School District of Black Hawk

August/September 2017

Message From The Principal

Welcome parents and students to Black Hawk Schools, and the 2017-18 school year. I hope all of our families enjoyed their time this summer with their children, and have made many great memories. We look forward to working with you and doing our best to serve your student’s educational needs. We are very proud of our small school community, and believe that we can offer opportunities that will help make your children’s experience here a positive one.

Please make sure to check out our school’s website and access the student handbooks that are posted online. These handbooks are linked under the parents/students tabs at the top of the page. The handbooks have information dealing with our schedules, grading policies, procedures, and behavioral expectations. If you a question on something in the handbook, please make sure you contact me at the school office.

We have a new reading curriculum that we are introducing to 5K students to 2nd grade this year. It is called Superkids, and we are very excited at what the research has shown in regards to this reading curriculum. We hope that it pays dividends with your early readers. Academic success is based on students being able to read fluently in order to be able to comprehend, and process information as they get older. As with anything, the more practice a person gets at something, the better they will be. It is so important for parents to read with their children at home. Listening to them read, or having them listen to you read, is an important activity. Ask your children questions about what they are reading in regards to setting, plot, characters, author’s intent, etc. This will be a fun and productive activity for you and your children. They grow up so fast, before you can blink your 6 year old will be 16 years old.

The high school will have a change in their final exam practices for this school year. We have collected feedback from former students and parents over the past couple of years, and we have learned that many favor having all students take final examina- tions in their courses. Therefore, all students in high school will be taking final exams in their first semester courses. There will be no final exam attendance waiver for first semester. However, Black Hawk High School will have a final exam waiver policy for second semester. Please refer to the student handbook for details.

We believe that teachers need time to discuss student progress and instructional methods with their peers. This year, the school board is allowing us to use the second Monday of each month, for late start collaboration time. The first late start will be on Monday, September 11. Starting times for classes will be pushed back two hours on these days, similar to a late start due to emergency weather. Doors for students will be open at 9:45 a.m. and classes will begin at 10:10 a.m. on these days. These have been added to the school calendar, which you can access on our school website.

We look forward to another exciting school year. As always, the quality of your experience is equal to the quality of attitude and effort put into it. We have great students at Black Hawk, and our very proud of what they have and will accomplish in 2017-18. Go Warriors! 3rd Annual OPEN HOUSE August 30, 4 to 7 PM The Black Hawk School District is planning to have an open house for all Black Hawk residents. We invite and encourage all residents to attend. The Board and staff are hoping residents will attend, ask questions, and see the great things happening for students. A free meal will be offered and several other activities will occur. The meal will be served by the Board and Administration. Menu:

 Lasagna/Mac & Cheese/Pizza  Salad  Cake  Garlic Bread  Lemonade/Milk/Coffee

Activities:

 Door Prizes  Tours of Building  Registration And Fees

Elementary:  Can demo. SMART Boards  Discuss classroom processes with child and parent  Discuss communication protocol  Students bring materials into room

Information Booths:

 District Goals/Question and Answer – available Board members  Standards Based Grading Cory Milz

Others include: Theatre Yearbook Forensics Music National Honor Society Fun Run Wellness Initiatives Running Club/Track Boys Basketball (including youth) Girls Basketball (including youth) Weight Room Alumni Questionnaire Book Fair (books will cost, but profit will be used to purchase additional books for children) Petting Zoo Wellness Initiatives Dental Program

Other organizations will be invited to attend to promote activities for children and the community. Please contact us if you would like to present as a community organization. We hope the event will promote community involvement and interaction with the district.

Thank you,

Willy Chambers Teen of the Week Elizabeth Holland Age: 18 Parents’ Names: Steve & Lynda Holland Address: FOOD SERVICE INFORMATION 10740 State Road 11 Gratiot, WI 53541 Lunch prices have increased. Lunch will be $2.55 School Activities (clubs, organizations, groups): for ECH-6th grade, and $2.90 for 7th-12th grade. Volleyball, School Play, Forensics, Mathletes, Band, Payment Information is a follows: Choir, National Honor Society, Class Officer, & Singing Star Spangled Banner at games. Skyward is the computerized prepayment system for Honors You Have Received: school meals in our district. This is a debit balance Honorable Mention for the 2016 Volleyball Season, system where funds are placed in advance on the Student of the Month (2013 & 2017), and the Gratiot account and purchases are drawn against the balance. State Bank award at the Lafayette County Fair (2013) The program is not a credit system. Students are Activities Outside of School: issued a 4-digit pin number, which is assigned to them 4-H when they first enter the district. Our policy requires Hobbies or Special Interests: all family accounts have a positive balance in order to Running, cooking, photography, reading, music, piano, purchase meals, extra milk, or a la carte items. volleyball If a family account balance reaches a low balance, Future Plans: a weekly email/computerized phone call will be sent I plan to attend UW-Platteville with a major in Biology on a pre-med track. out to the parents. Please send a payment to school Volunteering: when you get this low balance or a negative account balance call. Laying wood chips at the park, working a 5k run, church dinners, helping with church potlucks, helping in mass, You can check family account balances through the parent-teacher conferences, tutoring, and laying sod at the South Wayne Park. Family Access portal on our website. If you have any questions on your family account balance, please call Audrey Wells at 439-5400, ext.110.

Thank you to the class of 2017 for allowing me to speak at the graduation ceremony this past year and thank you to all of those who attended to show support for the graduates. I have been asked by many how I thought of the “Wear your Sunscreen” speech that I gave. To inform, it is actually based and derived from the lyrics of the song “Everybody’s Free to Wear Sunscreen” by the artist Baz Luhrmann. Many of the thoughts and language I used were from this song, with my Black Hawk experiences and Class of 2017 memories of lyrics being added in. By no means do I want to take credit for or come off as plagiarizing this song. There is great life advice in the lyrics that I felt pertained very well to the Class of 2017. I highly recommend you take the time and listen to it, and remember...wear your sunscreen.

Thank you, Andrew Beach Asbestos Management Plan Sub Bus Driver(s) Needed Under AHERA (Asbestos Hazard Emergency Response The Black Hawk School District is looking for Act), all primary and secondary schools are required to develop and implement a plan for managing all building qualified people to work as substitute bus drivers materials which contain asbestos. Included in the AHERA for the 2017-2018 school year. If you have interest Act is the requirement to annually notify all workers and or questions call Cory Milz, Transportation Direc- building occupants (or their guardians) of asbestos-related tor @ 608-439-5371 ext. 112 or Beth Zimmerman activities. @ 608-439-5371 ext. 100. Beginning in 1988, all buildings owned, lease, or “under the control of” the School District of Black Hawk were inspected by EPA accredited inspectors, with building material samples analyzed by an independent laboratory. Based on the inspection, the School District of Black Hawk prepared and the state approved a comprehensive management plan for managing the asbestos. Black Hawk Homecoming Environmental Management Consulting, Inc. (EMC) was contracted to be the school’s consultant for asbestos for the Saturday, October 7th school year. Where the asbestos-containing material are found, the Black Hawk District has in place an Operations 3rd Annual Fun Run/Walk - 7:00 a.m. and Maintenance program. The Black Hawk District has accomplished the following compliance mandates Homecoming Parade - 11:00 a.m. regarding the administration of asbestos in school buildings. The Black Hawk District is continuing with the BH Football vs Highland - 2:00 p.m. Operations and Maintenance Program as designed for the School District of Black Hawk. This ensures that all asbestos materials are kept in good condition. Periodic “surveillance” in each area containing asbestos has been completed every six months by our consultant. Also, Season Ticket Information the building is re-inspected by an accredited inspector Season tickets for Black Hawk High School athletic events are every three years. available to purchase. A family season ticket will cover two In the past year the District conducted the following adults and students currently attending Black Hawk School Dis- asbestos removal activities: None trict. This ticket allows admission for all home sporting events (excluding W.I.A.A. tournaments) during the 2017-2018 school The following activities are planned for the upcoming year: year. An individual season ticket will cover only the person Nothing Planned named on the season ticket. If you are interested in purchasing All outside contractors shall contact the lead maintenance either a family or individual season ticket, please call the high person before commencing work. school office at 439-5371 with your request and tickets will be Our goal at the Black Hawk School District is to be in full prepared for you. Season tickets may also be purchased when compliance with asbestos regulations. A copy of the paying school fees. You will be notified when the tickets are Asbestos Management Plan is available for review by ready to be picked up. contacting the District Office. Questions related to the plan The costs of the season tickets are as follows: or any other asbestos concerns should be directed to the Family Season Pass ……………………………………...$40.00 District’s Designated Person, Karlan Johnson (Two adults and student attending Black Hawk School District) Adult Individual Season Pass…………………………….$30.00 Student Individual Season Pass…………………………..$10.00 Replacement Pass………………………………………….$1.00

SWCF Grants Black Hawk Running Club

Ms. Rynes will offer a Running Club again this fall for all

students grades 5-12, as well as for all faculty, staff, and Black

Hawk community members. Running Club will begin

on Thursday, September 14th. We will meet on Mondays and Pictured above: Rosann Markese (SWCF Board Member) , Thursdays from September 14th-November 20th. Running Club is Josh Firgens, Brenda Whalen, & Jan Olson from 3:30pm-4:30pm. Permissions slips will be available at the Each year the South Wayne Community Fund Organization awards “Excellence in Education” Open House and during the first two weeks of school from Ms. grants to Black Hawk School District faculty. Rynes. If you have any questions, please contact her This year grants were awarded to Brenda Whalen for 5K through 5th grade “Words their Way” program at [email protected]. One of the main goals will be to materials, Jan Olson for the Black Hawk Reading help prepare you for the Homecoming Fun Run 5k which will be Connection that is published each month in the held on Saturday, October 7th. All are welcome to come run, Black Hawk News, and to Josh Firgens for purchase of materials for the program “Innovation with walk, and participate in the workouts and activities to the best of Makerspaces.” your ability. Hope to see you there, and happy running!

Find us on the Web www.blackhawk.k12.wi.us

Black Hawk Track & Field Wrap Up

With the end of the school year, things get busy. However, I wanted to share some results from the end of the 2017 track season. Haley Gertsch placed in the top 6 in three events at Conference. With her performance, she earned All-Conference in the 100m dash (3rd; 13:44), the 400m dash (2nd; 1:01.54), and the 800m run (4th; 2:39). Haley also was the only Black Hawk athlete to advance from Regionals to Sectionals this spring. She had the honor of running the 400m dash at the Sectional Meet in Bangor, where she placed 7th. Although small in number, I'd like to thank the seven high school athletes who finished what they started: Haley Gertsch, Noah Metz, Derek Stib, Trinity Fitzgerald, Grace Neff, Karl Seffrood, and Jared Vosberg. Many of them set numerous Personal Records throughout the season, and never gave up. End of the season awards were given to Derek Stib--Most Dedicated and Most Improved, Jared Vosberg-- Most Valuable, and Haley Gertsch who was given a "Coach's Award" for earning all three awards. Haley, Derek, Trinity, Grace, Karl, and Jared also earned Varsity letters! Thanks for the memories! --Coach Rynes FFA News Middle School FFA Quiz Bowl Competition held at the Alliant Energy Center in Madison, Wisconsin from June 12 through Thursday June 15. It gives me great pleasure to announce the Black Hawk FFA Members won the contest! I believe this is the first time in the long standing history of the Black Hawk FFA that this has ever happened. These members competed at the District level back in January for a chance to move on to the sectional level. In March they competed at the Sectional Contest for a chance to represent Section 4 and South West Wisconsin as the team competing in Madison in June at the State Contest. For your reference, Section 4 stretches from Prairie Du Chien south to the Illinois boarder and across to South Wayne...and all of the surrounding miles in between. I believe this is the 10th consecutive year the Black Hawk FFA has been the team representing Section 4 at the State Level Contest. Of the 10 teams here, Black Hawk finished first defeating Waupun, Sauk Prairie, and Amery. This is a HUGE accomplishment with countless hours of hard work and dedication to studying important facts, dates, and influential people all tied to the FFA History. Congratulations to the members. These 5 individuals will be recognized at the Third General Session on stage in front of thousands of FFA Members and guests!

