Hickory County Schools Student Enrollment Form

Skyline Middle School Enrollment Forms

Welcome to Skyline Middle School!

Things you will need to bring with you to enroll your child in school:

* Complete and up-to-date shot records

* Copy of Birth Certificate

* Copy of Social Security Card

* Proof of Residency (i.e. tax statement, utility bill, real estate contract)

* Copy of IEP/Evaluation Report (if applicable)

Middle School Supply List 2012-2013

This list of supplies may not last your child the entire school year – students are expected to supply themselves with these items throughout the entire school year.

5th Grade

Pencils – not mechanical

Wide lined notebook paper

Crayons

Scissors

Glue

Art box for supplies

6 folders with pockets

3 boxes of kleenex

2-3 spiral theme books

1 pkg. of colored pencils

1 black pen, 1 red pen, 1 green pen, and 1 blue pen

1 - Mead Composition Notebook or 1 subject notebook (for Writing)

Zip Lock Bags

Wet Wipes

1 medium size bottle of hand sanitizer

OPTIONAL: 1 – Trapper Keeper/Binder with closure

6th Grade

2 packages loose leaf wide lined paper

Pencils

Box for art supplies

3 boxes of kleenex

6 folders with pockets

2-70 sheet spiral theme books

1 pkg. colored pencils

1 container Wet wipes

1 medium size bottle of hand sanitizer

Zip Lock Bags

7th and 8th Grade

3 - 70 sheet spiral theme books

Pencils/Pens - 1 black pen, 1 red pen, 1 green pen, and 1 blue pen

Paper

Ruler, Scissors, Glue Stick

Markers or Colored Pencils

1 package of 4x6 ruled index cards

2 boxes of kleenex

1 - 2” 3 ring binder (for Math)

Calculator (basic, inexpensive – No Scientific calculators)

Student Enrollment 2012-2013

Please list all children presently living in your home from oldest to youngest.

Child 1 Name Age Child 2 Name Age

Child 3 Name Age Child 4 Name Age

Child 5 Name Age Child 6 Name Age

Please list all persons authorized to pick up your child.

Authorized Person 1 Phone Number

Authorized Person 2 Phone Number

Authorized Person 3 Phone Number

Authorized Person 4 Phone Number

Transportation Data Form

Parent/Guardian Name:

Address:

Home Phone Number:

Name and Number of Person to Contact in case of emergency:

Please list all school age children in your household that ride the bus:

Child 1 Child 2

Child 3 Child 4

Child 5 Child 6

Child 7 Child 8

A.M. Bus # Is this pick-up from home or other?

If other please specify:

Directions from pick-up point to school:

P.M. Bus # Is this drop-off at home or other?

If other please specify:

Directions from school to drop-off:

Safe Schools Act Student Discipline Enrollment Information

Date

Student Name

Date of Birth Social Security #

Parent/Legal Guardian

Address of Parent/Legal Guardian

1. Is the above student presently under suspension or expulsion from another school district? YES NO

If yes, please describe

2. Has the above student been convicted or charged with any of the following crimes? First degree murder Second degree murder First degree assault Forcible rape Forcible sodomy Robbery in the first degree Distribution of drugs to a minor Arson in the first degree Kidnapping

I attest that all the above information is correct and true:

Parent/Legal Guardian Signature

Student Enrollment Checklist

Address Verification – Parent/Guardian (Attach Copy of Document)

Tax Bill – Personal Property/Real Estate

Lease Signed by Both Parties

Real Estate Contract Signed by All Parties

Utility Bill

Utility Deposit Receipt

Other

Basis for Admission of Student (Section 167.020, RSMo)

Resides with Parent in District

Resides with Legal Guardian in District – Copy of Court Order Must be Attached

Student is less than 21 years of age and lacks a fixed, regular and adequate nighttime residence (homeless child) because student is

living on the street, in a car, abandoned building or other form of shelter not designated as a permanent home

living in a community shelter facility

living in transitional housing for less than one year

Student is less than 21 years of age and has a permanent or temporary home in the district and is an orphan or has only one parent living

parents do not contribute to his or her support

Student’s parents own real estate in the district provided

80 acres or more are used for agricultural purposes

parent’s residence is on real estate

at least 35% of the real estate is in the district

parent notified district on or before June 30th that student would be attending school in the district

(To be eligible for admission all 4 conditions above must be met)

Transportation hardship as agreed by both districts

Additional information supporting admission decision (address, location of where student is living, etc.)

Waiver Information

Student Denied Admission Date of Denial

Waiver Requested Date of Request

Waiver Requested by

Parent or Legal Guardian

Student – Must be at Least 18 Years Old

Reason for Waiver Request

Parent is Teacher Under Contract with the District or other Regular Employee of District

Student is Living with Unrelated Person for Reasons other Than Attending School in the District

Student is Living With Grandparents or Other Relative for Reasons Other Than Attending School in the District

Name of Person/Relative

Relationship

Address

City/State/Zip Code

Phone Number

Reason Why Student is Living With Person/Relative

Other Hardship or Good Cause Basis for Waiver (Can not Be Athletics) Explain:

Waiver Hearing Date (Must be Within 45 Days of Request)

Student Admitted Pending Decision on Waiver Request Date Student Admitted

Waiver Granted Date

Waiver Denied Date

Date of Student Permanent Admission:

Student Enrollment Affidavit

Name of Student:

Address:

Telephone Number:

Parent Guardian Name:

I am the parent/legal guardian of and I am providing this affidavit in support of the enrollment of my child in the Hickory County R-1 school district.

Parent/Guardian Signature Date:

Request for Release of Student Records

Student’s Name:

Grade: Date of Enrollment: Date of Birth:

Previous School Attended:

School Name:

Address:

City, State & Zip:

Phone/Fax Number:

User Agreement and Parent Permission Form

Student Signature

Date Parent Signature

Name of Student

School Grade

Social Security Number Birth Date

Home Telephone

Student Handbook - Use of Corporal Punishment

Please mark your preference for the use of corporal punishment, sign, and return the bottom half of this page as acknowledgement that you have read the rules and regulations of Hickory County R-1 Schools for the 2012-2013 school year.

I wish my child to receive corporal punishment for discipline purposes.

I DO NOT wish my child to receive corporal punishment for discipline purposes.

Student Name

Parent Signature

Extracurricular Activities Permission

Please return to school principal’s office. Signature required for student participation in extracurricular activities.

Parent Signature: Date:

Student Signature: