Dear Preschool Parent, Welcome to the Pikeville Independent Preschool Program. You are receiving the first step in determining the eligibility of your child for preschool. It is important to note that there is a $1000.00 tuition charge for all preschool students. The only students excluded from the $1000 tuition charge are 3 or 4 year old students with disabilities or 4 year old students “at risk” (income based). It is also important to note that our preschool is designed for children who are at risk for learning difficulty, eligible based on household income or have a disability/IEP. If your child already has an IEP there will be no screening necessary. Please provide that document with the preschool enrollment packet. If a 3 or 4 year old student with disabilities or a 4 year old student “at risk” moves into our district during the school year we are required by law to place this student/s in our classroom. This could possibly result in having to remove your child from our preschool program if we are already at our limit (19). All potential preschool children must be screened to determine the eligibility process. To have the screening scheduled, we ask that you complete and return the preschool enrollment packet as soon as possible. When we receive this information, we will contact you to schedule a screening time and date for your child. The screening is the first step toward eligibility. Based on the outcome of the screening, your child may or may not require interventions. This will be further explained to you after the screening has taken place. Your support in completing and returning the identified pieces is the first important step in providing a high quality preschool program for your children. Respectfully, Frosty Davis, Preschool Coordinator Documents Needed: ü Registration Packet ~ Available On-line April 1st ü Birth Certificate ~ Student must be five years old by August 1, 2018 ü Current Immunizations ~ including Hepatitis A ü Physical Exam ~ dated no earlier than July 1, 2017 ü Eye Exam ~ dated no earlier than January 1, 2018 ü Dental Screening ~ dated no earlier than January 1, 2018 ü Social Security Card ~ optional ü Insurance Card ü Proof of Income Preschool Coordinator Pikeville Elementary School Registration Packet In an effort to make registration easier and faster for you we are providing this electronic packet to be completed at your convenience and printed out. This form can be typed into. Once you complete the packet, please print it out and add your signatures where required. Please bring this completed packet to registration to lessen your wait time. As you fill in information on Form Page 1 duplicate information will automatically fill in the following pages. Boxes may be typed into and buttons may be clicked. Many boxes have small arrows indicating drop down boxes. Just click and select the best choice. When printing, PLEASE DO NOT PRINT DOUBLE-SIDED. Some of the pages must go to different offices. When enrolling your child, you must present the following documents before your packet is considered compete and we may process your enrollment packet: Required Documents: ● Birth Certificate – Student must be five years old by August 1, 2018 ● Social Security Card ● School Physical Certificate--dated no earlier than July 1, 2017 ● Kentucky Immunization Certificate *NEW* including Hepatitis A ● Vision Examination Certificate--dated no earlier than January 1, 2018 ● Dental Screening Certificate--dated no earlier than January 1, 2018 ● PES Enrollment Packet— available: online: www.pikeville.kyschools.us - April 1, 2018 and Elementary School Office - April 4th Packets will only be accepted on Tuesdays between 9am-2pm during Summer Enrollment; May 29-August 3, 2018. Only those students who have turned in all required documents will be eligible to attend KinderCamp, to be held in August 2018. For more information or to schedule an appointment at a later time, please contact: Lara Keene at 432-4196 or [email protected] PRESCHOOL REGISTRATION In addition to the documents listed above: • Medicaid Card (if eligible) • Proof of Income For more information concerning preschool enrollment, please contact Frosty Davis at 432-0185 or [email protected] When printing this form please ensure after clicking File, then Print, Orientation is set to “Auto portrait/landscape” so each page will print properly. PLEASE DO NOT PRINT DOUBLE-SIDED. Some of the pages must go to different offices. We apologize for the inconvenience, but you will have to complete one packet for EACH child you have attending PES this year. We cannot combine packets. PIKEVILLE ELEMENTARY SCHOOL ENROLLMENT FORM Student Information: School Year: 20___ - 20___ Tuition Student: Yes___ No___ Name: ________________________________________ Gender: _____ Race: _____________ Birth Cert #: _____________ Birthdate: _____________ Social Security #: _____________ (optional) Birthplace: _______________ Mother’s Maiden Name: _________________ Grade: ________ Does an IEP exist?: Yes___ No___ Does a 504 exist?: Yes___ No___ Does student have any health issues/concerns?: Yes___ No___ Name and Address of last school attended: Has your student been previously evaluated, identified, or received services in: ESL: ___ Speech: ___ G/T: ___ Special Education: ___ Legal Guardian Student Lives with this Person: Yes___ No___ (If not the parent do you have court documents on file with us?) Yes___ No___ Male: Female: Full Name: __________________________________ Social Security #: ______________(optional) Birthdate: ______________ Home #: _____________ Email: _____________________________________________ Mailing Address: ____________________________ Physical Address: ____________________________ Cell #: _______________ Work Phone#:__________________City, State, Zip: ______________________________ Place of Employment: ____________________________ Legal Guardian Student Lives with this Person: Yes___ No___ (If not the parent do you have court documents on file with us?) Yes___ No___ Male: Female: Full Name: __________________________________ Social Security #: ______________(optional) Birthdate: ______________ Home #: _____________ Email: _____________________________________________ Mailing Address: ____________________________ Physical Address: ____________________________ Cell #: _______________ Work Phone#:__________________City, State, Zip: ______________________________ Place of Employment: ____________________________ Emergency Contact & Pickup Information (please list individuals other than parent) Full Name Relationship to student Gender Work # Home # Cell # Social Security # 1) 2) 3) Other Household Members Transportation: Full Name Relationship to student Gender Birthdate # Grade School Attending AM BUS: PARENT: 1) BUS PM: PARENT: 2) Transportation changes will only be accepted in writing prior to 2:00pm via 3) Email or in person from the guardian. [email protected] Parent/Guardian Signature: __________________________________________________________ Parent/Guardian Printed Name(s): ________________________________________________________ Date: _______________________ ***Office Use Only*** Birth Certificate: _____ Immunization Records: _____ Physical: _____ Vision: _____ Dental: _____ Date Accepted: Grade: _____ Teacher: _________________ Logged in Book: _____ Brigance Appt: _____ Photo Release: _____ Early Entrance Petition: _____ Early Petition Received: _____ Early Entrance Approved: _____ Time Accepted: PIKEVILLE ELEMENTARY SCHOOL ! Student'Information:' !Name:!_____________________________________________________!!!!Grade:!______!! Student’s!Physical/911!Address:!________________________________! City,!State,!Zip:!_______________________! ! Media'Release'Form' ! 'I'DO!give!permission!to!the!school/news!media!to!photograph/videotape!my!child.!! It!is!my!understanding!that!this!photograph/videotape!or!portions!thereof!may!be!used!for!public!viewing.!I!agree!to!allow!my!child! ! to!participate!in!these!projects!without!financial!remuneration,!and!I!understand!that!this!releases!the!school/district!from!any! future!claims,!as!well!as!from!any!liability!arising!from!the!use!of!the!said!photograph/videotape.! !! 'I'DO'NOT!grant!permission!for!the!school/news!media!to!photograph/videotape/interview!my!child!or!to!post!information!on!the! Web!about!my!child.! ! ''''''''! ! !Student'Usage'of'Computers,'Network,'Internet,''and'Telephones! I,!the!student,!understand!and!will!abide!by!the!Pikeville!Independent!School!District's!Acceptable!Use!Procedures!for!the!Network,! !Internet!and!Telephone!Usage.!I!further!understand!that!any!violation!of!the!regulations!stated!in!these!procedures!is!unethical!and!may! constitute!a!criminal!offense.!Should!I!commit!any!violation,!my!access!privileges!may!be!revoked,!school!disciplinary!action!may!be!taken,! and/or!appropriate!legal!action!may!be!pursued.!This!document!shall!be!valid!until!revisions!are!made!to!the!District!Acceptable!Use! ! Policy!or!until!the!student,!parent,!or!guardian!makes!a!written!request!to!change!the!access.!!!!!!!!!!!!!!!!!Parent'Initials:'________! ! !I!agree!to!read,!review!and!discuss!the!District!Acceptable!Use!Procedures!for!the!Network,!Internet!and!Telephone!Usage!with!my! child/student,!which!is!found!in!the!District!Code!of!Acceptable!Behavior!and!Conduct!book,!prior!to!giving!permission!for!access.!!I! !understand!that!a!copy!of!The!District’s!Acceptable!Use!Procedures!for!the!Network,!Internet!and!Telephone!Usage,!The!District!Code!of! Acceptable!Behavior!and!Conduct,!The!Attendance!Policy!and!the!Pikeville!School!Code!of!Conduct!is!available:!1)!On!line!at!