Front Row From Left to Right: Delaney Holland and Emily Triem Back Row From Left to Right: Mr. Meyers, Jexen Stietz, Thatcher Schliem, Spence Seffrood.

CELL PHONES – MP3 PLAYERS – PERSONAL MUSIC DEVICES High School: Students may possess electronic devices; devices need to be turned off and out of hand unless directed otherwise by an instructor for educational purposes.  Students may use electronic devices during the lunch period Improper cell phone usage will result in device confiscation. 1st offense – Confiscation of device. Student conference. 2nd offense – Confiscation of device, parent pick-up. 3rd offense – Confiscation of device, loss of second semester waiver, detention assigned. Device must be turned into the office for period of time designated by administration.  There will be no phone use or Internet-capable devices used in study hall for any task which is not an official class assignment. Video games are not allowed in study halls or class time. Teachers may allow the last 10 minutes of study hall at their discretion for rewarding of proper studying behaviors. Music devices during class or study halls are at the discretion of the teacher and must be only during independent work time.  Receiving and sending texts, unauthorized picture/video taking, and use of social media sites during the instructional day is prohibited.  No phones or picture taking devices are allowed to be out or on in the locker room or bathroom areas.  Refusal to submit to staff’s request for phone confiscation will result in automatic office disciplinary protocols. Headphones MUST be completely removed from the ears during instructional time and hallway transitions. Middle School: Electronic devices must be kept in the lockers and turned off at all times during the school day.

Honor Roll 2016-17 2nd Semester Athletic Policies

Student Attendance on Game Day: Students shall be in Honor Roll 3-0 - 3.666 High Honor Roll 3.667- 3.999 attendance at school all day on the day of a contest/ Freshmen competition, and at least 4 hours on the day of practice. Cody Blosch Freshmen An exception can be made at the principal’s discretion for Hannah Butler Sydney Freitag Kiezer Curtis Madelyn Huschitt a doctor’s visit for the purpose of gaining a release to Lucas Flanagan Cayden Milz participate, or some other reasonable absence. Samuel Meier Hunter Metz Sophomores Permission must be obtained prior to the absence. If the Jaylen Rufenacht Rece Shelton competition falls on a non-school day then the student either had to be in attendance the full day or have an Sophomores Juniors Braden Abney Curtis Leuzinger excused absence for the school day preceding the event. Brooklyn Allaback Brody Milz The above applies to cheerleaders as well as athletes. Colby Argall Teearia Sweeney Scholastic Eligibility: Students must have earned a grade of Savanna Burmeister Jason Treuthardt Sydney Delzer D– or higher in all classes in order to be eligible to Kaitlyn Fey Seniors participate in extra-curricular activities. Trinity Fitzgerald Casi Blosch Mia Jackson Jordyn Delzer Athletic Code of Conduct: All athletes must meet and Colton Klemm Samantha Lovelace abide by all the rules and regulations set Kyle Lovelace Conner Meyer Distinguished Honors 4.0 forth in the BH Activities Handbook. Stephen Murray Grace Neff Freshmen Connor Novak Kristen Knapp Jayden Stietz Natalie Leuzinger Lydia Stietz Tyler Triem Sophomores Jace Tuescher Hunter Bredeson Jared Vosberg Juniors Juniors Haley Gertsch Abigail Argall Hannah Herbst Jeffery Cobb, Jr. Lauren Schultz Michael Flanagan, Jr Brianna Hagen Seniors Rachel Hagen Elizabeth Holland Benjamin Holland Nathan Hull Megan McCallum Jared Knapp Megan Stephens Noah Metz School Board of Education Hannah Ritschard The Board holds a regular business meeting on the second Monday Jett Rufenacht of the month, beginning at 7:00 p.m. The meetings are held in Alena Wheeler South Wayne. All board meetings are open public meetings unless Allyson Whitcomb posted otherwise. Residents are encouraged to attend and may Seniors telephone 439-5400 for information. Kaitlin Akins President……….………………….………………...Kerry Holland Teela Ellingson Joshua Meier Vice President…………………….………………....Steve Holland Hannah Plath Treasurer………………...………………………….....Gary Signer Jeanna Rupnow Clerk…………………………...………………………...Jason Figi Briana Schoville Member………………………………………….Jimmy Rufenacht Morgyn Stauffacher Member………………………………………….Michael Flanagan

Member………………….…………………………...Jon Satterlee

3-Year Old Screenings:

Early childhood screening helps a school district identify children who may benefit from district and community resources available to help in their development. Early childhood is an important time of rapid learning and growth. With the increasing recognition of the early years as critical in a child’s development, schools are evaluating children at younger ages to determine their strengths and concerns in important activities, allowing time for strengthening these concerns and helping all children be as ready for school as possible. Early Childhood Screening is a FREE service available for all children, even if home- schooling or private school is the family’s choice.

What is Early Childhood Screening? It is a careful, simple check of your child’s growth in all areas – physical, developmental and emotional. Early Childhood Screenings are conducted to ensure that all young children are well-equipped and ready for learning and that families are aware of resources in their school and community. It helps parents see how their child is progressing compared to other children of the same age. In general, screening provides a way for parents to learn more about their children.

The results of the screening will be reviewed with the parent or guardian, and any follow-up recommendations will be discussed. Screening appointments take approximately 30 minutes and are scheduled once your child turns three. To set up an Early Childhood Screening for your child you can contact Linda Figi, ECH/4K Teacher directly at (608) 439-5444 ext. 223.

3-Year Old Playgroups

Do you have a 3 year old that does not qualify for Early Childhood and does not turn 4 until AFTER September 1st? Please contact Linda Figi at (608) 439-5444 ext. 223 for more information on having your 3-year old screened and to register for the playgroups that will be held during the 2017-18 school year. Please register by August 1, 2017. Limited spots available.

4K SCREENING: Please contact Linda Figi ASAP to sign your child up for the 2017-18 school year! (608) 439-5444 ext. 223. ACADEMIC STANDARDS NOTICE The School District of Black Hawk has adopted the following Wisconsin Academic Standards for the 2017-18 school year.

Disciplinary Literary Standards Agriculture, Food and Natural Resources Art & Design Education Business and Information Technology Early Learning Standards English Language Arts Environmental Education Health Education/Health Science Information and Technology Literacy Marketing, Management, and Entrepreneurship Mathematics Music Education Nutrition Education Personal Financial Literacy Physical Education Reading School Counseling Science Social Studies Technology and Engineering Theatre Education World Languages

EDUCATIONAL OPTIONS Children who reside in the School District of Black Hawk, have the following educational options: Attendance at public schools Attendance at private schools participating in the Wisconsin Private School Choice Program Attendance at charter schools Attendance at virtual schools Full-time open enrollment; and Youth options, course options, and options for pupils enrolled in a home-based private educational program Parents of children with disabilities are also advised that there is a special needs voucher program For more information, please contact: Willy Chambers, District Administrator [email protected] (608) 439-5400 ext. 103 For more information on these standards, please visit http://dpi.wi.gov/standards

English Language Arts Common Core Standards For more information on these standards, please visit https://dpi.wi.gov/sites/default/files/imce/standards/pdf/ ela-stds-app-a-revision.pdf

Mathematics Common Core Standards For more information on these standards, please visit https://dpi.wi.gov/sites/default/files/imce/standards/pdf/ common-core-math-standards.pdf

Common Core Literacy Standards For more information on these standards, please visit https://dpi.wi.gov/sites/default/files/imce/standards/pdf/ las-stds.pdf

Wisconsin Model Early Learning Standards For more information on these standards, please visit https://dpi.wi.gov/sites/default/files/imce/fscp/pdf/ec- wmels-rev2013.pdf

You will find additional information at: http://dpi.wi.gov/standards/literacy-all-subjects http://dpi.wi.gov/standards/guiding-principles SCHOOL ACCOUNTABILITY REPORT (SCHOOL REPORT CARD)

The School District of Black Hawk’s School Accountability Report may be found at: https://apps2.dpi.wi.gov/reportcards/

The most recent ranking (for the 2015-2016 school year) level assigned to each school within the District is:

District Schools:

Black Hawk Elementary: 76.3 Exceeds Expectations

Black Hawk Middle School: 63.7 Meets Expectations

Black Hawk High School: 55.9 Meets Few Expectations

District Report Card: 68.4 Meets Expectations th Elementary (ECH-5 ) School Day Schedule The safety of your children is our number 1 priority here at Black Hawk. Our protocols for morning drop-off and afternoon pick-up are in place to maintain the best possible environment for the safety and security of your children.

 Doors will open at 7:45 a.m. Supervision cannot be guaranteed until 7:45 a.m. Buses will arrive at school at 7:55 a.m. Classes will begin at 8:10 a.m. Elementary students are expected to be in their classrooms at 8:10 a.m.

 Students not riding the bus should be dropped off at the main doors at our south entrance, or on E. Center Street by the fire station. Please do not park on Division Street (west school side).

 Please enter the school parking lot using the southeast entrance, drop off your children as close to the pedestrian walk as possible, and then circle out to depart through the southwest exit. East Center Street is not available during the times of 7:50 a.m. and 8:00 a.m., as our buses are parked on that street for student drop-off. During these times, the school parking lot can be accessed from the east on Robert Homb Memorial Drive or by using Pleasant Street to S. Wyota Street from the west.

 Students arriving at school prior to 8:00 a.m. will follow the guidelines below: a. ECH – 3rd grade will report directly to the elementary doors. They will line up at the doors until 8:00 a.m. At 8:00 a.m., they will be allowed to enter their classrooms and the elementary hallway. If your child needs to be escorted by older siblings, the older siblings must line up with the younger student at the elementary hallway doors. b. Students in 4th and 5th grades will sit at the cafeteria tables in the lower commons until 8:00 a.m. At that time they will be dismissed to classrooms by our supervising aide. For security purposes, no student is allowed outside the commons without permission until 8:00 a.m. c. Students have between 7:45 a.m. and 8:05 a.m. to acquire breakfast in the lower commons. The cafeteria will stop serving breakfast at 8:05 a.m. Students are allowed 10 minutes to eat breakfast. The latest a student would arrive into their classroom from the cafeteria would be 8:15 a.m.

 Students arriving at school between the times of 8:00 a.m. and 8:10 a.m. can proceed directly to their classrooms or to the lower commons for breakfast. Students arriving after 8:10 a.m. should sign in at the office. Parents escorting their children to the classrooms after 8:10 a.m., need to first report to the office to sign in their child.

 The end of the instructional school day is officially 3:24 p.m. Buses will line up on E. Center Street between the times of 3:15 p.m. and 3:30 p.m. E. Center Street will be unavailable during those times. Buses will depart school at 3:30 p.m. Parents picking up their children from classrooms can do so at 3:15 p.m. If parents need to pick up their children prior to 3:15 p.m., they must report to the office to sign out their children. Parents accessing the parking lot to pick up their children at the end of the school day are respectfully asked to use Robert Homb Memorial Drive from the east or E. Pleasant Street to S. Wyota Street from the west. Also parents, we are asking that parents not park on Division street (west side of school) to pick up their children for safety reasons. You may park on E. Center Street by the fire station.

th th 6 -12 Grade School Day Schedule

The safety of your children is our number 1 priority here at Black Hawk. Our protocols for morning drop-off and afternoon pick-up are in place to maintain the best possible environment for the safety and security of your children.

 Doors will open at 7:45 a.m. Supervision cannot be guaranteed until 7:45 a.m. Buses will arrive at school at 7:55 a.m.

 Classes will begin at 8:10 a.m. Students not riding the bus should be dropped off at the main doors at our south entrance, or on E. Center Street by the fire station. Please do not park on Division Street (west school side).

 High school students driving to school, must park in our parking lot. They must use Robert Homb Memorial Drive from the east or Pleasant Street to S. Wyota Street from the west. Please remind your students that the speed limit is 5 m.p.h. in the parking lot and to be mindful of pedestrians.

