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Madison Public SchoolsMadison, ConnecticutKINDERGARTEN REGISTRATION INFORMATION2012-2013KINDERGARTEN AM/PM DISTRICTSAlthough subject to change due to enrollment differentials, the boundary line currently extends from theintersection of Chestnut Hill Road and Route 79, west to Opening Hill Road at the intersection ofWinterhill Road. Students living NORTH of this boundary line will attend the morning session ofkindergarten; students living SOUTH of the boundary line will attend the afternoon session ofkindergarten. Please call our office at 203-245-6307 or visit our website at www.jeffreyschool.org orwww.madison.k12.ct.us for specific street and additional information.KINDERGARTEN REGISTRATIONRegistration for students entering kindergarten for 2012/2013 will be held on Thursday, March 1st from3:00 – 7:00 p.m. and Friday, March 2nd from 9 -11:30 a.m. and 12:30 – 3:00 p.m. in theHammonassett Room at The Town Campus. If you are unable to attend the scheduled registration,registrations must be done through Sara Caraszi at Central Office, 10 Campus Drive (203-245-6307).REQUIREMENTS FOR REGISTRATIONStudents eligible to enter kindergarten in August 2012 must reach their fifth birthday by December 31,2012. It is not necessary for the children to be present at registration.Birth certificates must be presented at the time of registration as well as proof of residency. (i.e.bills addressed to you) Kindergarten physicals performed 12 to 15 months prior to entry into Kindergarten, areacceptable, provided they are completed on the three-page blue State Health Assessment form(REV-4/11) Immunizations required for entry to Kindergarten must be reviewed by the school nursebefore a student can be cleared for entry. Please inform the nurse of food allergies, diabetes, asthma, or any significant health concerns. Students entering from outside of the U.S. are required to have a physical exam by a providerlicensed to practice in the United States. Including the TB risk assessment as part of this exam.PLEASE NOTE: Parents not electing to register their age-eligible child will be asked to sign awaiver to that effect.
March 2012Dear Parents,Welcome to Kindergarten!You and your child have reached an important milestone, the beginning of their formal schoolcareer. We know this will be an exciting and anxious time and we would like to do everythingpossible to help you with this transition. It is our hope that the information provided here willbegin to answer many of your questions.The kindergarten program supports the belief that children learn best through active participationin a variety of developmentally appropriate activities. It is essential that these experiences beprovided in a safe environment staffed by adults sensitive and responsive to the needs of eachchild. As educators, we value the close ties between the child and the family and encourage astrong reciprocal relationship between home and school.It is our strong belief that parental participation in education promotes academic success. Yourinvolvement in the school and the PTO can enrich your child’s education. We encourage andsupport any level of participation that is appropriate for you and your family.The staff at Jeffrey Kindergarten is looking forward with great enthusiasm to your child’s arrival.We want to assure you that we will do everything possible to help your child experienceacademic, social, and emotional growth.We invite each of you to attend a parent’s evening about the kindergarten program on Monday,May 14, 2012 at 7:00 p.m. at Jeffrey School.Sincerely,Mona GoodmanPrincipalRachel WeissAssistant Principal*Please access the Madison website at www.madison.k12.ct.us for additional informationregarding registration specifics. Information will also be available on cable channel 19 as well aslocal newspapers.
