THAYNE ELEMENTARY - STUDENT REGISTRATION PACKET

Student Information IBest phone # to call in an emergency:

Does your student currently have IEP, 504, or Title 1 services? Yes / No
Legal Name: 1
G rade student is entering:
Ethnicity (circle one): White Hispanic Native America African American Asian Gender (circle): Male Female
Social Security Number: 1
D ate of Birth: Place of Birth:
Physical Address (include city):
Mailing Address (include city):
Home Phone: Mother’s cell: Father’s cell:
Mother’s or Mother’s Mother’s
Guardian’s Name: Employer: work phone:
Father’s or Fathers Father’s
Guardian’s Name: Employer: work phone:
Parent’s email address:

Home Information
Who does child live with: Siblings: Sibling’s Date of Birth:
Parents only
only Mother and Stepfather
and Stepmother Grandparents
Other:__________________________
Who has guardianship?
Is there a custody alert? Yes / No
If yes, give details:_________________________________________________________________

Emergency Contacts
1st contact: Work and Home Phone Numbers:
2nd contact: Work and Home Phone Numbers:
3rd contact: Work and Home Phone Numbers:
Doctor: Doctor’s phone number:
Dentist: Dentist’s phone number:

Medical Information
List all medical problems such as epilepsy, diabetes, asthma, etc. and describe condition and treatment.

Allergies:
Is your child taking medication? Yes I No If yes, list name of medication and reason for taking medication:

Other information you feel is important:

In case of emergency, and school officials are unable to contact the parents or guardian of the named child, you
have permission to take this student to a doctor or hospital for emergency care. This consent shall continue,
until
revoked in writing, by a parent or legal guardian of the student. I will not hold the school district financially
responsible for the emergency care and/or transportation for said child.

Date Parent signature:

 _______________________
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ADMINISTRATIVE GUIDELINES FOR SCHOOL BUS BEHAVIOR AND BUS RULES

1. Students may not bring any of the following
items on the school bus: baseball bat, roller
blades, skis, skateboard, or any other item that
could be used as a projectile. Parents should
make other arrangements to get these items to
school if needed.
8. The use of tobacco, alcohol, or controlled
substances is prohibited on the bus.
9. Damages and vandalism of the bus by students
shall be repaired and the student or his/her
parent shall pay the cost of the repair.

2. Riding the bus is a privilege. Improper conduct 10. Obscene or vulgar language is prohibited.
on the buses will result in that privilege being
denied. 11. Do not eat or drink on the bus. Keep the bus
clean.
3. Students will be expected to be ready and
waiting at the bus stop for the bus, both at home 12. Keep your hands and head inside the bus.
and at the school.
13. Violence is prohibited.
4. Loud talking, shouting, whistling, or boisterous
conduct will not be permitted. 14. Students will use safe loading/unloading
practices at all times.
5. Students will remain seated at all times while the
bus is in motion. 15. The driver of the bus is in complete charge of
the students. The driver’s word is final and shall
6. No guns or weapons of any kind are allowed on be respected the same as a teacher or principal.
the bus.
16. Verbal notification for a change in student drop-
7. No animal will be transported under any off must be received by the school’s secretary
circumstance. no later than 2:00 p.m. or the student will be
delivered to their normal drop-off site.

I have read and understand the Administrative Guidelines for School Bus Behavior and School Bus Rules for Lincoln
County School District #2.

Parent Student

District policy is for students to go to hislher regular destination after school unless there is a note stating
otherwise. Please be diligent in sending notes and instructing your student to give notes to the teacher.
If there
is a change in the regular destination, please contact the school with the new information.

Student’s name____________________________________ Best phone # to call if questions

Student’s regular destination after school is:

Home
Physical address
Phone number

Daycare
Provider’s name Physical address Phone number
Walk or parent will transport

My student’s schedule changes daily. (Please fill out chart below.)

Monday Tuesday Wednesday Thursday Friday
Destination
Address,
phone # —

****
To arrange for morning bus pick-up for your student, call the bus garage at 885-7146!
 Thayne Elementary

Field Trip and Excursion Permission Slip

I want my child to receive the learning experience of field trips and hereby give my
permission for himlher to participate in field trips while attending Thayne Elementary
School.

Student’s name

Signature of Parent

Date__________________________

To publicize the achievements of our students and the great work they do, we like to
occasionally publish our student’s names, photographs, or achievements in our school
publications or release the information to local newspapers. We may also post the
information on the school’s web site.

We understand that you may not want to have your child’s name, photo, or achievements
published. Please fill out this form to let us know your wishes.

CONSENT TO RELEASE CHILD’S PHOTO AND OTHER INFORMATION

WHILE ENROLLED AT THAYNE ELEMENTARY SCHOOL

consent to having my child’s photo, name, and/or achievements published in

school newspapers and/or newsletters, released to local newspapers, and/or posted on the
school’s web page.

do not want my child’s photo, name, andlor achievements published in school

newspapers and/or newsletters, released to local newspapers, and/or posted on the
school’s web page.