 Students arriving at school prior to 8:00 a.m. will follow the guidelines below:

a. Students in grades 9th – 12th will assemble in the upper commons until 8:00 a.m. They will be dismissed to the classrooms at that time by our supervising aide b. Students in grades 6th-8th will assemble in the lower commons until 8:00 a.m. They will be dismissed to the classrooms at that time by our supervising aide. For security purposes, no student is allowed outside the commons without permission until 8:00 a.m.

 Students arriving at school between the times of 8:00 a.m. and 8:10 a.m. can proceed directly to their classrooms.

 Students arriving after 8:10 a.m. should sign in at the office.

 Students have between 7:45 a.m. and 8:05 a.m. to acquire breakfast in the lower commons. The cafeteria will stop serving at 8:05 a.m. They are allowed 10 minutes to eat breakfast. Students reporting to classrooms after 8:10 a.m. without an excused pass, will be marked tardy. After 8:20 a.m., they will be marked absent.

 If parents need to pick up their children prior to 3:24 p.m., they must report to the office to sign out their children.

 Doors will lock at 4:15 p.m.

 Students staying after school should report directly to the area to which they are assigned. Students will not be allowed to stay in the building in unsupervised areas after 4:15 p.m. After 4:15 p.m., the upper commons or lob by areas are the only allowed locations for students who are waiting for rides.

Bus Transportation

The Black Hawk bus transportation service will only be provided to eligible students. These students are provided a bus route, pick-up, and drop-off point. Temporary school bus transportation may be allowed as follows. The building principal may approve temporary school bus transportation on a regular bus route for a student whose parent/guardian requests temporary busing in writing for a good cause. Examples of good cause include death in the family, ill- ness, etc. Bus riding rules should be posted in each bus. It is the bus driver’s responsibility to enforce the bus riding rules. Violations must be documented on the school district’s “Bus Violation Form” and turned into the principal. Violations must be written appropriately in order to have action taken on the violation. Eating food of any kind and drinking of beverages is strongly discouraged. Bus drivers may allow eating and drinking with the understanding they may revoke the privilege at any time for any reason. All materials should be disposed of properly in the appropriate receptacles placed on the bus. Video cameras are installed on all buses. The cameras have been installed to help bus drivers complete their jobs safety and to ensure the safety of everyone.

Bus Rules THE DRIVER IS IN CHARGE. Do what you are told. BE A WARRIOR! MAINTAIN YOUR PILLARS. BE RESPECTFUL AND BE RESPONSIBLE. Drivers will notify Mr. Milz for checks and disciplinary action. Be Respectful DO NOT DESTROY PROPERTY. You will pay for what you damage. THROW ALL GARBAGE IN TRASH. BULLYING BEHAVIOR WILL NOT BE TOLERATED. Subject to verbal and or sexual harassment and slander laws. NO YELLING OR LOUD VOLUME. Talk quietly if at all. NO PUSHING OR SHOVING ON WAY TO OR FROM BUS. PROFANITY AND VULGAR LANGUAGE WILL NOT BE TOLERATED. Be Responsible FOR YOUR OWN SAFETY, DO NOT DISTRACT THE DRIVER THROUGH MISBEHAVIOR. KEEP THE BUS CLEAN. If not, you will clean it up. CHECK ALL BELONGINGS AND REMOVE THEM FROM BUS AT DESTINATION. Homecoming 5K Fun Run rd 3 Annual Homecoming 5K Fun Run Registration Form

Saturday, October 7, 2017 Black Hawk Schools - 202 E Center St. – South Wayne, WI

Registration/Packet pick-up begins at Black Hawk School District on Friday, October 6th from 6:30pm to 7:30pm or Saturday, October 7th from 6:15am to 6:45am Run/Walk begins at 7:00am Price for all participants include entry fee, t-shirt (not guaranteed for those who do not pre-register before Homecoming week), breakfast from the FFA, post-race snack, and area donated items (Prices are the same for the 5K run or the 1 mile walk)—our number one goal is for this to be a FUN way to start the day!!

*Adults: $20.00 *Students: $15.00 *Max Family Fee (5 or more) $80.00 5K and 1 mile walk/fun run begins on the track and will loop around on Robert Homb Dr. and go through parts of the Village of South Wayne. The run will end on the track. No official timing system will be used, but timers will be at the finish. Event will be held rain or shine!

Registration and payment may be mailed to: Black Hawk Fun Run, 202 E. Center St. – PO Box 303, South Wayne, WI 53587

(Only one participant per registration form. Please Print) Individual Name: ______Email: ______Phone Number: ______I would like to participate in the ______5K ______1 Mile Shirt Sizes: Youth: 6/8 ______10/12 ______14/16 ______Adult: Small ______Med. ______Large ______XL ______2X ______3X ______

Release of Liability/Waiver The undersigned acknowledges that the Homecoming 5K Fun Run is voluntary and that I am voluntarily participating. I hereby release the Village of South Wayne, The Black Hawk School District, its officers, directors, agents and all sponsors and volunteers and all other parties from any and all liability whatsoever, including all claims, demands, or causes of action of every nature, which arise out of or are in any way connected with this race. The undersigned agrees that the above-mentioned parties shall be held harmless in the event of an accident causing damages or loss of property to the undersigned. I have read the foregoing Release, understand its terms, and freely and voluntarily sign the same. ______Date Signature (parent signature if under 18) What: Black Hawk Warrior Football is running a fundraiser taking place during the four 2017 home football games.

How To Participate: Individuals can purchase yard lines before the season or during the season. Yard lines are designated East and West. For example, E49 and W49. Yard lines acquired are good for the entire 2017 football season. The cost of purchasing a yardline:

1. $20 for a random draw. 2. $50 for a specific pick on double yard lines (E49 and W49 for example)

Individuals can purchase their yard lines at the high school office, during the home varsity football games, at the Vault bar in South Wayne, or at Marty’s Village Inn in South Wayne.

Chances To Win: There will be 2 chances to win $50.00 at each home game. At the conclusion of the first and third quarters, participants will win $50.00 if the ball remains on the yard line that they have drawn or chosen. Ex., you have drawn E49 and the ball is placed on the E49 yard line at the end of the first quarter.

Purpose: Running a quality football program with 35-45 participants requires funding. With the soaring cost of equipment and supplies, the Warrior football team needs additional sources of revenue to maintain the quality of its program. Black Hawk Varsity Football 2017 Game Schedule

Day/Date Time Opponent Location

Fri/Aug. 11 5:00pm Fall River (Scrimmage) Fall River High School

Sat/Aug. 19 2:30pm Owen-Withee UW Platteville

Fri/Aug. 25 7:00pm Potosi/Cassville Black Hawk High School

Fri/Sep. 1 7:00pm New Lisbon New Lisbon High School

Fri/Sep. 8 7:00pm Pec/Argyle Pecatonica High School

Fri/Sep. 15 7:00pm Belmont Belmont High School

Fri/Sep.22 7:00pm Benton/Scales Mound Black Hawk High School

Fri/Sep. 29 7:00pm River Ridge River Ridge Usgrd Field - Bloomington

Sat/Oct. 7 2:00pm Highland Black Hawk High School- Homecoming

Fri/Oct. 13 7:00pm Shullsburg Black Hawk High School JV Football 2017 Game Schedule

Day/Date Time Opponent Location

Mon/Aug. 21 3:00pm Owen-Withee Owen-Withee High School

Thu/Aug. 24 5:00pm New Glarus New Glarus High School

Mon/Aug. 28 5:30pm Potosi/Cassville Black Hawk High School

Mon/Sep. 11 5:30pm Pec/Argyle Pecatonica High School

Mon/Sep. 8 5:30pm Belmont Belmont High School

Mon/Sep. 25 5:30pm Benton/Scales Mound Black Hawk High School

Mon/Oct. 2 5:30pm River Ridge RR - Usgrd Field-Bloomington

Mon/Oct. 9 5:30pm Highland Black Hawk High School

Mon/Oct. 16 5:30pm Shullsburg Black Hawk High School

Black Hawk Warrior Football Kicks Off at the Six Rivers Jamboree

Come kick off the 2017-18 school year by watching the Black Hawk Warrior football team take on the Owen-Withee Black- hawks at the Six Rivers Football Jamboree at UW Platteville’s Ralph E. Davis Stadium on Saturday, August 19 at 2:00 p.m.

Tickets are on sale at the high school office, and are good for all Six Rivers’ games played at the stadium on the 19th.

Proceeds from tickets sold at the school, come back to Black Hawk High School’s athletic department. Ticket sales at the gate at Platteville, do not come back to the school. Tickets purchased in advance at the school office are $5.00 for adults and $3.00 for students. Tickets purchased at the gate are $6.00 for adults and $4.00 for students. Bell Schedule

Regular Daily 2 Hr. Delay Professional Collaboration Day RED Schedule Late Start Monday 7:45 Doors Open 9:45 Doors Open 9:45 Doors Open 8:10-8:55 1st Period

st 10:10-10:43 1 Period 10:10-10:25 1st Period 8:58 – 9:43 2nd Period

nd 10:46 -11:19 2 Period 10:28 -10:43 2nd Period 9:46-10:31 3rd Period

11:22 – 12:12 Period 5A/HS 10:46 – 11:01 3rd Period 10:34 -11:19 4th Period Lunch

11:04 – 11:19 4th Period 11:22 – 12:12* 5A / HS Lunch 12:15 – 1:00 Period 5B/MS Lunch 11:22 – 12:12 Period 5A/HS Lunch 12:15 – 1:00 5B /MS Lunch 1:03 – 1:48 6th Period 12:15 – 1:00 Period 5B/MS Lunch 1:03 – 1:48 6th Period 1:51 – 2:36 7th Period 1:03 – 1:48 6th Period 1:51 – 2:36 7th Period 2:39 – 3:24 Flex Period (8th) 1:51 – 2:36 7th Period 2:39 – 3:24 Flex Period (8th) 4:15 Doors th Locked 2:39 – 3:24 Flex Period (8 ) 4:15 Doors Locked

4:15 Doors Locked 2 Hr. Delay Early Release Schedule BLACK Schedule 7:45 Doors Open 9:45 Doors Open 8:10-8:39 1st Period 10:10 -10:43 3rd Period 8:42 – 9:12 2nd Period 10:46 -11:19 4th Period 9:15 - 9:45 3rd Period 11:22 – 12:12 Period 5A/ HS Lunch 9:48 -10:18 4th Period

12:15 – 1:00 Period 5B/MS 10:21 – 10:51 5th Period Lunch

10:54 – 11:24 6th Period 1:03 – 1:48 6th Period

11:27 – 11:57 Period 7A /HS Lunch 1:51 – 2:36 7th Period

12:00 – 12:30 Period 7B / MS Lunch 2:39 – 3:24 Flex Period (8th)

12:45 Doors Locked 4:15 Doors Locked

NONDISCRIMINATION POLICY It is the policy of Black Hawk Board of Education that no person shall, on the basis of sex, race, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation, physical, mental, emotional, or learning disability or handicap be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activityor in employment. Any student questions concerning Title VI, which prohibits discrimination on the basis of race, color, and national origin; Title IX which prohibits discrimination on the basis of sex; or Section 504, which prohibits discrimination on the basis of handicap, should be directed to: William Chambers, Ed.D, Superintendent, 202 E. Center Street, South Wayne, WI 53587 or call 608-439-5371

The School District of Black Hawk has established the following guidelines for playing time for athletes. The district philosophy establishes different philosophies at the varying competitive levels.

Black Hawk Playing Time Philosophy: The Coaches Purpose: The coach is to provide an opportunity for student/athletes to have a positive experience. The coach should focus on developing sport specific skills, teamwork, sportsmanship, and self-regulation. The coach shall communicate her/his expectations with the students, parents, and other key stake holders. The coach should be open and honest with athletes and parent/guardians. The coach should be sensitive and compassionate to the student/athlete’s perspective.

