School Health RecordsScoliosis (Grades 6-7)Review of Immunization RecordsPhysical Examinations (Entry into school (Grade K or 1st), and Grades 6 and 11)Dental Screening by the Dental Hygienist (Grades K, 2, 5, 8 and Special Education)Dental Health Education (Grades K-8)Weekly Fluoride Mouth Rinse Program (Grades 3 and 4)I understand that if I inform the school nurse that I am not able to provide a private physical for my childthe medical examination required by the School Health Act will be given by the School Physician.I understand that I will be notified of recommendations for further evaluations as a result of the screeningor examinations.I understand that the information I give to the school nurse is important for the school staff to understandthe health and education of my child.I understand that the information will be kept confidential by the School Health staff and may be sharedwith other professionals in the school only when it is required as part of a comprehensive evaluation andin the best interest of the child’s health and education.Signature of Parent / GuardianDateSignature of RegistrarDateSN-6Revised 5/16
DON’T WAIT TO VACCINATE!Dear Parent/Guardian:All students entering grade Kindergarten are required by the stateof Pennsylvania to have the following immunizations by the firstday of school: Four (4) doses of DTaP-properly spaced-**one dose must beon/after the 4th birthday Three (3) doses of Polio– properly spaced Three (3) doses of Hepatitis B –properly spaced Two (2) doses of MMR-properly spaced Two (2) doses of Varicella- properly spaced; or evidence ofimmunityContact your school nurse with any questions.Montgomery County Health Department: 610-278-5145Regional Health Center: 610-278-7787
IMMUNIZE!PA Law mandates that every child K-12 be immunizedon the 1st day of school.Vaccination RequirementsVaccinesKindergarten &Grades 1-6Grades7-11Grade12Tetanus, diphtheria, andacellular pertussis4 doses4 doses4 doses(Usually given as DTaP, DTP,DT, or Td)(1 dose on or after 4th birthday)Polio4 doses4 doses4 doses(4th dose on or after 4thbirthday and at least 6 monthsafter previous dose given)(A 4th dose is not necessary ifthe 3rd dose was administeredat age 4 years or older and atleast 6 months after theprevious dose)(A 4th dose is not necessary ifthe 3rd dose was administeredat age 4 years or older and atleast 6 months after theprevious dose)(A 4th dose is not necessary ifthe 3rd dose was administeredat age 4 years or older and atleast 6 months after theprevious dose)Measles, Mumps, &Rubella2 doses2 doses2 dosesHepatitis BVaricella (chickenpox)3 doses2 doses3 doses2 doses3 doses2 doses(Usually given as MMR)Tetanus, diphtheria,acellular pertussis (Tdap)Meningococcal Conjugate(MenACWY)or evidence of immunityor evidence of immunityor evidence of immunityNot applicable1 dose1 doseNot applicable1 dose(First dose is given at 11-15years of age; a second dose isrequired at age 16 or entry into12th grade)1 or 2 doses(If 1st dose of MenACWY wasgiven at 16 years of age orolder, that shall count as the12th grade dose)For more information on the vaccines your child needs in order to attend school, talk to yourhealthcare provider, school nurse, or visit www.montcopa.org/schoolvaccinelaw
NORRISTOWN AREA SCHOOL DISTRICTSTUDENT HEALTH HISTORYGradeSTUDENT’S NAME DATE OF BIRTHADDRESSNUMBERSTREETCITYZIPPARENT FATHER(cell) MOTHERChild lives with (home)Health Insurance Dental InsuranceHEALTH CONDITIONS (Please check any health condition your child has/had):Allergy: Seasonal Bee Sting Medication Food LatexMy child is allergic to . Please describe what happens to your child whenhe/she is stung or takes the above substance.Conditions to be reported immediately to the School Nurse:Asthma uses inhalerBehavioral/Emotional (describe)Cancer (describe)Diabetes (year diagnosed) TreatmentHeart (Cardiac) Issues (describe)Physical Limitations (describe)Seizures (medication)(date of last seizure) (type of seizure)Toileting Problem (describe)Other Conditions:AutismAnemiaLead PoisoningAnxietyMuscle/Bone/JointArthritisSkin Rash/EczemaAttention Deficit Disorder (ADHD)Sleep DisturbanceDentalTires EasilyFrequent Colds/Sore ThroatsVision Difficulties (wears glasses)HepatitisUrinary Tract InfectionsHigh Blood PressureKidney ConditionHearing Difficulties (wears hearing aid) uses FM systemExplain any condition checked above:Describe any serious illnesses, accidents or operations your child has had:
STUDENT NAME GRADEList any and all limitations and restrictions:Does your child take any medication? Please list the name of the medication, dose and frequency and thereason he/she takes the medication.PregnancyYesNoCommentsIllness of mother during pregnancyLabor and/or delivery extremely shortLabor and/or delivery extremely longHeavily sedated during labor and/or deliveryBaby born prematurelyBaby had feeding problemsChild had toilet training problemsBirth Weight lbs. oz.Growth and DevelopmentChild sat without supportChild walked aloneChild spoke a few wordsChild spoke a few sentencesChild was toilet trained—bowelsChild was toilet trained—bladderChild isNormalDelayedCommentsRight handed Left handedFamily History: Is there a history ring ImpairmentHeart DiseaseHigh Blood PressureKidney ConditionSeizureTuberculosisVision ProblemsAre there any other health areas of concerns or information that would be helpful to our school staff?Physician/Health Care Provider: Name PhoneLast School Attended: Name:AddressSignature of Parent/GuardianSN52/17Relationship to StudentDate
Norristown, PA 19403 Phone: 610-630-8550 Stewart Middle School 1315 W. Marshall St. Norristown, PA 19401 Phone: 610-275-6870 East Norriton Middle School 330 Roland Dr. Norristown, PA 19401 Phone: 610-275-6520 Eisenhower Science and Technology Leadership Academy 1601 Markley St. Norristown, PA 19401 Phone: 610-277-8720 Norristown Area High School
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