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South Lyon Community Schools — Admission and EnrollmentAge of Enrollment Michigan’s Revised School code specifies a child must be 5 years old on or before September 1st in orderto be eligible to enroll in kindergarten/junior kindergarten.If the child turns 5 years old between September 2nd and December 1st of the year in which the child is enrolling, the law allowsa parent/guardian to sign a waiver. The parent/guardian is required to submit this waiver with their enrollment documents. Thedistrict retains the right to refuse any waivers submitted after the first full day of the school year.Guardianship (If applicable) -If someone other than the parent is enrolling the student, legal guardianship documentation,obtained from the Probate Court, is required at the time of enrollment.- If custody has been established by the courts, a copy of the court order must be submitted.- Step parents must provide a copy of the marriage certificate.Required Enrollment DocumentationA completed District Enrollment Form must be completed for each child a parent/guardian is enrolling.The following information must be provided by the parent/guardian at the time of enrollment:1. Identification – Photo I.D., such as a driver’s license, state I.D., or passport of the parent/guardian.2. Proof of Residency – Three current proofs; one from Column I and two from Column II, in the name and address of the parent/guardian. If your statements/bills are received online, the most recent statement/bill must be printed and a copy provided.Column Ione (1) requiredColumn IItwo (2) requiredMortgage DocumentUtility Bill – Gas, electric, phone, etc.Property Tax Statement - (most recent)Vehicle insurance documentClosing Papers—Accepted only if you’ve moved into yourhouse within the past 30 days. Signed by all parties with closingdate indicated.Homeowners/renters insurance documentLease – Apartment/Home Rental—All tenants and occupant’snames, including lease beginning/ending dates, must be onlease. Lease must be signed by both landlord and tenant.Bank StatementCable TV BillCredit Card StatementMedical bill or health insurance statement3. Certificate of Birth A parent/guardian who seeks to enroll a child in the School District shall provide a certified copy of thechild’s birth certificate.If a birth certificate is not available, the parent/guardian must complete the birth certificate affidavit form and submit the documentary evidence called for therein. If such verification is not received within thirty (30) days of enrollment or the document appears tobe inaccurate or suspicious, the principal shall notify the local law enforcement agency that the student may be a missing child.(Michigan Missing Children’s Act, MCL380.1135.)4. Immunization Records In order for a child to attend school, the Michigan Public Health code requires a parent/guardian toprovide one of the following:1. A valid, current immunization record2. A medical doctor’s (MD/DO) signed State of Michigan Medical Contraindication Form3. A current, certified State of Michigan Immunization Nonmedical Immunization Waiver Form issued by the local healthdepartmentA valid, signed FERPA consent form should also be provided.Any student whose parent/guardian fails to submit the required immunization information shall not be admitted into the school.5. Vision Screening (kindergarten/junior kindergarten only) Proof of a vision screening is required before the start ofkindergarten/junior kindergarten.