Playing Time Guidelines (School Sponsored Sports):

Middle School: Focus on skill development Focus is not on winning Work to provide all student/athletes an ample amount of playing time

Junior Varsity: Focus on skill development Winning is still not #1 focus, winning does take a small role. Work to provide all student/athletes an ample amount of playing time

Varsity: Coach’s discretion Winning Becomes a main focus Best players play the most – Assuming the following Eligibility Following team/school rules Meeting Coaches expectations Strive to find playing time for other athletes Outcome of game is well in control Work other athletes into games when there is a significant point differential Seek opportunities to work athletes in throughout the game

Filing a Grievance related to Playing Time The District would strongly encourage parent/guardian and students to discuss their concerns with each other before either the parent/guardian or child approaches the coach.

Guidelines: All discussions about playing time should involve the following parameters Allow for a 24 hour period to pass after a game Be pre-arranged – set a time to meet with the coach

Parent and student should meet with the coach first (all individuals involved shall) *The district would support a student approaching the coach on their own accord* Be respectful Be honest Refrain from discussing other athletes

If the parent and student are not satisfied with the explanation/result then they can proceed through the next chain of command in the following order, using the same parameters: Athletic Director Administration School Board

Thank you to the parents, students, and staff of the Black Hawk School District for giving me the opportunity to work for

you and your children the past four years. Whether I taught your children general music, led them in a choir, directed them

in a play or musical, shared fun activities in my flexi schedule, or ran clock/announced at your children's basketball,

volleyball, or wrestling competitions, I am truly thankful for the opportunity to work with your children and the community.

I am leaving the district for a full time position in Coleman, WI teaching band and general music.

Please continue to support the music and theater departments. These are life-long skills that can become hobbies.

Thank you for the fantastic four years and Go Warriors!

-- Rob Doersam,

Warrior Open Campus Lunch Pass Black Hawk Schools maintains a closed campus lunch and free period policy. Students are expected to remain in assigned and supervised areas of campus during lunch. The “Warrior Open Campus Pass” extends the privilege to seniors to leave the school campus for their lunch period with parent permission and provided they have met certain requirements. These requirements include a minimum GPA of 1.76, all disciplinary obligations satisfied, acceptable attendance (no more that 3 unexcused tardies for the previous quarter), Pictured Curt Meier, Josh Meier, Mark Cullen raised behavioral expectations, earned at least JP Cullen & Sons challenged those working with the Company to senior status – 16 credits or more and signed an employer match. I am pleased to report that the response to the parent/guardian permission. Students who are challenge was tremendous! $2500.00 will be donated to the MACC fund on behalf of Josh. Congratulations!! approved for the “Warrior Open Campus Pass” and maintain the program requirements would be able to go home or to area restaurants during Senior Citizen Passes Available The Six Rivers Conference is providing all senior the lunch period (students are not allowed to citizens age 62 or older with a pass to all home and away drive or ride with others during the school day). sporting events (excluding W.I.A.A tournaments). If you Students will be expected to return to school by don’t already have an orange senior pass and would like 11:50 a.m. and be on time to their advisory class one, we ask that you call the district office at 439-5371 following lunch. Failure to do so will result in requesting a current Six Rivers Conference Senior Citizen pass. revocation of this privilege. Senior students *If you have an orange senior pass, it is good for a eligible are required to apply for the “Warrior lifetime. There’s no need to get a new card each Open Pass” each quarter. school year. Black Hawk MS/HS Dress Code

Head Acceptable Unacceptable No caps, visors, hoods, bandanas, or other head gear, except with administrative permission.

No Sunglasses allowed, unless for medical purposes. *May wear hats outside of the building on school grounds

No earphones during instructional hours.

Upper Garments Acceptable Unacceptable No rips/tears, skintight items, or modified apparel that exposes excessive skin. Long enough to overlap the beltline or stay tucked. Tops must not expose excessive cleavage or bare sides. Be modest when in a professional setting. No clothing clearly designed as under garments. Coats and Jackets are not allowed to be worn during instructional hours. Shirts must not depict or endorse actions that are illegal; including alcohol and drug promotion and/or consumption. Overtly offensive and sexual content on shirts will not be permitted.

Lower Garments Acceptable Unacceptable Undergarments MUST remain entirely covered even while seat- ed. Dresses, skirts, and shorts must be modest and not be modified. Shorts must be no shorter than a 3” in-seam. Rule of thumb – mid knuckles No rips/tears above in- seam rule , pockets exposed, or exposed skintight items, such Yoga pants covered as leggings or tights. No Chains

Footwear Acceptable Footwear that is not fash- ioned securely to the foot or presents injury risk.

School District of Black Hawk 2017-2018 School Supplies EARLY CHILDHOOD/4 SECOND GRADE cont… YEAR OLD KINDERGARTEN 1 - 1 inch 3-ring binder (with clear plastic front) Large Backpack with zipper (NO backpacks on WHEELS) 3 - One-subject wide-ruled spiral notebook Rest Mat (ONLY 4K STUDENTS need this!) Clip board 3-prong folder (used for the communication folder) (2 for Mrs. Lumley) 1 - Plastic folder with the 3-hole punch 1 ½ inch 3-ring binder (with clear plastic front) Avery sheet protectors (25) Avery sheet protectors (50) 2 - Dry Erase markers (black) 12 count Crayola colored pencils Headphones (jack size 3.5mm) NO ear buds please 24 count Crayola crayons No Trapper Keepers!! 10 count Crayola washable broad-line markers Art Class Supplies: (In addition to classroom supplies) 10 count Crayola washable fine-line markers 4 - #2 Pencils (Ticonderoga or plain yellow) 6 - Elmer’s glue sticks (3 any size for Mrs. Figi) 1 - Large plain Pink or White Eraser Change of clothes (Labeled in a Ziploc Bag) this is for all students 1 - Art Bag with 24 count crayons and 3 glue sticks (labeled) Two-Pocket Blue Folder with 3-prong fasteners 5 YEAR KINDERGARTEN for students new to the District Backpack (No backpacks on rollers - 3-ring binder has to fit) Gym shoes (Velcro if they can’t tie) THIRD GRADE (An extra pair is not necessary if they wear gym shoes to school that day) Back Pack Red/Blue foldable rest mat Gym shoes (May be worn to school) 24 count Crayola Twistable crayons 1 - Box of 24 #2 Pencils 30 count Crayola Twistable colored pencils Red pen 10 count Crayola Classic Color washable markers-broad line Crayons 1 - Pair Fiskar scissors Colored pencils 1- Box of 12 Pencils (#2 lead) Crayola Classic Colors washable markers 1. - Pink erasers 2 - 4oz. Elmer’s glue 2 - Folders 3 - Large glue sticks 4 - 4oz. Elmer’s glue Fiskar scissors 2 - 1-inch 3-ring binder (with clear plastic front) 2 - Large pink erasers Avery sheet protectors (75) 6 - Folders with pockets 1 Pkg (100 count) Brown lunch bags 1 Yellow highlighter marker 2 - Prepackaged snacks for 17 students 3 - One-subject wide-ruled spiral notebook Art class: (In addition to classroom supplies) 2 - Dry Erase markers 1 - Large plain Pink or White Eraser Headphones Two-Pocket Purple Folder with 3-prong fasteners 3-ring binder (with clear front) - Ms. Rynes (Supplies will be kept in the Art room) 1 pack 4x6 Lined Index Cards - Ms. Place

Art Class Supplies: (In addition to classroom supplies) FIRST GRADE 4 - #2 Pencils (Ticonderoga or plain yellow) Backpack 1 - Large plain Pink or White Erasers Gym shoes (May be worn to school) 1 - Art Bag with 24 count crayons and 3 glue sticks (labeled) 24 - #2 Pencils Two-Pocket Yellow Folder with 3-prong fasteners Crayons - 16 or 24 for students new to the District Crayola Classic Colors washable markers Colored Pencils (optional) 1 - 4oz. Elmer’s glue - (no school glue) AND 12 - Glue sticks FOURTH GRADE 5 - Fine-tip dry erase markers Backpack Fiskar scissors #2 Pencils 2 - Large pink erasers Crayons (24 count) or colored pencils 5 - Folders with pockets Washable colored markers (No permanent markers ) 1- 12-inch Standard/Metric Ruler with Centimeter Markings Elmer’s school glue or glue stick 1- 1-inch 3-ring Binder (White with clear plastic front) Fiskar scissors (check hand size) Avery sheet protectors (50) Erasers Headphones Zippered pencil case (One small enough to fit in your desk) PLEASE LABEL EVERYTHING BOLDLY Art box Art class: (In addition to classroom supplies) 4 - Dry Erase markers 4 - #2 Pencils (Ticonderoga or plain yellow) Highlighter 1 - Large plain Pink or White Eraser Headphones for computers Two-pocket Green Folder with 3-prong fasteners for students new to the dis- 1 - Two-pocket folder (Labeled for each subject below) AND trict 1 - One-subject wide-ruled spiral notebook (Art bag is not necessary because supplies will be kept in the art room (Labeled for each subject below): Math Reading/Language Arts SECOND GRADE Science Backpack Social Studies Gym shoes (May be worn to school) SSR 1. - Box of 24 #2 Pencils 2 Notebooks for use as a Math journal and Language Arts journal Crayons Please have extra folders/notebooks available Colored pencils Art Class Supplies: (In addition to classroom supplies) Crayola Classic Colors washable markers 5 - #2 Pencils (Ticonderoga or plain yellow) 4 - Large glue sticks 1 - Large plain Pink or White Erasers 1- 4oz. Elmer’s glue 1 - Art Bag with 24 count crayons and 3 glue sticks (labeled) Fiskar scissors Two-Pocket Orange Folder with 3-prong fasteners 2 - Large pink erasers for students new to the District 4 - Folders with pockets

FIFTH GRADE MIDDLE SCHOOL GYM CLASSES (Grades 6-8) Backpack Gym clothes #2 Pencils Gym shoes Red correcting pens Shampoo/Soap 2 - Black pens Towel 24 count Crayons Colored pencils Washable colored markers (No permanent markers ) HIGH SCHOOL SPECIAL EDUCATION STUDENTS Elmer’s school glue 1 - Calculator that does fractions and exponents (Texas Glue stick Instruments TI-30XIIS) Fiskar scissors (check hand size) 1 - Bottle of whiteout 1 - Large box of Kleenex Protractor 1 - Pack of Pencils 1 - Pack of Pens Compass 1 - Large eraser 1 - Glue stick Erasers 7 - Notebooks (Match Colors) 7 - Folders 12-inch Standard/Metric ruler (If you buy mechanical pencils, buy refills to go with them) Zippered pencil case (One small enough to fit in your desk) Art box 8 - Dry Erase markers Music Supplies Highlighters (2 different colors) 1-inch binder for 3rd through 6th grade 3 - Packs of 3x5 index cards 1-inch black binder for all choir students 3 - Small packages of Kleenex 4 - #2 Pencils 2 - Black Sharpie markers 1 - Two-pocket folder (Labeled for each subject below) AND ART SUPPLIES 1 - One-subject wide-ruled spiral notebook (Labeled for each subject below): Math 5K-1st: Reading 4 - #2 Pencils (Ticonderoga or plain yellow) Language Arts 1 - Large plain Pink or White Eraser Science/Health (Kindergarten) 1 - Two-Pocket Purple Folder with 3-Prong Fasteners Social Studies (1st Grade) 1 - Two-Pocket Green Folder with 3-Prong Fasteners for stu- 1 - 2 Gig Flash Drive dents new to the District Headphones or Ear Buds 2 - Travel size hand sanitizer 2nd-3rd: 1 spare folder (2nd Grade) 1 - Two-Pocket Blue Folder with 3-Prong Fasteners for stu- Please have extra folders/notebooks available dents new to the District Art Class Supplies: (In addition to classroom supplies) (3rd Grade) 1 - Two-Pocket Yellow Folder with 3-Prong Fasteners for 4 - #2 Pencils (Ticonderoga or plain yellow) students new to the District 1 - Large plain Pink or White Eraser 1 - Art Bag with 24 count crayons and 3 glue sticks (labeled) 4th-5th: 1 - Two-Pocket Folder with 3-Prong Fasteners for students new 4 - #2 Pencils (Ticonderoga or plain yellow) to the District 1 - Large plain Pink or White Erasers 1 - Art Bag with 12 count or more colored pencils and 3 glue sticks (4th Grade) 1 - Two-Pocket Orange Folder with 3-Prong Fasteners for SIXTH/SEVENTH/EIGHTH GRADES students new to the District Pencils Pens - several - blue, black, red 6th-8th: Sharpie pens (Black - fine and wide line) 4 - #2 Pencils (Ticonderoga or plain yellow) Big eraser 2 - Large Plain Pink or White Erasers 250 count package - Loose Leaf notebook paper 1 - Ultra-fine Sharpie Trapper keeper 3 Glue Sticks Folders for every class Art Bag Spiral notebook for every class 1 - Two-Pocket Folder with 3-Prong Fasteners for 6th grade students new Stretchy book covers for every class to the district Stenographers top-spiral notebook - Mrs. Olson (6th grade only) 1 - 1 ½ inch binder - Mrs. Weber/Mr. Firgens Graph paper - Mr. Anderson HIGH SCHOOL: Crayons 4 - #2 Pencils (Ticonderoga) Colored pencils 2 - White or Pink plain erasers Colored markers 1 - Clic Eraser Dry Erase markers 1 - Ultra-fine Sharpie Highlighter 3 - Glue Sticks Glue or glue stick Spiral Bound Sketchbook (9x11 or 9x12) Scissors Whiteout Wooden ruler ALL HIGH SCHOOL STUDENTS 100 count Pack of colored index cards Large box of Kleenex Ear phones/Ear buds Art Class Supplies: (In addition to classroom supplies) 4 - #2 Pencils (Ticonderoga or plain yellow) PLEASE Be prepared to RESTOCK supplies periodically throughout 2- Large plain Pink or White Erasers 1 - Two-Pocket Folder with 3-Prong Fasteners for 6th grade the year. new to the district only Ultra-fine Sharpie 3 Glue sticks Art bag BLACK HAWK SCHOOL FEES

