Online registration TH Bell Print documents

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Online registration

TH Bell

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T.H. BELL JUNIOR HIGH SCHOOL

REGISTRATION FEE CHECKLIST

RETURN THIS FORM COMPLETED

Student Name: ______________________________ Grade:

REQUIRED FEES

Student Activity Card

$18.00

Textbook Rental

$35.00

Computers & Technology Fee

$18.00

Science Lab

$7.00

Mailing Costs

$6.00

7

th

_{Grade only – CCA Introduction}

_$14.00

7

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_{GRADE STUDENT TOTAL REQUIRED FEES}

_$98.00

8

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_& 9

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_{GRADE STUDENT TOTAL REQUIRED FEES}

_$84.00

OPTIONAL FEES

Yearbook

$20.00

School Lunch

P.T.S.A. Student Membership

$6.00

P.T.S.A. Parent Membership

$6.00

Class Fees

Art

$15.00

Band, Guitar, Piano, Orchestra

$15.00

Band/Orchestra Instrument Rental‐talk to teacher first

$85.00

Choir

$15.00

Clothing 1

$15.00

Conditioning/Weight Lifting

$5.00

Drama

$15.00

Facs Exploration A & B

$10.00

Food & Nutrition

$20.00

Gate DM & ST

$10.00

Gate ME & AR

$10.00

Tech Ed(Manufacturing‐Communications)

$20.00

TOTAL FEES PAID

MAKE CHECK OR MONEY ORDER PAYABLE TO T.H. BELL JUNIOR HIGH SCHOOL

Are you applying for a Fee Waiver? _ Yes _ No If yes, please attach fee waiver application with

appropriate Verification (1040 TAX FORM) to this form.

MUST ARRIVE AT T.H. BELL BY AUGUST 12

TH

_{FOR EARLY REGISTRATION}

FEES MAY BE PAID ONLINE AT WWW.MYSCHOOLFEES.COM

Required Registration forms must still be mailed in.

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School Lunch

Students may purchase daily, monthly or quarterly

First quarter prepaid regular lunch is $103.50 Reduced is $18.40.

Daily regular lunch …...$2.25

Daily reduced lunch... .40

Daily regular breakfast………$1.50

Daily reduced breakfast……….. . 30

Registration - August 18, 2015

All students who have completed Mail-In registration

7:30-9:00 a.m.

(Recommended)

9 th

_{graders who have not completed Mail-In registration}

9:00 – 10:00 a.m.

8 th

_{graders who have not completed Mail-In registration}

10:00 – 11:00 a.m.

7 th

graders who have not completed Mail-In registration

11:00 – 12:00 p.m.

Please return these documents to the school with your payment or you may pay on

line. All documents should arrive at the school no later than August 12, 2015 for

early registration. FEE WAIVER MUST BE ACCOMPANIED BY SUPPORTING

INCOME DOCUMENTS.

T.H. Bell Junior High

165 West 5100 South

Ogden, Utah, 84405

o

Registration fee checklist

o

Demographic/Emergency form (if changes have been made)

o

Language survey

o

Medical Information

o

Special Services (Sp. Ed, 504, etc) if needed

o

Fee Waiver Forms-if applicable-with supporting income documentation

o

7 th

_{Grade: Proof of Immunization Updates}

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Weber School District

STUDENT INFORMATION FORM

The district is requesting this information under the authority of PL 94-142, title IV of the Civil rights law and State Administrative Rule R227-716 (1 to 5)

This information will be handled confidentially and will be used only for the purposed noted in the law or rule. This information will not subject you to any unfair or discriminatory treatment.

Student Legal Last Name Legal First Name Middle Name Preferred Last Name Preferred First Name Birth Date Place of Birth

Grade Student Home Phone

Student Cell Phone

Social Security No. Gender ___ Female ___ Male

Native Language

School Last Attended Address Country If Born Outside U.S. what Date Entered U.S. Schools Ethnicity (Choose one)

_____ Hispanic/Latino _____Not Hispanic/Latino

Race (Choose one or more, regardless of Ethnicity

____ Asian ____ Black ____ Caucasian ____ Pacific Islander ____ American Indian/Alaskan Native Tribal Affiliation (if AI/AN) Restrict Directory ___ Yes ___ No

Student Lives With

Special Programs Student Currently Receives

___ Father ___ Mother ___ Legal Guardian ___ Stepfather ___ Stepmother

____Grandparent ___Foster Parent ___ Other ____________________________

____ 504 ____ ESL ____ Spec. Ed/Resources ____ Title 1 ____ ELL ____ Speech/Communication

Primary Parent/Guardian Information

Last Name First Name Middle Name Relationship to Student Active Duty Military

Branch: Rank: Residence Address City State Zip

Emergency Contact ____ Yes ____ No

Employed at Federal Facility

_____Hill AFB _____Fed Admin Bldg _____Alliant Tech _____Forest Serv Bldg _____ATK AF Plant #78 _____Ft Douglas _____Army Resv Ctr _____Job Corps Miltry Sp _____ANG Facility _____VA Hosp _____NG Facility _____Tooele Army Depot _____IRS _____FAA Bldg _____Fed Office Bldg, SLC _____Fed Depot, Clrfld _____Fed Bldg, Ogden _____UT Defense Depot _____Little Mtn Test Annex _____Dugway Proving Grds _____Hercules Powder, Plant 81, Magna _____Other___________________________________

____Contractor at HAFB

Mailing Address City State Zip Federally Employed ____ Yes ___ No Home Phone Cell Phone Employer Phone Ext

Additional Parent/Guardian Information

Branch: Rank: Residence Address City State Zip Emergency Contact

____ Yes ____ No

Mailing Address City State Zip Federally Employed ____ Yes ____ N0 Home Phone Cell Phone Employer Phone Ext