South Lyon Community SchoolsStudent Registration Form* Please complete all sections on BOTH sidesSelect applicable school: Bartlett Brummer Centennial Middle SchoolPage 1 Dolsen Hardy Millennium Middle School Kent Lake Pearson Salem South Lyon High School Sayre ECC South Lyon East High SchoolStudent InformationDate: Entering Grade::Gender: Boy GirlYesMultiple Birth?NoTwinTripletQuadrupletStudent Last Name: First Name: Middle Name:Student Date of Birth: Birth City/State: Home Phone:Street Address: City: Zip Code: County:Subdivision/Development Name:Housing Type: Existing House/Apt New ConstructionCountry of child’s birth if not USA: Date child entered USA: Date 1st enrolled in USA School:Family Information—Household #1Parent/Guardian #1 (Primary contact for school communications and Food Service information)Relationship to Student:Last Name: First Name: Middle Name:Work Phone: Cell Phone: E-mail:Parent/Guardian #2Relationship to Student:Last Name: First Name: Middle Name:Work Phone: Cell Phone: E-mail:Parent Living Elsewhere—Household #2Last Name: First Name: Phone: MotherFatherGuardianStreet Address: City: Zip Code:E-mail:Other Children Living at HomeBirth DateAgeGradeSchool (if attending)NamePrevious SchoolIf your child is coming from another school district, please enter the following:(School admission is conditional pending receipt of school records from the previous school.)Name of Last School Attended: Name of District: City:Has student previously attended a South Lyon School? Yes NoName of school:
Please complete all sections, sign and dateSouth Lyon Community Schools Student Registration FormPage 2Student Last Name: First Name:Ethnic Origin Not Hispanic or LatinoEthnicity (Select One): Hispanic or LatinoRace (Select One or More): Black Asian Hawaiian/Pacific White American Indian: Tribal Affiliation: Multi-Racial - Please record percentages of races.Home Language SurveyIs your child’s native tongue a language other than English? Yes NoIs the primary language used in your child’s home a language other than English?If yes, what language? Yes NoIf yes, what language?Special ServicesHas your child ever been evaluated for or received SPECIAL EDUCATION PROGRAMS OR SERVICES?Does your child have a SECTION 504 PLAN? Yes Yes NoNoIf you answered yes to either question, please contact the Special Education Office at 248-573-8220.Residence: Where is your child/family currently living?Is address a temporary situation? Yes NoIf both are yes, where are you staying Check oneone):Miscellaneous Status:If yes, is it due to economic hardship or loss of housing?doubled upmotel/hotelsheltercampground Yes NootherActive Military, Foster ChildIs one or more parent/guardian a member of the military currently on Active Duty Status?Is this student a Foster Child?(This question is federally mandated by ESSA) Yes No Yes No** If Yes, please provide a copy of the Placement Letter.Parent/Guardian AffirmationMy signature certifies that all information provided on this form is true and accurate, and that my child and I reside at the listed address. I understand that my student maybe dropped from the school’s rolls the following school year if a parent/legal guardian moves out of the SLCS District. I understand any false information provided by memay subject me to legal penalties for perjury. I understand that I have been provided the “Understanding Concussions” form at registration.Parent/Guardian Signature:Date:Rev. 12/10/19
STUDENT EMERGENCY INFORMATIONSouth Lyon Community SchoolsSchool YearParent/Guardian(s)Last:(With whom student ed:Address:City:Zip:Emergency Contacts:(individuals who can release mystudent from school-must be 18years of age)Apt. #:Household # 1 - Parent/Guardian(s)Name:Guardian:Relationship:Work ionship:Work Phone:Cell/Pager:Email:Name:Household # 2 - Parent/Guardian(s)Phone- Home/Work/Cell::P.O. Box:School:Grad YrStudent Id #:Medical Alert:Special health conditions, medications, allergiesor religious restrictions, etc.:Phone- Home/Work/Cell::Relationship:(With whom student does not reside)Check box to also receive mailings/ report cards:Guardian:Relationship:Work Phone:Cell/Pager:Email:Guardian:Relationship:Work Phone:Cell/Pager:Email:Name:Relationship:Phone- Home/Work/Cell::Knowingly falsifying registration information is grounds for the immediate removal of the registrant from South Lyon Community Schools. Iattest that the information provided on this emergency card is accurate and complete to the best of my knowledge and that I am responsible forall fees or tuition due in the event that the registrant is removed from school under this clause.The board does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, disability, age, height, weight,marital status, genetic information, or any other legally protected characteristic, in its educational programs and activities.By signing this emergency card, in the event of an accident or injury, and I am unable to be reached, I authorize school personnel to transportmy child to the nearest emergency facility where he/she may be treated by a licensed physician until I may be reached.All school communications will be sent via your email address. Secondary marking period grades will be posted via Skyward. If you do nothave an email address, please contact the office.I have received and reviewed the concussion awareness information provided by South Lyon Community Schools.Parent/Guardian(s) Signature:Date:I have reviewed my email address above, and it is correct.New email (only one per household).Household #1 (with whom student resides) email:Household #2 (with whom student does not reside) email:
South Lyon Community SchoolsRegistration Packet SurveyStudent Information:Student Name:Student Date of Birth:Grade:Building:Family Information:Parent Name:Cell Phone:Work Phone:Email:Please check below all services or conditions that apply to your child.YESNOTakes medication regularly at school.If yes, please explain:YESNOReceived Special Education ServicesLDEICISpeechIf yes, please explain:Social WorkPhysical TherapyOccupational TherapyYESNOMEDICAL ALERT: Special health conditions, medications, allergies or medical religious restrictions.If yes, please explain:YESNOSection 504 Plan – MEDICALIf yes, please explain:YESNOSection 504 Plan – ACADEMICIf yes, please explain:YESNOTitle I – Extra help with:ReadingMathIf yes, please explain:Social StudiesOtherScienceYESNOBilingual Services/Limited English Proficient ServicesIf yes, please explain:YESNOGifted/talented Program (school sponsored) If so, *Contact Kelly Bell * at bellk2@slcs.usIf yes, please explain:YESNOAlternative ProgramsIf yes, please explain:YESNODoes your child have any physical/medical conditions or other disability which may affect his/her success in school?If yes, please explain:
Official Request for Student RecordsFor South Lyon Community SchoolsStudent Name:Date of Birth:Parents/Guardian:Grade:Please forward the following information: Cumulative file (CA60) Complete transcript Portfolio or Writing Folder UIC # School Records Check out grades (Date of leaving and grades todate) Test Scores (MEAP, ACT, SAT) Confidential Records Educational Development PlanRecords for Special Education students need a separate release form dispatched from the South Lyon SpecialEducation Office.Last School Attended:Address:Phone:Parent /Guardian SignatureDateForward Records to: Frank E. Bartlett Elementary School350 School Street, South Lyon, MI 48178248-573-8300 William A. Brummer Elementary School9919 North Rushton Road, South Lyon, MI 48178248-573-8520 Ann L. Dolsen Elementary School56775 Rice St., New Hudson, MI 48165248-573-8400 Sharon J. Hardy Elementary School24650 Collingswood, South Lyon, MI 48178248-573-8650 Kent Lake Elementary School30181 Kent Lake Road, South Lyon, MI 47178248-573-8350 Pearson Elementary School57900 Eleven Mile Rd., South Lyon, MI 48178248-573-8750 Salem Elementary School7806 Salem Road, Salem, MI 48175248-573-8450 Sayre Elementary School23000 Valerie, South Lyon, MI 48178248-573-8500 Centennial Middle School62500 West Nine Mile Road, South Lyon, MI 48178248-573-8600 Millennium Middle School61526 West Nine Mile Road, South Lyon, MI 48178248-573-8200 South Lyon High School1000 N. Lafayette, South Lyon, MI 48178248-573-8160 South Lyon East High School52200 Ten Mile Road, South Lyon, MI 48178248-573-8700
AFFIRMATION OF STUDENT DISCIPLINE RECORDA willful false statement on this document will result in a report to the appropriate authorities.DIRECTIONS: Check the applicable paragraph, provide all appropriate information, and sign this document.The undersigned affirms that, DOB has not been suspended or expelled from a public or private school for an offense involving weapons, alcohol,drugs, the willful infliction of injury to a person, or any act of violence against a person or property . has been suspended or expelled from a public or private school for an offense involving a weapon, alcohol,drugs, the willful infliction of injury to another a person, or any act of violence against a person or property.Identify the school, date(s) of suspension/expulsion, and describe the incident giving rise to the suspension/expulsion.I affirm that the above information is true to the best of my knowledge and belief. I also authorize the(former school district) to complete this form and forward the requested records.DateStudent SignatureDateParent/Guardian Signature .Sending (former) School District:Please check one: According to our records, we verify that the information provided above by the parent/student is correct. According to our records, the information provided above by the parent/student is not correct. (explain)If the student has been involved in any offense involving a weapon, alcohol, drugs, the willful infliction of injury to aperson, or any act of violence against a person or property, please forward appropriate disciplinary documentation.Thank you.DateSignature of Sending District Administrator, Title