Curriculum: Book, K-6 (limit 3 per family) ...... ……..$25.00 Book, 7-12 (limit 3 per family) ...... $40.00 Limit three per family (will be the highest three charges, would include 7-12 fees first)

Musical Instrument Rental ...... $35.00 Tech Ed ...... Actual Cost Participation Charge: Forensics ...... $35.00 Athletics Grades 7 & 8 ...... $15.00 Grades 9-12 (3 per family, per season) ...... $35.00

Student Activity Pass ...... $10.00 Available to all district students for high school sponsored athletic events. Any student without an Activity Pass at any given high school event will be charged the full $3.00 admission.

Season Tickets: Season tickets for all home sporting events (excluding W.I.A.A. tournaments) may be purchased. Family Season Pass ...... $40.00 Family Pass includes two adults and students attending Black Hawk School District.

Adult Season Pass ...... $30.00 Senior Citizens Pass, Contact District Office……………………..………………………………………………...Free

Breakfast Prices for one week: Reduced Student ...... $1.00 (.20/day) ECH-6th Grade ...... $6.00 (1.20/day) Grade 7th -12th ...... $7.25 (1.45/day) Adult ...... $9.25 (1.85/day) Lunch Prices for one week: Reduced Student ...... $2.00 (.40/day) ECH-6th Grade ...... $12.75 (2.55/day) Grade 7th -12th ...... $14.50 (2.90/day) Adult ...... $18.00 (3.60/day)

Bus Charge: Athletic Participants ...... no charge School Field Trips ...... no charge Adult Spectator ...... $5.00 Student Spectator ...... $2.00 School District of Black Hawk Regular Meeting April 10, 2017 The meeting of the Black Hawk School District was called to order by President Kerry Holland at 7:00 pm in the Library in South Wayne. Members present were Steve Holland, Kerry Holland, Jason Figi and Gary Signer. Members absent were Carl Huschitt and James Rufenchant. Also present was Administration of William Chambers, Cory Milz and guests. Motion by S. Holland and seconded by Figi to approve the consent to agenda with adding S. Holland to abstaining on the minutes from the Regular meeting on March 13th for the Support staff raises. Motion carried on a voice vote. Administration Reports- Chambers- Would like to Thank Carl Huschitt for his service to the District and the Community and appreciate his insights and on initiatives - Will keep the Board about the State and Federal Funding that affects the District nothing is set yet, Potential effects Fed- eral Level Title II being cut, Idea money going to be affected base on vouchers, transportation aide ??, Categorical Aid potential increase of $200/student and Sparsity Aid potential increase of $100/ student. Insurance from Unity we did get a proposal of a 4.96% increase which is a 1% decrease from earlier numbers, Joint Board meeting went well in Monticello with ideas from other Districts. Pat Baumgartner called about not having a second coach for coaching Softball. Milz- Josh Meier and Sam Lovelace were selected to the Wisconsin Basketball Coaches all Star teams for 2017, State Forensics Competition will be April 22nd in Madison- Those attending will be Josh Meier, Brody Milz, Jason Treuhardt, Hunter Breadson, Mike Flanagan, Cayden Milz, Lucas Flanagan, Hannah Fair and Meghan Stephens; April 29th Solo and Ensemble will be represented with Casi Blosch and Trinity Fitzgerald; ACT average is 20.5 for the 2018 Cohort which matches the state average from last year; Curie Regional Math Competition 7th and 8th grade teams placed 4th , 1st in Team Events, 5th and 6th Grade teams also placed 4th and had the highest point total in 3 years. Upcoming events- end of year field trips and we will be hosting some Track Meets, Large Group Music Festival, Junior Prom. Also the Seal a Smile that was run by Lafayette County Health Services will be discontinued for 2017-18-we will be bring on Bridging Brighter Smiles program for 2017-18 to help provide the service to our families who desire it.

Board of Education Report- Figi -Question was asked that we haven’t hired Herb Tornow as a bus driver and we still haven’t approved the Audit that was performed for the District by Johnson and Block which we should of approved in October or November meeting. Willy will look into and bring to May meeting.

Also looking at the numbers for Softball we should look at a paid JV Coach since we are fielding Varsity and a JV Team.

Public Comment – Mike Flanagan expressed interest in the open positon on the Board and wanted to know what to do. Kerry stated that a letter needed to be submitted to the Board President.

Oath of Office was taken by – Steve Holland & Jon Satterlee

Motion by S. Holland and seconded by Signer to set Special Meeting for April 18th at 7:00 pm to fill open Board Seat. Motion carried on a voice vote.

Motion by S. Holland and seconded by Signer to approve Lunch prices for 2017-18 school year Elementary will be $2.55 and 6-12 will be $2.90. Motion carried on a voice vote.

Motion by Signer and seconded by Flanagan to hire Mike Flanagan as Varsity Girls Basketball Coach for 2017-18 school year. Mo- tion carried on a voice vote.

Motion by S. Holland and seconded by Signer to hire Mike Flanagan as Middle School Girls Basketball Coach for 2017-18 school year. Motion carried on a voice vote.

Motion by Signer and seconded by S. Holland to hire Don Hawkinson as Middle School Boys Basketball Coach for the 2017-18 school year. Motion carried on a voice vote. Motion by S. Holland and seconded by Signer to hire Curt Leuzinger as JV Baseball Coach for 2016-17 school year. Motion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve a hire date of May 1st for the part-time office help that would get hired. Motion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve Dan Teuthhardt as Volunteer Baseball Coach. Mo- tion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve the Fun Run on the Morning of October 7th, 2017. Motion carried on a voice vote. Motion by Signer and seconded by Figi to have Board Employee Dinner on May 6th at 7:30 pm at the Berg in Shullsburg President Declared the 1st Reading of Policy Semester Exam Waiver # 348.1 Motion by S. Holland and seconded by Signer to approve purchase of bus camera through Monroe Truck Equipment. Motion carried on a voice vote. Motion by S. Holland and seconded by S. Holland to approve sponsoring a bus to use for transportation to and from the dairy breakfast at the Shippy Farm. Roger Jackson said he would volunteer to drive the bus. Motion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve Hawkins Ash for the next 3 years to Audit District Books at a total cost of $33,300. Motion carried on a voice vote. Motion by S. Holland and seconded by Signer to approve Open House August 30th,2017 from 4-7 pm. Motion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve 3 new office window in the Office from Guys Home Improvements for $2625; painting of the Library from Complete Painting for $3250 and Library Flooring from HTF doing a 3 coat Epoxy system for $8370. Motion carried on a voice vote. Motion by S., Holland and seconded by Signer to approve the letter that was drafted to be signed so the Funds from the Gladys and Norman Leck Scholarship Fund could be moved from the Hunting National Bank to Woodford State Bank the use of these funds will not change only the Bank holding the account will change. Motion carried on a voice vote. Motion by Signer and seconded by Figi to issue a preliminary notice of non-renewal to Kathy Brandenburg- Neff. Motion carried on a voice vote. Motion by S. Holland and seconded by Signer to adjourn at 8:25pm. Motion carried on a voice vote. Submitted by, Jason Figi, Clerk

School District of Black Hawk Special Meeting April 18, 2017 The meeting of the Black Hawk School District was called to order by President Kerry Holland at 7:00 pm in the Library in South Wayne. Members present were Steve Holland, James Rufenchant, Kerry Holland, Jason Figi and Gary Signer. Members absent were Carl Huschitt. Also present was Admin- istration of William Chambers and Guests. The purpose of this meeting was to fill the positon that was vacated by Tara Herbst. Motion by Figi and seconded by S. Holland to approve the consent to agenda. Motion carried on a voice vote. The following individuals submitted letters to the Board President showing interest in sitting on the Board- Alicia Sigafus, Mike Flanagan, Adam Metz and Jason Herbst they were all present at the meeting. Kerry Holland read the Board Policy for filling vacancies Policy # 133 We then drew names in the order for addressing the Board- 1st – Adam Metz 2nd – Jason Herbst 3rd -Mike Flanagan 4th – Alicia Sigafus After they all addressed the Board a vote was taken by written ballot and the votes were Adam-0, Ja- son-0, Mike-4 and Alicia-3 per policy the low vote getter name is thrown out since we had 2 with a ze- ro both were thrown out and votes were taken again with Mike and Alicia. Ballots were counted again and Mike-4 and Alicia-3 School District of Black Hawk

Regular Meeting

May 8, 2017

The meeting of the Black Hawk School District was called to order by President Kerry Holland at 7:14 pm in the Library in South Wayne. Members present were James Rufenchant, Steve Holland, Kerry Holland John Satterlee, Mike Flanagan, Jason Figi and Gary Signer. Also present was Administration of William Chambers, Cory Milz and guests.

Motion by Figi and seconded by S. Holland to approve the consent to amended agenda. Motion carried on a voice vote.

Administration Report-

Chambers- Mary Ellingston did the CPR training for the school staff and did a good job, Senator Howard Marklin stopped in to get feedback on state budget may look at a $299 increase per student. Welcome to the Mike Flanagan and John Satterlee, will be teaching a class at UW Platteville and have put in for a leave request on those days, new floor scheduled for July 10th install in the library, Custodial will be working 4-10 hours’ days and office will be open every day with the staff alternating with a Monday- Thursday and Tuesday – Friday schedule, on the staff development day gave all staff a $35 Gift Card to all, we have resignations and will be looking at filling them, have applied for the WTI Grant

Milz- State Forensics was held on April 22nd, State Solo and Ensemble was held on April 29th, April 29th Prom was held and thanks to the parents for hosting the Post Prom at the Dells, May 4th will have a program for Freshman and Sophomores about the dangers of Heroin use and addiction, May 5th students were treated to the Bouncy House and Ice Cream through the Gotcha Program Thanks to the Parents Club for their support and funding to make it happen, May 10th had Fuel to play program, May 10th will be Scholarship Night, May 15th in the AM the ASVAB Test will be administered to the Sophomores, Senior Exams will be on May 23rd and 24th, High School Graduation will be May 26th at 7pm and 8th Grade Promotion will be June 1st at 7pm.

Board of Education- S. Holland stated that the Board Employee dinner at the Burg was well attended and Good. Kerry Holland welcomed the new board members and let Mike Flanagan know that he will be filing the vacated seat of Tara Herbst and John Satterlee will have the 3-year term.

Public comment was called for – Lowell Delsarno asked if the school could be opened to the Public for use.

