docArroyos del Norte Elementary P.O. Box 279 405 Hondo/Seco Road
download 
Demanda Transcripción
Arroyos del Norte Elementary P.O. Box 279 405 Hondo/Seco Road
Office Use Student ID #_______________ State ID#_________________ Date Enrolled _____________ Enrollment Status__________ Grade____________________ Arroyos del Norte Elementary P.O. Box 279 405 Hondo/Seco Road Arroyo Seco, New Mexico 87514 Last/Apellido First/Nombre MI/MI Physical Address/Domicilió Físico City/Cuidad Mailing Address/Dirección de Correo City/Cuidad Zip/Código Postal Gender/Sexo Home Phone/Teléfono [ ] Male/Masculino [ ] Female/Feminina Place of Birth/Lugar de Nacimiento Date of Birth/Fecha de Nacimiento City/Cuidad / / State/Estado ETHNICITY/Origen Étnico (Select only ONE) (Seleccione sólo UNO) [ ] Hispanic [ ] Caucasian [ ] Native American Resides with/¿Con quien vive el estudiante?: [ [ [ [ ] Father/Padre and(y) Mother/Madre ] Father/Padre and(y) Stepmother/Madrastra ] Mother/Madre and(y) Stepfather/Padrastro ] Grandparents/Abuelos [ ] Asian [ [ [ [ [ ] Black ] Father only/Solamente con el Padre ] Mother only/Solamente con la Madre ] Uncle/Tío and/or Aunt/Tía ] Foster Parents/Padres Adoptivos [ ] Other/Otros ______________________________ Father/Guardian Information/Información de Padre/Guardian: Name/Nombre Home Phone/Teléfono Cell phone/Teléfono Celular Employer/Work Phone E-Mail Address: Mother/Guardian Information/Información de Madre/Guaridan: Name/Nombre Home Phone/Teléfono Cell phone/Teléfono Celular Employer/Work PhoneE-Mail Address: Page 1 of 2 Other Emergency Contacts (Must be 18 years or older) who you are also authorizing to pick up your child. Otros contactos de Emergencia (Debe tener 18 años o mayores) si usted también se autoriza para recoger su niño/a. Name/Nombre Relation/Relación Telephone/Teléfono Yes No ¿Hay alguien que está prohibido por orden de la corte para estar en contacto con su niño/a? Yes No If yes, proper documentation must be provided in order to complete this section. En caso afirmativo, se necesitara la documentación adecuada para poder completar esta sección. List prohibited people/Lista de personas prohibidas: Name/Nombre Office use Is there anyone who is prohibited by court order to be in contact with your child? Has proper documentation been provided? Yes No Relation/Relación Where did your child last attend school. ¿Cual fue la ultima escuela a la que asistió su niño(a) School Name/Nombre de Esquela Address/Dirección Telephone Number/Teléfono Did your child receive special education services? ¿Recibio tu nino servicos educativos especiales? Yes No List your other children and grades attending this school. Los nombres y grado de sus otros niños que atenden a la escuela aquí. Name/Nombre_____________________________________ Grade/Grado_______ Name/Nombre_____________________________________ Grade/Grado_______ Name/Nombre_____________________________________ Grade/Grado_______ Migrant Status:____Yes ____No Migrantory Children with migrant status who are, or whose parents or spouses are, Migratory agricultultural workers, including dairy workers, or migratory fishers, and who, in the preceding 36 months, in order to accompany such parents or spouces in order to abtain temporary or seasonal employment in agriculteral or fishing work, have moved from one Local Education Agency (LEA) to another. Military Status: _______Active______National Guard ______ Reserve _____None Page 2 of 2 EMERGENCY DISMISSAL PROCEDURE TEACHER NAME:________________________________ BUS NO.______ MY CHILD, _______________________________IS TO DO THE FOLLOWING IN CASE OF AN EMERGENCY EARLY DISMISSAL (PLEASE CHECK ONLY ONE) WALKING HOME IS NOT AN OPTION. ____ MY CHILD RIES THE BUS. HE/SHE SHOULD ALSO GO HOME ON THE BUS DURING AN EMERGENCY. HE/SHE HAS A KEY OR KNOWS WHAT TO DO AND WHERE TO GO IF NOBODY IS HOME. BUS NO._____ _____ MY CHILD SHOULD NOT RIDE THE BUS. MY CHILD SHOULD NOT WALK HOME. MY CHILD SHOULD STAY AT SCHOOL UNTIL I GET THERE OR ANOTHER INDIVIDUAL LISTED BELOW ARRIVES TO TAKE HIM/HER HOME. I GIVE MY PERMISSION FOR MY CHILD TO LEAVE SCHOOL WITH ONE OF THE INDIVIDUALS LISTED BELOW: NAME: ________________________ RELATIONSHIP TO CHILD: __________________ NAME: ________________________ RELATIONSHIP TO CHILD: __________________ _______________________________________________ PARENT/GUARDIAN SIGNATURE/FIRMA DE PADRE/GUARDIAN _____________________________________ DATE/FECHA Please note that any persons that you list on the emergency contacts will be put on your approved pick up list. If at anytime you need to make changes (add or take off) we MUST have it in writing. Page 3 of 3