STUDENT ENROLLMENT FORMSTUDENT INFORMATIONDate:Last Name First NameMiddle NamePresent Grade as of Today GenderStudent ID(assigned by district)Residence AddressHome Telephone Date of BirthSocial Sec. # (optional)City / State of Birth Country of CitizenshipRace / Ethnicity:1. Is this child Hispanic / Latino? YesNo2. What is the Child’s race? American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific Islander(Please check one or more, even if you answered “Yes” to question 1) Note: A parent / guardian has the right to refuse to provide this information.WhiteStudent’s Primary Language Language Spoken in HomeStudent Lives With: Both ParentsMother OnlyFather OnlyOther (please describe)Name and Address of School Last Attended(include pre-school) Grade Last AttendedAddress of Former ResidencePARENT / GUARDIAN INFORMATION MOTHER / GUARDIAN 1 / OTHERLast Name First NameMiddle InitialResidence AddressMailing Address (if different than Residence)City State ZipCity State ZipHome Telephone Cell / Other Phone EmailWork Telephone ExtensionU.S. Citizen Yes NoResponsible for Student Yes NoStudent Resides with this Parent / Guardian Yes No FATHER / GUARDIAN 2 / OTHERLast Name First Name Middle InitialResidence AddressMailing Address (if different than Residence)City State ZipCity State ZipHome Telephone Cell / Other Phone EmailWork Telephone ExtensionU.S. Citizen Yes NoResponsible for Student Yes NoStudent Resides with this Parent / Guardian Yes NoParental / Custody arrangements the school should be made aware of: Please send extra mailings to non-custodial parentSignature of: Parent Legal GuardianDate Parent Legal GuardianDateRev. 05/20101 OF 2(OVER)
SIBLING INFORMATIONPlease List Other Children in Student’s Household:Last NameFirst Name Middle InitialAge Gender Grade as of Now Enrolled in Madison Public Schools? Daycare / Preschool? Not Yet Enrolled in Madison Publics SchoolsIf enrolled in the Madison Public Schools, School Name:Last NameFirst Name Middle InitialAge Gender Grade as of Now Enrolled in Madison Public Schools? Daycare / Preschool? Not Yet Enrolled in Madison Publics SchoolsIf enrolled in the Madison Public Schools, School Name:Last NameFirst Name Middle InitialAge Gender Grade as of Now Enrolled in Madison Public Schools? Daycare / Preschool? Not Yet Enrolled in Madison Publics SchoolsIf enrolled in the Madison Public Schools, School Name:PLEASE LIST ADDITIONAL CHILDREN ON SEPARATE SHEETPRELIMINARY ASSESSMENT OF DOMINANT LANGUAGEConnecticut state law requires that each school district conduct a preliminary assessment of the dominant language of each student in its public schools.This assessment is made in order to ascertain English proficiency. If the assessment indicates limited proficiency, a required bilingual education program is provided.What language did your child learn to speak first?What language does your child speak at home?What language is spoken to your child at home?What language is spoken by adults at home?HEALTH INFORMATIONPhysical examinations are required before entry if: Entering from another CT district and your child will be in grades K, 7 or 11. Entering from out–of –state. You may submit a new physical or a physical performed in the previous state within 12 months of enrollment in Madison.It should be documented on the blue CT form.Specific immunizations are required at certain grade levels. Please consult with the school nurse who can review your child’s record and advise you regardingcompliance. You may also visit the Madison School Health Services webpage on Immunizations Required for guidance at http://www.madison.k12.ct.us/Forward to: School Executive Secretary – Grades K- 4School Guidance Secretary – Grades 5 - 12Rev. 06/04
Jeffrey Elementary School, 331 Copse Road, Madison, CT 06443203.245.6460KINDERGARTEN PARENT INTERVIEW FORM**Information contained on this form is solely for the use of the school administration and kindergarten staff planning for yourchild’s first school experience. It is considered to be confidential information!CHILD’S NAME:DATE OF BIRTH:Male FemaleADDRESS:PHONE NUMBER:Has your child attended Nursery School?Yes NoIf yes, name of Nursery School:How many years in attendance: Describe your child’s nursery school experience, any particular challenges that werepresented, and any feedback that preschool staff provided.What would you like us to know about your child? Please share any information about your child that will help us to create a positiveKindergarten experience. (If necessary, you may use the back of this interview form tocomplete this question.)
ACKNOWLEDGEMENT OF OPTION TO EXEMPT ATTENDANCE OFCHILD FIVE OR SIX YEARS OF AGE FROM SCHOOLPursuant to Section 10-184 of the Connecticut General Statutes,I , of ,Name of Parent, Guardian or OtherAddressthe parent, guardian or other person charged with the care of the following minor childName of Childwho wasAddressborn on do hereby choose not to send my child to public schoolduring the .School YearFurthermore, before signing this form, a representative of the Madison, Connecticut school district metwith me and provided me with information concerning the educational opportunities and schoolaccommodations available in the school system.ACKNOWLEDGED BY:Signature of Parent, Guardian or OtherDate
Jeffrey Elementary School, 331 Copse Road, Madison, CT 06443 203.245.6460 . KINDERGARTEN PARENT INTERVIEW FORM* * Information contained on this form is solely for the use of the school administration and kindergarten staff planning for your child's first school experience. It is considered to be confidential information!