Parent signature Date_____________________

************************************************************************

Applicants for admission and employment, students, parents, persons with disabilities, employees, and all
unions or professional organizations holding collective bargaining or professional agreements with Lincoln
County School District #2 are hereby notified that this school district does not discriminate on the basis of
race, sex, color, national origin, age, religion, or disability, in admission or access to, or treatment or
employment in, its programs and activities. Any person having inquiries concerning the school’s compliance
with the regulations implementing Title VI, Title IX, The Americans with Disabilities Act (ADA) or Section 504
is directed to contact the following individual who has been designated to coordinate efforts to comply with
the regulations regarding nondiscrimination- Mark Taylor, PD Box 219, 222 2.4th Avenue, Afton, WY
83110, (307) 885-3811.
 In October of 2007, the US Department of Education (USED) released new guidance on
collecting and reporting racial and ethnic data.

Parents should be informed that race/ethnic information is collected for the purpose of
monitoring, accountability and to ensure that schools are receiving the proper educational
programs and services they need. The USED has provided definitions of the following:
-Race: Relates to a person’s appearance —chiefly the color of their skin.
-Ethnicity: Relates to cultural factors such as nationality, culture, ancestry and beliefs.

Part A. Is this student Hispanic/Latino? (Choose only one.)

No, not Hispanic/Latino

Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, Cuban,
South or Central American, or other Spanish culture or origin, regardless of race.)

The above part of the question is about ethnicity, not race. No matter what you selected
above, please continue to answer the following by marking one or more boxes to indicate
what you consider your student’s race to be.

Part B. What is the student’s race? (Choose one or more.)

American Indian or Alaska Native (A person having origins in any of the

original peoples of North and South America (including Central America), and who
maintains tribal affiliation or community attachment.)
(A person having origins in any of the original peoples of the Far East,
Southeast Asian, or the Indian subcontinent including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand,
and Vietnam.
or African American (A person having origins in any of the black racial
groups of Africa.)
Hawaiian or Other Pacific Islander (A person having origins in any of
the original Peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White (A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.)
 STUDENT RESIDENCY QUESTIONNAIRE
Lincoln County School District #2

This questionnaire is intended to address the McKinney-Vento Act. Your answers will help the
administrator determine residency of your child.

1 Presently, where is the student living?

In a shelter Please explain Section A:

.
.

With more than one family (not immediate) in

.
Check here
a house or apartment ec ions
andBdonot
In a motel, car or campsite
apply.

With friends or family members (other than

parent/guardian)

2. The student lives with:

1 parent 1 relative, friend(s) or other adult(s)

2 parents Alone with no adults

1 parent & another adult — An adult that is not the parent or legal guardian

School:

Name of Student: Male Female

Birthdate: dnth!Day/Year Age: Social Security #: Qption

Name of Parent(s)/Legal Guardian(s):

Address: Zip: Phone:

Signature of Parent/Legal Guardian: Date:

Name and phone number of a School Contact Person who may know of the family’s residence

classification:

School Use Only

Signature of School Official

The State of Wyoming provides Hathaway Merit and Needs Scholarships to Wyoming students attending
the University of Wyoming and Wyoming community colleges. Every Wyoming student who meets the
merit requirements can earn a Hathaway Merit Scholarship. Contact your school counselor for more
information.
 _______
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Lincoln Co. School Dist. #2

Home Language Survey

The purpose of this form is to accurately determine the principal native language of each of the
students in Lincoln Co. School Dist. #2. Federal guidelines require that all school districts be
aware of languages other than English used by each student or family. This form needs to be
completed and returned to your child’s school by

Student’s Name: Date of Birth:

Grade: School:
Teacher:
Date:

Parents, please answer the following questions as accurately as possible as it allows us to

better provide the most appropriate academic programming for your children.

Was your child born in the United States Yes No

If yes, in which state?
If no, in what other country?
Is English the ONLY language spoken at home? Yes No

If you answered yes, to both questions above, stop and sign here.

If you answered no, sign here and please continue with this survey.
Parent Signature:
Has your child attended any school in the United
States for any three years during their lifetime? Yes No
If yes, please provide school name(s), state and dates attended:
Name of School State Dates
Name of School State Dates
Name of School State Dates

What was the first language the student used when he/she first began to speak?

What is the language(s) spoken in the home?

What language does the student speak with you at home? (circle your answer)
A. No English
B. A language other than English
C. Another language and English equally
D. English more often
E. Only English

What language does the student understand in your home? (circle your answer)
A. No English
B. A language other than English
C. Another language and English equally
D. English more often
E. Only English
 ____
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________________

Lincoln County School District #2

Afton,WY 83110
Authorization for Exchange
of Confidential Information
C

Student: Date Of Birth:

As parent/guardianladult student, I hereby request release of confidential information (including

educational plans, assessment results, medical findings, developmental, health and
immunization history, legal proceedings, and/or relevant data) on the above student between the
parties below:

From To From To

Thayne Elementary
Name of Agency/Contact Person Name of Agency/Contact Person

P0 Box 520
Address Address

Thayne WY 83127
City State Zip City State Zip

(307) 885-2380 (307) 883-2032

Phone Number Fax Number Phone Number Fax Number

I request the following records be exchanged for the purpose of new student enrollment:

_x general education records, specifically

_x special education records, specifically
_x discipline records

x medical record/information, specifically

_x_ counseling information, specifically
x_ testing/evaluation results, specifically
x other information, specifically

ParentlGuardianlAdult Student Signature

Address

City State Zip

Phone Number Date of Request