Motion by Figi and seconded by Flanagan to approve open enrolments as presented 3 IN and 10 Out. Motion carried on a voice vote.

Motion by Rufenchant and seconded by Flanagan to accept the Resignation of Ashley Thoel’s at the end of the school year. Motion carried on a voice vote.

Motion by Signer and seconded by Satterlee to accept the Resignation of Justin Doyle’s at the end of the school year. Motion carried on a voice vote.

Motion by Signer and seconded by Flanagan to issue and approve a non-renewal of food service to Kathy Brandenbury-Neff. Motion carried on a voice vote.

Motion by Signer and seconded by Flanagan to approve Wavier Policy # 348.1. Motion carried on a voice vote.

Motion by S. Holland and seconded by Satterlee to approve contracts for Teachers for the 2017-18 school year as presented. Motion carried on a voice vote. Figi, Signer and Flanagan Abstained.

Motion by Signer and seconded by Flanagan to approve contracts for the non-certified staff for the 2017-18 school year. Motion carried on a voice vote. S. Holland Abstained.

Motion by Signer and seconded by Figi to hire Summer Custodial help of Rhonda Lincicum, Darlene Foster and Lisa Flanagan for 180 hours each. Motion carried on a voice vote. Flanagan Abstained

Motion by Signer and seconded by Rufenchant to hire Angie Butler as JV Basketball coach for the 2017-18 school year if the numbers show the need. Motion carried on a voice vote.

Motion by S. Holland and seconded by Satterlee to hire Bruce Jackson as JV Softball Coach for the 2016-17 school year. Motion carried on a voice vote.

Have Policy Committee look into setting up a direction for number of coaches versus the number of players and have some coaches sit in on the discussion.

Motion by Signer and seconded by S. Holland to hire Herb Tornow as Bus Driver recto to July 1, 2016. Motion carried on a voice vote.

Motion by Flanagan and seconded by S. Holland to hire Jennifer Schiferl for the e.5 FTE office position. Motion carried on avoice vote.

Motion by Signer and seconded by S. Holland to approve the SECA Contract for 2017-18 School Year. Motion carried on a voice vote.

Motion by S. Holland and seconded by Flanagan to approve a 2% Extra Curricular for the Website and Facebook Maintenance based on base Salary. Motion carried on a voice vote.

Motion by Flanagan and seconded by Figi to approve the WIAA Contract for the 2017-18 school year. Motion carried on a voice vote.

Motion by Figi and seconded by S. Holland to approve the Audit Report that was prepared by Johnson and Block. Motion carried on a voice vote.

Motion by Signer and seconded by S. Holland to approve the 2016-17 Membership Audit prepared by Johnson and Block. Mo- tion carried on a voice vote.

Motion by Signer and seconded by Satterlee to purchase 2 Blue Bird Buses from Wisconsin Bus Sales for Delivery after July 1st,2017 with Diesel engines and Air Brakes. Motion carried on a voice vote.

No information was presented for Insurance so no action was taken on it.

Motion by S. Holland and seconded by Flanagan to adjourn @ 9:55pm. Motion carried on a voice vote.

Submitted by,

Jason Figi, Clerk School District of Black Hawk Organizational Meeting May 8, 2017 The meeting of the Black Hawk School District was called to order by President Kerry Holland at 7:00 pm in the Library in South Wayne. Members present were James Rufenchant, Steve Holland, Kerry Holland John Satterlee, Mike Flanagan, Jason Figi and Gary Signer. Also present was Administration of William Chambers, Cory Milz and guests. Motion by Figi and seconded by Signer to approve the consent to agenda. Motion carried on a voice vote. Public Comment was called for – None Motion by Figi and seconded by Signer to cast a unanimous ballot for Kerry Holland as President. Motion carried on a voice vote. Kerry Holland was declared President. Motion by Signer and seconded by Rufenchant to cast a unanimous ballot for Steve Holland as Vice Presi- dent. Motion carried on a voice vote. Steve was declared Vice President. Motion by Signer and seconded by Rufenchant to cast a unanimous ballot for Jason Fig as Clerk. Motion carried on a voice vote. Jason Figi was declared Clerk. Motion by Figi and seconded by Flanagan to cast a unanimous ballot for Gary Signer as Treasurer. Motion carried on a voice vote. Gary Signer was declared Treasurer. Motion by Signer and seconded by S. Holland to designate The Monroe Times as the official newspaper. Mo- tion carried on a voice vote. Motion by Flanagan and seconded by S. Holland to designate First National Bank of Darlington Gratiot Branch as the official Depository. Motion carried on a voice vote. Motion by Figi and seconded by Signer to have Kerry Holland as WASB Convention Delegate. Motion carried on a voice vote. Motion by S. Holland and seconded by Flanagan to have Jason Figi as WASB Convention Delegate Alternate. Motion carried on a voice vote. Motion by Signer and seconded by Figi to have Flanagan as CESA 3 Delegate. Motion carried on a voice vote. Motion by Figi and seconded by S. Holland to adjourn at 7:14pm. Motion carried on a voice vote.

Submitted by,

Jason Figi, Clerk School District of Black Hawk

Regular Meeting

June 12, 2017

The meeting of the Black Hawk School District was called to order by President Kerry Holland at 7:00 pm in the Library in South Wayne. Members present were James Rufenchant, Steve Holland, Kerry Holland Mike Flanagan and Jason Figi Also present was Administration of William Chambers and guests. Members absent were Gary Signer and John Satterlee, and Cory Milz was absent.

Motion by S. Holland and seconded by Flanagan to approve the consent to amended agenda. Motion carried on a voice vote.

Administration Report-

Chambers- Custodians have begun work on making the building a more inviting learning environment, ceiling and some electrical concerns are being addressed in Mr. Beach’s room, work will start on cleaning out the Library for the painting and new floor that will take place in July, we are still waiting to hear about the Round 11 WTI Grant if awarded it will assist in the transition of the computer lab into a collaboration room, in the near future I will be seeking the use of the Gratiot Gym from the Village, we have had 3 staff resign and are looking to replace them, Mr. Laird didn’t return his letter for coaching Baseball and Mr. Milz talked to him and he will not be doing it next year, Chambers will be presenting a AGR Report that is required at the end of the year and Cham- bers will be bring changes to the Handbook for next year.

Board of Education – Figi-It was brought up that the Grounds look very poor with all the tall weeds growing up in the fence and the weeds down by the dumpsters. Also we had a track meet and the weeds were as tall as the picnic table that was setting down by the track. Also water was setting down by where people had to walk through on the day that we had a track meet we could have put something down. Also a load of lime was dumped right by the ball diamond by the road and still isn’t cleaned up. We need to do a better job of making the school look good we need it to look like a 5-million-dollar business and not a dump.

Public Comment was called for none.

Discussion Items-

Attendance of staff at Graduation and Promotions Chambers feels that we need to have in the hand book that all staff f is required to attend. Chambers stated that the attendance has gone down with staff attending. Question was asked how many attended but that really wasn’t know. Chambers only stated that he had heard that there was a concern about the number of staff attending the Celebrations. Discussion was had about that and the Board feels that it shouldn’t be a requirement to attend the promotions and graduation. But for the ones that attend we need to at least recognize them. It was decided that the best thing is have in the handbook that would like them to attend.

Athletic Play time went over what they think should be in the Activities Code

Still working on the number of coaches for sporting events will be bring something in the future.

Looking at replacing the phone system will get better 3’s and a timeline in the future.

Scott Nelson presented information about the live animal lab and stated the Justin Doyle is doing a very good job getting everything in line for it.

Motion by S. Holland and seconded by Rufenchant to approve the live animal lab contract with Zimmer Design LLC. Motion carried on a voice vote.

Motion by Flanagan and seconded by S. Holland to approve the purchase of a bus camera from Monroe Truck Equipment. Motion carried on a voice vote.

Motion by S. Holland and seconded by Figi to approve doing a Fall Consignment Auction with Powers Auctions date to be determined. Motion carried on a voice vote.

No action was taken on the Heat/AC Service contract since all the bids were not in.

Motion by Flanagan and seconded by S. Holland to set the High School Graduation date of May 25th, 2018 @ 7:00pm. Motion carried on a voice vote.

Motion by Flanagan and seconded by S. Holland to set the 8th Grade Promotion date on May 31st, 2017 @ 7:00 pm. Motion carried on a voice vote.

Motion by S. Holland and seconded by Figi to approve the Resignation of Shelley Weber as Science Teacher and Thank her for her years of service. Motion carried on a voice vote.

Motion by S. Holland and seconded by Flanagan to approve payout of sick days remaining at the end of the year June 30th, 2017 for Diane Goodrich @ $15/per day. Motion carried on a voice vote.

Motion by Rufenchant and seconded by S. Holland to hire Dakota Bockehhauer as Tech Ed Teacher pending getting the necessary License. Motion carried on a voice vote.

Motion by S. Holland and seconded by Flanagan to hire Curt Leuzinger as Head Softball Coach for 2017-18 School Year. Motion carried on a voice vote.

Motion by Figi and seconded by Flanagan to set June 30th, 2017 at Noon for the Special Meeting. Motion carried on a voice vote.

Motion by S. Holland and seconded by Rufenchant to approve short term borrowing with First National Bank Darlington- Gratiot Branch. Motion carried on a voice vote.

Motion by S. Holland and seconded by Rufenchant to approve the continued coverage with Unity Health Insurance for 2017- 18. Motion carried on a voice vote.

Motion by Rufenchant and seconded by S. Holland to approve the continued coverage with Delta Dental for 2017-18. Motion carried on a voice vote.

Motion by S. Holland and seconded by Flanagan to adjourn @ 8:28pm. Motion carried on a voice vote.

Submitted by,

Jason Figi, Clerk School District of Black Hawk Special Meeting June 30, 2017 The meeting of the Black Hawk School District was called to order by President Kerry Holland at 12:00pm in the District Office in South Wayne. Members present were Gary Signer, Steve Holland, Kerry Holland Mike Flanagan and Jason Figi Also present was Administration of William Chambers and guests. Members absent were James Ru- fenchant and John Satterlee, and Cory Milz was absent. Motion by S. Holland and seconded by Flanagan to approve consent to amended agenda. Motion carried on a voice vote. Administration Report- Chambers- Custodial Crews are busily working on Summer Projects. Public Comment was called for- None Motion by S. Holland and seconded by Flanagan to purchase 30 Chrome Books from Heartland Business Systems at a cost of $6,522.60. Motion carried on a voice vote. Motion by S. Holland and seconded by Signer to approve the milk bid from Prairie Farms for the 2017-18 School Year. Motion carried on a voice vote. Motion by Flanagan and seconded by S. Holland to approve the resignation of Kristina Rynes from her coaching duties. Motion carried on a voice vote. Motion by Signer and seconded by Flanagan to hire Scott Cernek as Head Baseball Coach for the 2017-18 School Year. Motion carried on a voice vote. Motion by S. Holland and seconded by Flanagan to approve Shelley Weber as a Volunteer Supervisor for the Rural Summer Science Camp from July 10-13,2017. Motion carried on a voice vote. Motion by S. Holland and seconded by Signer to approve Monroe Heating and Sheet Metal as HVAC Service Con- tract for the 2017-18 School Year at a cost of $5,781.46. Motion carried on a voice vote. Motion by Flanagan and seconded by S. Holland to acknowledge the Achievement Gap Reduction Presentation. Mo- tion carried on a voice vote. Motion by Signer and seconded by S. Holland to approve the changes for the Employee Handbook for the 2017-18 School Year as presented. Motion carried on a voice vote. Motion by S. Holland and seconded by Flanagan to adjourn at 12:41pm. Motion carried on a voice vote.

Submitted by, Jason Figi, Clerk School-Based Dental Program

Bridging Brighter Smiles, Inc. offers preventative dental care right at school for students Pre-K through 12th grade. Visits are held throughout the school year.

Services Provided Include: Oral Screenings Cleanings Fluoride Varnish Dental Sealants (prevents cavities) Dental Health Education Referral Assistance

To enroll in the program please complete the enclosed one page Enrollment Form and return it back to any school office, fax it to 262-347-4449, or scan and email it back to [email protected].