Elementary Acceptable Use Policy(based on Policy 7540)1. I will only use the school district’s technology for educational purposes.2. I will not use the school network to bully others.3. I will not use my own technology (email, cell phone, cameras, texting, social media, etc.)to bully others.4. I will not post rumors or negative remarks about students or school staff members.5. I will not send emails that are mean or threatening.6. I will not use a camera on a phone, chrome book, etc. to embarrass others. I will not postfake photos or other fake pictures.7. I will take care of school computers and equipment and never deliberately damage them.8. I will not open a folder or file that is not mine to use. I will not copy or delete a folderthat is not mine or without permission from its owner.9. I will not violate copyrights, trademarks, or licensing agreements. I10. I will not use district computer facilities for unsupervised chat rooms, instant messagingor sharing photos11. I will not use district computer facilities for the purchase, sale and/or advertisement ofgoods or services. I will not use district computer facilities for political campaigning.If I do not follow any of the above policies, I understand that the consequences could be:a. Temporary or permanent removal of privileges, as determined by the Superintendent orthe Principal, including school discipline or legal action.b. I would be required to make restitution for any intentional damages to educationaltechnology or unauthorized expenses incurred through the misuse of educationaltechnology.Student SignatureDateAs the parent or guardian of this student, I have read the Acceptable Use Policy forTechnology and understand the terms of this agreement. I understand that studentaccess to educational technology is a privilege which is conditioned upon the student’sadherence to the Acceptable Use Policy for Technology. I further understand thatalthough the School District prohibits inappropriate use of technology, it is impossibleto restrict all access inappropriate materials which may be available on the Internet orthrough other electronic communications. Accordingly, I will not hold the SchoolDistrict or its employees responsible for materials which may be acquired through theSchool District’s Network.Parent/Guardian SignatureDate
345 South Warren, South Lyon, Michigan 48178 248-573-8127Consent for Disclosure of Immunization InformationConsent for Disclosure of Immunization Information to Local and State Health DepartmentsImmunizations are an important part of keeping our children healthy. Schools and State andLocal health departments must monitor immunization levels to ensure that all communitiesare protected from potentially life-threatening diseases and, if necessary, respond promptlyto an emerging public health threat. It is important that disease threats be minimizedthrough the monitoring of students being immunized. Sharing immunization and personallyidentifiable information including the student’s name, date of birth, gender, and addresswith local and state health departments will help to keep your child safe from vaccinepreventable diseases. The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, requires written parental consent before personally identifiable information fromyour child’s education records is disclosed to the health department. If your child is 18 orover, he or she is an “eligible student” and must provide consent for disclosures ofinformation from his or her education records. You may withdraw your consent to share thisinformation in writing at any time.I authorize South Lyon Community Schools to release my child’s immunization record to theMichigan Department of Health and Human Services and Local Health Department. Iunderstand this information will be used to improve the quality and timeliness ofimmunization services and to help schools comply with Michigan Law. This includes anyimmunization information and limited personally identifiable information from the school.Student’s Name: Date of Birth: / /Signature of Parent/Guardian or Eligible Student:Date: / / Printed Parent/Guardian Name:
Immunization Rule ChangeSince 1978, Michigan law has required children to be up-to-date with required immunizations ON orBEFORE the first day of school/childcare. A child who fails to meet this requirement will not be admittedto school/childcare. The following circumstances allow a required vaccine to be waived or delayed:1. A valid medical contraindication exists, preventing the child from receiving the vaccine at this time. Amedical waiver should be completed and signed by the child’s physician and should state thecontraindication, vaccine involved, and time period during which the child is prevented from receivingthe vaccine.2. The parents/caregivers have valid religious or philosophical beliefs which prevent receipt of avaccination. Waivers should not be taken lightly. A child who is not fully vaccinated against vaccinepreventable diseases could be a risk to