Additional Parent Information (Complete this section for non-enrolling parent if parents are divorced)

Branch: Rank: Residence City State Zip Emergency Contact

____ Yes ____ No

Mailing Address City State Zip Federally Employed ____ Yes ____ No Home Phone Cell Phone Employer Phone Ext

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Other School-Age Children in the Home

Name Gender Birth Date School Relationship to Student

_______________________________________________ ___ Female ___ Male _________________ _______________________________ _____________________________ _______________________________________________ ___ Female ___ Male _________________ _______________________________ _____________________________ _______________________________________________ ___ Female ___ Male _________________ _______________________________ ____________________________ _______________________________________________ ___ Female ___ Male _________________ _______________________________ ____________________________ _______________________________________________ ___ Female ___ Male _________________ _______________________________ ____________________________

Emergency Contacts: (Please include at least two people authorized to check out student if parent/guardian is unavailable)

Name Relationship Phone (w/ area code & ext.) Alternate Phone (w/area code & ext.) Permission to Check Out ________________________________________________ ___________________ ___________________________ ______________________________ Yes

□

No

□

________________________________________________ ___________________ ___________________________ ______________________________ Yes

□

No

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________________________________________________ ___________________ ___________________________ ______________________________ Yes

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No

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Disclosure Statement

WEBER SCHOOL DISTRICT POLICIES AND PROCEDURES

On the school web site are the following Weber School District Policies: WSD Attendance & Truancy Policy, WSD Acceptable Use for Computer Network Communications, FERPA, Student Discipline Policy (including Safe School Policy), and Locker Agreement.

http://wsd.net/index.php?option=com_content&view=article&id=1523:kindergarten-registration-packet&catid=88:elementary-education

Also on the school web site are school policies: Class Change Policy, Eligibility, Sexual Harassment, Cell Phone/Electronic Devices and Dress Code policies.

Please read each one carefully and review and discuss them.

I have read all policies and agree to abide by all provisions. I understand that I am ultimately responsible for my child’s actions and, where applicable, agree that any violation of these policies may result in appropriate disciplinary action.

_____________________________________________________________________________ Student Signature Date

______________________________________________________________________________ Parent/Guardian Signature Date

Parent/Guardian Information Signature

It is a class B misdemeanor in Utah to knowingly make any false written statement to a public servant while he or she is performing an official function (Utah Code 76-8-505).

I CERTIFY THAT THE INFORMATION ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

Parent/Guardian Signature______________ Date _

Has any student information changed since last year?

Yes

No

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Weber School District/Student Medical Information

(Update annually if medical information has changed or you are new to Weber School District)

In an effort to insure that your child’s health is protected at school, we request that you provide the school with current information regarding the health of your student.

This information will be kept confidential, and shared only with those who have direct contact with your child and have a need to know.

Student_____________________________________________________________________________Date of Birth

GradeTeacher_______Date_Guardian/Parent Home Phone_ Cell Phone______

Does your child have a medical condition (diagnosed by a doctor) that requires a Health Care Plan to help guide faculty and staff in providing care to your child to

be kept on file at the school? Yes No Do you want a Health Care Plan? Yes No

Does your child have any of the following medical conditions the school should be aware of?

Yes No

ADHD: Medications prescribed_______________________________________________________________________________

Life Threatening Allergies:___________________________________________________________________________________________

Medications to be kept at school for life threatening allergy: EpiPen/Auvi Q Benadryl

Asthma: Medication to be kept at school: Inhaler_ Nebulizer____________

Bladder/Bowel problems (Diagnosed by Physician): Type/describe__________________________________________________________

Diabetes Type I Type II Medications____________________________________________________________________________

Heart Conditions: Type/describe____Medications

Mental Health conditions: Type/describeMedications____

Seizures: Type/describe________ Medications

Special Dietary needs: (A Special Meal Request form is required for meal accommodations at school):______________________________

Other Significant Medical Conditions that may impact your child while at school:_______________________________________________

__________________________________________________________________________________________________________________________________

If your child will be taking medication at school, a Medication Authorization Form must be signed by the parent and physician before medications can be given at school. These

forms must be updated each school year. These forms, as well as health care plans, can be obtained from the school, or under nursing department online at

www.wsd.net

.

My signature below indicates that I have read and understand the above statements. I will update this health information if/when changes occur.

Parent/Guardian Signature ___________________________Date _

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Weber School District

Home Language Survey (HLS)

Note: Federal and State regulations require schools to determine the language(s) spoken and understood by each student in order to provide appropriate

instruction. This form must be completed for every student who speaks a language other than English or who comes from a home where a language other

than English is spoken. This does not include students or parents who have learned a foreign language by taking classes or by other means.

Student’s Full Name _________________________________________________________ Grade _ Birthdate _/_/___

Student’s Country of Birth ___________________________________________________________

If student was not born in the United States, date first enrolled in a U.S. school. ___/_/___

1. Has your child attended a school in the U.S. for more than three years? _ Yes _ No

2. What language or languages did your child use when he/she first began to talk? _______________________________________________________

3. What language or languages does your child speak with you at home? ______________________________________________________________

4. What language or languages do you (parents or guardians) use when you speak to your child? ___________________________________________

5. Do the adults in your home (parents, guardians, grandparents or other adults) speak to each other in a language other than English? _Yes _ No

If yes, what language? _____________________________________________

What language do you prefer for school-to-home communication? _ English _ Other (please specify) _____________________________

Note: If there is another language at home other than English, students will automatically be tested for English language development services.

Parent/Guardian

Signature

______________________________________ Date _

1-22-15

Online registration TH Bell Print documents