We accept the Forward Health (BadgerCare) Card! (We do not bill/accept other private dental insurances)

Questions? Call 262-896-9891 www.bridgingbrightersmiles.org

Bridging the gap in dental care by offering access to services, building wellness relationships within communities and educating students to instill life-long healthy habits. Bridging Brighter Smiles, Inc. Enrollment Form Questions? Please feel free to call (262) 896-9891 Scan and email forms to [email protected] or Fax forms to (262) 347-4449

Name of School: ____Black Hawk______Student Enrollment Black Hawk

Yes, please enroll my dependent.

First Name:______Last:______Middle:______

Date of Birth:______Sex: Male Female

Race: (Optional) White Hispanic Black Asian Native American Other:______

Type of Dental Insurance: BadgerCare/Forward Health No Insurance Other

Parent/Guardian First Name:______Last:______

Primary/Day Phone:______E-mail:______

Address:______

City/State/Zip:______Student Health History

If yes please explain, be specific.

Does your dependent have any allergies? (Bridging Brighter Smiles, Inc. is Latex Free):______YES NO

Has your dependent been diagnosed with a physical or mental disability?______YES NO

YES NO Does your dependent use medicine prescribed by a doctor?______

Authorization I understand that by signing this form, initial and ongoing preventative oral care treatment will be provided for my dependent. This consent is good for two school years. I have the ability to dis- enroll at any time by written withdrawal of consent. I authorize BadgerCare/Medicaid insurance payments for services rendered to Bridging Brighter Smiles, Inc. and agree to pay any BadgerCare/Medicaid copays. If my dependent is not insured through BadgerCare/Medicaid insurance, I agree to pay the attached standard fees for services rendered.

Parent/Guardian Signature:______Date:______Initial Here I have received the enclosed Notice of Privacy Practices and Coverage Information, and I have been provided an opportunity to review it.

It is still strongly recommended that you seek out a dental home (family dentist) for routine dental care including any follow up care which may be recommended by this school based oral health program. School Office 17.18 Bridging Brighter Smiles, Inc. Coverage Information

Questions? Call (262) 896-9891 www.bridgingbrightersmiles.org

Forward Health (BadgerCare) Card Accepted!

Initial and ongoing preventative oral care treatment is covered for students with the Forward Health (BadgerCare) Card.

If Your Dependent Does Not Have the Forward Health (BadgerCare) Card See Fees Below (PLEASE NOTE: Bridging Brighter Smiles Does Not Accept Private Dental Insurance.)

Oral Screening $15.00 Cleaning $32.00 Fluoride Application $18.00 Sealants $25.00/Tooth Fees are subject to change without notice.

For private or no dental insurance participants your dependent will receive a screening, cleaning, and fluoride varnish application on average every 6 months. Please notify us if you would prefer services one time per school year only.

Prior to sealant placement you will be contacted by the Bridging Brighter Smiles coordinator for prior authorization. Bridging Brighter Smiles, Inc. - Confidentiality Notice

This notice describes how medical and drug and alcohol related information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

GENERAL INFORMATION: Information about your treatment and care, including payment for care, is protected by two federal laws-

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Confidentiality Law. Under these laws the program may not say to a person outside of the program that you attend the program, nor may the program disclose any information identifying you as an alcohol or drug abuser, or disclose any other protected information except as permitted by the federal laws referenced below.

The program must obtain your written consent before it can disclose information about you for payment purposes. For example, the program must obtain your written consent before it can disclose information to your health insurer in order to be paid for services. Generally, you must also sign a written consent before the program can share information for treatment purposes or for health care operation. However, federal law permits the program to disclose information in the following circumstances without your written permission:

To program staff for purposed of providing treatment and maintaining the clinical record; Pursuant to an agreement with a business associate (e.g. clinical laboratories, pharmacy, record storage services, billing services); For research, audit or evaluations (e.g. State licensing review, accreditation, program data reporting as required by the State and/or Federal government); To report a crime committed on the program’s premises or against program personnel; To medical personnel in a medical/psychiatric emergency; To appropriate authorities to report suspected child abuse or neglect; To report certain infectious illnesses as required by state law; As allowed by a court order.

Before the program can use or disclose any information about your health in a manner which is not described above, it must first obtain your specific written consent allowing it to make the disclosure. Any such written consent may be revoked by you in writing. (NOTE: Revoking consent to disclose information to a court, probation department, parole office, etc may violate an agreement that you have with that organization. Such a violation may result in legal consequences for you.)

CONFIDENTIALITY NOTICE, YOUR RIGHTS: Under HIPAA you have the right to request restrictions on certain uses and disclosures of your health and treatment information. The program is not required to agree to any restrictions that you request, but if it does agree with them, it is bound by that agreement and may not use or disclose any information which you have restricted except as necessary in a medical emergency. You have the right to request that we communicate with you by alternative means or at an alternative location ( e.g. another address). The program will accommodate which requests that are reasonable and will not request an explanation from you. Under HIPAA you also have the right to inspect and copy your own health and treatment information maintained by the program, except to the extent that the information contains psychotherapy notes or information compiled for use in a civil, criminal or administrative proceeding or in other limited circumstances. Under HIPAA you also have the right, with some exceptions, to amend health care information maintained in the program’s records, and to request and receive an accounting of disclosures of your health related information made by the program during the six (6) years prior to your request. If your request to any of the above is denied, you have the right to request a review of the denial by the program Administrator. To make any of the above requests, you must fill out the appropriate form that will be provided by the program.

THE USE OF YOUR INFORMATION AT THE PROGRAM: In order to provide you with the best care, the program will se your health and treatment information in the following ways: Communication among program staff (including students or other interns) for the purposes of treatment needs, treatment planning, progress reporting and review, staff supervision, incident reporting, medication administration, billing operations, medical record maintenance, discharge planning, and other treatment related processes. Communication with Business Associates such as clinical laboratories, food service , agencies that provide on-site services, and long term record storage.

THE PROGRAM’S DUTIES: The program is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. The program is required by law to abide by the terms of this notice. The program reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information it maintains. The program will provide current patients with an updated notice, and will provide affected former patients with new notices when substantive changes are made in the notice.

BLACK HAWK SCHOOL DISTRICT BOARD OF EDUCATION WASB CODE: 411.1

BULLYING The Black Hawk School District is committed to providing a safe, caring, respectful learning environment for all students and staff and strictly enforces a prohibition against bullying.

DEFINITION: “Bullying” can include, but is not limited to: Intimidation and/or harassment such as teasing, put-downs, cruel rumors, false accusations, hazing, name-calling or making threats; Social alienation, exclusion and isolation such as shunning or spreading rumors; Extortion; Written notes, phone calls or electronic messages that are offensive, hurtful, slanderous, threatening, embarrassing, intimidating, insulting, degrading, or stereotyping; Verbal aggression or verbal assaults which are offensive, hurtful, slanderous, threatening, embarrassing, intimidating, insulting, degrading, or stereotyping; Nonverbal or emotional threats or intimidation; Any act, attempted act or threat of physical aggression such as assaults on a student or attacks on a student’s property; Any act which threatens or intimidates any person or group because of sex, race, religion, national origin, color, disability, sexual orientation, age, or other protected status.

“Bullying” includes aggression or hostile behavior that is intentional and involves an imbalance of power between the bully and the bullied. The behavior is typically repeated over time.

PROHIBITION: “Bullying” behavior by students and staff is prohibited whether it is of the nature of student(s) to student(s), staff member to staff member, staff member to student or student to staff member. Bullying is prohibited at school, on school premises, during school sponsored activities, on school buses and at bus stops, or through the use of electronic, computer, and telecommunications messaging devices (cyber bullying).

COMPLAINT PROCEDURES: It is considered a responsibility of all students and staff members to watch for and report acts of bullying in any of the above-described situations to a member of the school staff or administration. Students are requested and encouraged to report acts of bullying to a school staff member, building principal, or at a minimum a parent or other adult. All school district staff members are required to report acts of student bullying to their building principal or designee.

All reports are to be taken seriously. School staff and administrators will support students and coworkers making such reports and protect against any potential retaliation for making such a report.

An investigation to determine the facts will take place immediately or as soon as practicable in order to verify the validity and seriousness of the report.

Filing a report in good faith will not reflect upon the individual’s status, nor will it affect his or her grades if the complainant is a student or employment status by the District if the complainant is an adult staff member.

CONSEQUENCES: Where it is determined that students participated in bullying behavior in violation of the policy, the school may take disciplinary actions including suspension, expulsion and referral to law enforcement for legal action when deemed appropriate. Employees found to have participated in bullying behavior, or having become aware that bullying was taking place and failed to take action or to report the behavior, are considered to be in violation of the prohibition expressed by the policy and, therefore, subject to disciplinary action consistent with the relevant collective bargaining agreement or, for non-bargaining unit employees, consistent with the relevant contract or handbook.

LEGAL REF.: Sections 118.02(18) Wisconsin Statutes 118.164(2) 120.13(1) APPROVED:

CODE: 411 – EXHIBIT 1 BULLYING INCIDENT REPORT FOR USE WHEN REPORTING BULLYING INCIDENTS AT SCHOOL. IT MAY BE USED BY SCHOOL AND POLICE OFFICIALS WHEN INVESTIGATING THIS OR OTHER RELATED INCIDENTS.

REPORT MADE BY:______DATE:______

LOCATION/S OF INCIDENT/S:______

DATE OF INCIDENT:______APPROXIMATE TIME OF INCIDENT______

TYPE OF BULLYING: CIRCLE THOSE THAT APPLY:

KICKING TEASING HITTING EMBARASSMENT NAME CALLING PUSHING TRIPPING RUDE GESTURES SPITTING INSULTING DISCRIMINATION CYBER-BULLYING HAZING PUT DOWNS INTIMIDATION HATE NOTES SPREADING RUMORS EXCLUSION OTHER

PLEASE DESCRIBE IN DETAIL EXACTLY WHAT OCCURRED, ANYONE WHO WAS INVOLVED, POSSIBLE WITNESSES. IF THE INCIDENT WAS WRITTEN, A TEXT MESSAGE OR EMAIL, OR WAS PLACED ON A COMPUTER, PLEASE PROVIDE A COPY.

______

I CERTIFY THAT ALL STATEMENTS MADE ABOVE ARE TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I FALSIFY THIS DOCUMENT, I CAN BE HELD SUBJECT TO CONSEQUENCES AT SCHOOL AND BY LEGAL AUTHORITIES. SIGNATURE DATE

FOOD SERVICE INFORMATION

With the start of the new school year, there will be some changes within the food service program.

First, the lunch prices have increased. Lunch will be $2.55 for ECH-6th grade, and $2.90 for 7th-12th grade.

Secondly, the payment information is a follows:

Skyward is the computerized prepayment system for school meals in our district. This is a debit balance system where funds are placed in advance on the account and purchases are drawn against the balance. The program is not a credit system. Students are issued a 4-digit pin number, which is assigned to them when they first enter the district. Our policy requires all family accounts have a positive balance in order to purchase meals, extra milk, or a la carte items.

If a family account balance reaches a low balance, a weekly email/computerized phone call will be sent out to the parents. Please send a payment to school when you get this low balance or a negative account balance call.