others and for contracting the disease.On December 11, 2014, the administrative rule was passed by Michigan Department of CommunityHealth requiring any parent/guardian wanting to waive vaccine/vaccines for nonmedical reasons toreceive vaccine education from their local health department. This rule applies to children enteringchildcare, kindergarten, and 7th grade or newly enrolled in the school district after January 1, 2015.Oakland County Health Division (OCHD) will provide this education for Oakland County residents and/orthose students attending Oakland County childcare facilities and/or schools at no cost, but appointmentsare required. The 30-minute education session will include information on the risks of not receivingvaccines and the benefits of vaccination to the individual and the community. This will allow parents tomake an educated, informed choice for their child.Parents/guardians deciding to immunize their child will be able to do so after the education session at theOCHD clinic or their own doctor. If the parent/guardian still wants to waive one or more vaccines, OCHDstaff will provide a certified waiver. The parents will be required to provide the certified waiver to theirchild’s school.You may schedule your appointment by calling 1-800-848-5533. Appointments are limited and scheduledon a first-come, first-served basis. We look forward to working with you to keep you, your family, andyour community healthy.What you need for your appointment: 1/16/18Picture ID and guardianship papers, if foster parentOfficial immunization recordName of school / childcare
A Fact Sheet for ParentsWhat are the signs and symptomsof a concussion?What is a concussion?A concussion is a type of brain injury that changesthe way the brain normally works. A concussion iscaused by a bump, blow, or jolt to the head. Concussionscan also occur from a blow to the body that causes thehead and brain to move rapidly back and forth. Even whatseems to be a mild bump to the head can be serious.Concussions can have a more serious effect on a young,developing brain and need to be addressed correctly.You can’t see a concussion. Signs and symptoms ofconcussion can show up right after an injury or may notappear or be noticed until hours or days after the injury.It is important to watch for changes in how your child orteen is acting or feeling, if symptoms are getting worse,or if s/he just “doesn’t feel right.” Most concussions occurwithout loss of consciousness.If your child or teen reports one or more of the symptoms ofconcussion listed below, or if you notice the symptomsyourself, seek medical attention right away. Children andteens are among those at greatest risk for concussion.SIGNS AND SYMPTOMS OF A CONCUSSIONSIGNS OBSERVED BYPARENTS OR GUARDIANS Appears dazed or stunnedIs confused about eventsAnswers questions slowlyRepeats questionsCan’t recall events prior tothe hit, bump, or fallCan’t recall events after thehit, bump, or fallLoses consciousness(even briefly)Shows behavior or personalitychangesForgets class schedule orassignmentsSYMPTOMS REPORTED BY YOUR CHILD OR TEENThinking/Remembering: Difficulty thinking clearly Difficulty concentrating orremembering Feeling more slowed down Feeling sluggish, hazy, foggy, or groggyPhysical: Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Fatigue or feeling tired Blurry or double vision Sensitivity to light or noise Numbness or tingling Does not “feel right”Emotional: Irritable Sad More emotional than usual NervousSleep*: Drowsy Sleeps less than usual Sleeps more than usual Has trouble falling asleep*Only ask about sleep symptoms ifthe injury occurred on a prior day.May 2010To download this fact sheet in Spanish, please visit: www.cdc.gov/Concussion. Para obtener una copia electrónica de esta hoja de información en español, por favor visite: www.cdc.gov/Concussion.U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention
DANGERSIGNSBe alert for symptoms that worsen over time. Your childor teen should be seen in an emergency departmentright away if s/he has: One pupil (the black part in the middle of the eye) largerthan the other Drowsiness or cannot be awakened A headache that gets worse and does not go away Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Convulsions or seizures Difficulty recognizing people or places Increasing confusion, restlessness, or agitation Unusual behavior Loss of consciousness (even a brief loss of consciousnessshould be taken seriously)Children and teens with a concussionshould NEVER return to sports orrecreation activities on the same day theinjury occurred. They should delayreturning to their activities until a healthcare professional experienced in evaluatingfor concussion says they are symptom-freeand it’s OK to return to play. This means,until permitted, not returning to: Physical Education (PE) class, Sports practices or games, or Physical activity at recess.What should I do if my childor teen has a concussion?How can I help my child return toschool safely after a concussion?1. Seek medical attention right away. A health careprofessional experienced in evaluating for concussioncan determine how serious the concussion is and whenit is safe for your child or teen to return to normalactivities, including physical activity and school(concentration and learning activities).Help your child or teen get needed support whenreturning to school after a concussion. Talk withyour child’s teachers, school nurse, coach, speechlanguage pathologist, or counselor about yourchild’s concussion and symptoms. Your child mayfeel frustrated, sad, and even angry because s/hecannot return to recreation and sports right away,or cannot keep up with schoolwork. Your child mayalso feel isolated from peers and social networks.Talk often with your child about these issues andoffer your support and encouragement. As yourchild’s symptoms decrease, the extra help orsupport can be removed gradually. Children andteens who return to school after a concussionmay need to:2. Help them take time to get better. If your child or teenhas a concussion, her or his brain needs time to heal.Your child or teen may need to limit activities while s/heis recovering from a concussion. Exercising or activitiesthat involve a lot of concentration, such as studying,working on the computer, or playing video games maycause concussion symptoms (such as headache ortiredness) to reappear or get worse. After a concussion,physical and cognitive activities—such as concentrationand learning—should be carefully managed andmonitored by a health care professional.3. Together with your child or teen, learn more aboutconcussions. Talk about the potential long-termeffects of concussion and the dangers of returningtoo soon to normal activities (especially physicalactivity and learning/concentration). For moreinformation about concussion and free resources,visit: www.cdc.gov/Concussion. Take rest breaks as needed, Spend fewer hours at school, Be given more time to take tests orcomplete assignments, Receive help with schoolwork, and/or Reduce time spent reading, writing, or onthe computer.To learn more about concussion and to order materials FREE-OF-CHARGE,go to: www.cdc.gov/Concussion or call 1.800.CDC.INFO.
Skylert (School Messenger) provides the District with the ability to send instant communication viaphone, SMS text message, and email to parents and staff. Our goal is to utilize this effective andefficient communication system as part of our continuous effort in keeping staff, students andparents informed and safe!In order for Skylert to be as effective as possible, we ask you to review and update your contactinformation and notification preferences in your Skyward Family Access account. We highlyrecommend updating your information, as we will be relaying important district updates during theschool year.To make changes to your Skylert preferences, log in to Skyward Family Access . (If you do not knowyour family access login and password, please contact your child’s school office.) Once logged-in,click on Skylert on the General Information menu on the left navigation bar. Your Skylert settings willdisplay. If you desire to make changes, click on Edit on the right of the screen. Please contact yourchild’s school office staff if you have questions regarding changes to your Skylert account.Note: Only Primary Guardians are able to update the Skylert primary contact information via FamilyAccess.The Skylert notification system allows South Lyon Community Schools the ability to disseminateinformation to parents and staff by way of three notification types: Emergency, General, andAttendance. Emergency notifications will reference events such as school closings, safety relatedincidents, and other emergency notifications determined by District administrators. Generalnotifications are for informational purposes only and will reference various District and school eventsand information.Attendance notifications will only be generated if your student has an unexcused absence for one ormore periods during an instructional day.
Welcome to South LyonDo you want to be part of a dynamic, team-oriented organization?Are you ready to make a meaningful contribution to our childr,enand the community?Become a Member of the South LyonCommunity Schools Team!If you are interested in part-time work, South LyonCommunity Schools is seeking: Guest teachersBus drivers and/or sub driversParaeducators and/or guest paraeducatorsLunch monitors and/or substitute lunch monitorsSubstitute custodiansFor more information on any of the above positions, please visit:http://www.slcs.us/slcs employment opportunities/index.php
William A. Brummer Elementary School. 9919 North Rushton Road, South Lyon, MI 48178 . 248-573-8520 Ann L. Dolsen Elementary School. 56775 Rice St., New Hudson, MI 48165 . 248-573-8400 Sharon J. Hardy Elementary School. 24650 Collingswood, South Lyon, MI 48178 . 248-573-8650 Kent Lake Elementary School. 30181 Kent Lake Road, South Lyon, MI 47178 .