You can check family account balances through the Family Access portal on our website. If you have any questions on your family account balance, please call Audrey Wells at 439-5400, ext. 110. PUBLIC RELEASE NATIONAL SCHOOL LUNCH AND BREAKFAST PROGRAMS This is the public release that we will send to: The Monroe Times, South Wayne and Gratiot Post Offices, Woodford and First National Bank at Darlington/Gratiot, and the South Wayne Food Pantry on August 7, 2017. RELEASE STATEMENT The School District of Black Hawk today announced its policy for children unable to pay the full price of meals served under the National School Lunch Program and School Breakfast Program. Each school office and the central office has a copy of the policy, which may be reviewed by any interested party. The following household size and income criteria will be used for determining eligibility. Children from families whose annual income is at or below the levels shown are eligible for free and reduced price meals. FAMILY SIZE INCOME SCALE For Determining Eligibility for Free and Reduced Price Meals or Milk

ANNUAL INCOME LEVEL MONTHLY INCOME LEVEL Free Reduced Price Free Reduced Price Family Must be at or below Must be at or between Must be at or below Must be at or between (Household) Size figure listed figures listed figure listed figures listed 1 $15,678 $ 15,678.01 and $22,311 $ 1,307 $ 1,307.01 and $1,860 2 21,112 21,112.01 and 30,044 1,760 1,760.01 and 2,504 3 26,546 26,546.01 and 37,777 2,213 2,213.01 and 3,149 4 31,980 31,980.01 and 45,510 2,665 2,665.01 and 3,793 5 37,414 37,414.01 and 53,243 3,118 3,118.01 and 4,437 6 42,848 42,848.01 and 60,976 3,571 3,571.01 and 5,082 7 48,282 48,282.01 and 68,709 4,024 4,024.01 and 5,726 8 53,716 53,716.01 and 76,442 4,447 4,447.01 and 6,371 For each additional household member, add + 5,434 + 5,434 and +7,733 + 453 + 453 and + 645

Application forms are being sent to all homes with a notice to parents or guardians. To apply for free or reduced price meals or free milk, households must fill out the application and return it to the school (unless notified at the start of the school year that children are eligible through direct certification). Additional copies are available at the office in each school. The information provided on the application will be used for the purpose of determining eligibility and may be verified at any time during the school year by agency or other program officials. Applications may be submitted at any time during the year. To obtain free or reduced price meals or free milk for children in a household where one or more household members receive FoodShare, FDPIR, or Wisconsin Works (W-2) cash benefits, list the FoodShare, FDPIR or W-2 case number, list the names of all school children, sign the application, and return it to the school office. For the school officials to determine eligibility for free or reduced price meals or free milk of households not receiving FoodShare, FDPIR or W-2 cash benefits, the household must provide the following information requested on the application: names of all household members, total number of household members, and the adult signing the application form must also list the last four digits of his or her Social Security Number or mark the box to the right of “Check if no SSN”. Also, the income received by each household member must be provided by amount and source (wages, welfare, child support, etc.). Under the provisions of the free and reduced price meal and free milk policy, the Food Service Administrative Assistant will review applications and determine eligibility. If a parent or guardian is dissatisfied with the ruling of the official, he/she may wish to discuss the decision with the determining official on an informal basis. If the parent/guardian wishes to make a formal appeal, he/she may make a request either orally or in writing to: William Chambers, 202 East Center St., P.O. 303, South Wayne WI 53587, (609) 439-5400. If a hearing is needed to appeal the decision, the policy contains an outline of the hearing procedure. If a household member becomes unemployed or if the household size changes, the family should contact the school. Such changes may make the household eligible for reduced price meals or free meals or free milk if the household income falls at or below the levels shown above, and they may reapply at that time. Children formally placed in foster care are also eligible for free meal benefits. Foster children may be certified as eligible without a household application. Households with foster children and non-foster children may choose to include the foster child as a household member, as well as any personal income available to the foster child, on the same application that includes their non-foster children. The information provided by the household on the application is confidential. Public Law 103-448 limits the release of student free and reduced price school meal eligibility status to persons directly connected with the administration and enforcement of federal or state educational programs. Consent of the parent/guardian is needed for other purposes such as waiver of text book fees.

Non-discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

(2) fax: (202) 690-7442; or

(3) email: [email protected].

This institution is an equal opportunity provider.

Any questions regarding the application should be directed to the determining official. FREQUENTLY ASKED QUESTIONS ABOUT FREE AND REDUCED PRICE SCHOOL MEALS FOR SCHOOL YEAR 2017-18

Dear Parent/Guardian:

Children need healthy meals to learn. The School District of Black Hawk offers healthy meals every school day. Breakfast costs $1.20 and lunch costs $2.55 for children in ECH – 6th grade. Breakfast costs $1.45 and lunch costs $2.90 for children in 7th - 12th grade. Your children may qualify for free meals or for reduced price meals. Reduced price is $.20 for breakfast and $.40 for lunch. This packet includes an application for free or reduced price meal benefits, and a set of detailed instructions. Below are some common questions and answers to help you with the application process.

1. WHO CAN GET FREE OR REDUCED PRICE MEALS?  All children in households receiving benefits from FoodShare, the Food Distribution Program on Indian Reservations (FDPIR)], or W-2 cash benefits are eligible for free meals.  Children in households that receive Medicare benefits may qualify for free or reduced price meals.  Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals.  Children participating in their school’s Head Start program are eligible for free meals.  Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.  Children may receive free or reduced price meals if your household’s income is within the limits on the Federal Income Eligibility Guidelines. Your children may qualify for free or reduced price meals if your household income falls at or below the limits on this chart. FEDERAL ELIGIBILITY INCOME CHART For School Year 2017-2018 Household size Yearly ($) Monthly ($) Weekly ($) 1 22,311 1,860 430 2 30,044 2,504 578 3 37,777 3,149 727 4 45,510 3,793 876 5 53,243 4,437 1,024 6 60,976 5,082 1,173 7 68,709 5,726 1,322 8 76,442 6,371 1,471 Each additional person: 7,733 645 149

2. HOW DO I KNOW IF MY CHILDREN QUALIFY AS HOMELESS, MIGRANT, OR RUNAWAY? Do the members of your household lack a permanent address? Are you staying together in a shelter, hotel, or other temporary housing arrangement? Does your family relocate on a seasonal basis? Are any children living with you who have chosen to leave their prior family or household? If you believe children in your household meet these descriptions and have not been told your children will get free meals, please call the School District of Black Hawk at (608) 439-5371, ext 100.

3. DO I NEED TO FILL OUT AN APPLICATION FOR EACH CHILD? No. Use one Free and Reduced Price School Meals Application for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information. Return the completed application to: the Food Service Administrative Assistant, 202 East Center St., P.O. Box 303, South Wayne WI 53587.

4. SHOULD I FILL OUT AN APPLICATION IF I RECEIVED A LETTER THIS SCHOOL YEAR SAYING MY CHILDREN ARE ALREADY APPROVED FOR FREE OR REDUCED PRICE MEALS? No, but please read the letter you got carefully and follow the instructions. If any children in your household were missing from your eligibility notification, contact the Food Service Administrative Assistant, 202 East Center St., P.O. Box 303, South Wayne WI 53587, (608) 439-5400 ext. 110.

5. If your household has automatically qualified for reduced meals based on Medicare, we encourage you to complete an application to potentially qualify for free meals based on household size and income. 6. DO I NEED TO FILL OUT AN APPLICATION IF MY CHILD ATTENDS A COMMUNITY ELIGIBILITY PROVISION SCHOOL (CEP)? If your child attends a school that participates in CEP, receipt of free breakfast and lunch meals does not depend on returning this application. However, this information is necessary for other programs and may be used to determine if your household is eligible for additional benefits.

7. MY CHILD’S APPLICATION WAS APPROVED LAST YEAR. DO I NEED TO FILL OUT A NEW ONE? Yes. Your child’s application is only good for that school year and for the first few days of this school year, through October 13, 2017. You must send in a new application unless the school told you that your child is eligible for the new school year. If you do not send in a new application that is approved by the school or you have not been notified that your child is eligible for free meals, your child will be charged the full price for meals.

8. I GET WIC. CAN MY CHILDREN GET FREE MEALS? Children in households participating in WIC may be eligible for free or reduced price meals. Please send in an application.

9. WILL THE INFORMATION I GIVE BE CHECKED? Yes. We may also ask you to send written proof of the household income you report.

10. IF I DON’T QUALIFY NOW, MAY I APPLY LATER? Yes, you may apply at any time during the school year. For example, children with a parent or guardian who becomes unemployed may become eligible for free and reduced price meals if the household income drops below the income limit.

11. WHAT IF I DISAGREE WITH THE SCHOOL’S DECISION ABOUT MY APPLICATION? You should talk to school officials. You also may ask for a hearing by calling or writing to: William Chambers, 202 East Center St., P.O. Box 303, South Wayne, WI 53587, (608) 439-5400.

12. MAY I APPLY IF SOMEONE IN MY HOUSEHOLD IS NOT A U.S. CITIZEN? Yes. You, your children, or other household members do not have to be U.S. citizens to apply for free or reduced price meals.

13. WHAT IF MY INCOME IS NOT ALWAYS THE SAME? List the amount that you normally receive. For example, if you normally make $1000 each month, but you missed some work last month and only made $900, put down that you made $1000 per month. If you normally get overtime, include it, but do not include it if you only work overtime sometimes. If you have lost a job or had your hours or wages reduced, use your current income.

14. WHAT IF SOME HOUSEHOLD MEMBERS HAVE NO INCOME TO REPORT? Household members may not receive some types of income we ask you to report on the application, or may not receive income at all. Whenever this happens, please write a 0 in the field. However, if any income fields are left empty or blank, those will also be counted as zeroes. Please be careful when leaving income fields blank, as we will assume you meant to do so.

15. WE ARE IN THE MILITARY. DO WE REPORT OUR INCOME DIFFERENTLY? Your basic pay and cash bonuses must be reported as income. If you get any cash value allowances for off-base housing, food, or clothing, it must also be included as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. Do not include any combat pay resulting from deployment as income.

16. WHAT IF THERE IS NOT ENOUGH SPACE ON THE APPLICATION FOR MY FAMILY? List any additional household members on a separate piece of paper and attach it to your application.

17. MY FAMILY NEEDS MORE HELP. ARE THERE OTHER PROGRAMS WE MIGHT APPLY FOR? To find out how to apply for FoodShare or other assistance benefits, contact your local assistance office or call 1-800-362-3002.

If you have other questions or need help, call (608) 439-5400 ext 110.

Sincerely,

Food Service Administrative Assistant 2017-2018 Household Application for Free and Reduced Price School Meals Apply online at: (Schools insert link to your online application, if applicable, or delete). Complete one application per household. Please use a pen (not a pencil). In Community Eligibility Schools (CEP), receipt of free breakfast and lunch meals does not depend on returning this application; however, this information is necessary for other programs.

STEP 1 List ALL infants, children, and students up to and including grade 12 who are Household Members If more spaces are required for additional names, attach another sheet of paper. Definition of Household Member: “Anyone who is living with you and shares income and expenses, even if not related.” School the child attends or Homeless, Foster Migrant, Head Child’s First Name MI Child’s Last Name Grade NA if not in school Child Runaway Start

that apply ck all

Che

STEP 2 Do any Household Members (including you) currently participate in any of the following assistance programs: FoodShare, W-2 Cash Benefits, or FDPIR? Yes / No Case Number Program Name

If you answered NO > Complete STEP 3. If you answered YES > Write a case number here, then go to STEP 4 (Do not complete STEP 3) Write only one case number in this space. Badger Care does not qualify for free meals. STEP 3 Report Income for ALL Household Members (Skip this step if you answered ‘Yes’ to STEP 2) Flip the page and review the charts titled “Sources of Income” for more information. How often?

A. Child Income Child income Weekly Bi-Weekly 2x Month Monthly Sometimes children in the household earn income. Please include the TOTAL income earned by all infants, children, and students up to

and including grade 12 listed in STEP 1 here. $ B. All Adult Household Members (including yourself) List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total gross income (before taxes) for each source in whole dollars only (no cents). If they do not receive income from any source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report. F. Seasonal Workers, and others with fluctuating D. Public Assistance/ E. Pensions/Retirement/ income, project the C. How often? How often? How often? Name of Adult Household Members Child Support/ Social Security, annual income and (First and Last Name) Earnings from Work Weekly Bi-Weekly 2x Month Monthly Alimony/SSI/VA Benefit Weekly Bi-Weekly 2x Month Monthly Other Income Weekly Bi-Weekly 2x Month Monthly report here.

$ $ $ $

G. Total Household Members (Children and Adults)— H. Last Four Digits of Social Security Number (SSN) of Primary Wage Earner or REQUIRED Other Adult Household Member—REQUIRED or check box if no SSN X X X X X Check if no SSN

STEP 4 Contact information and adult signature Return completed form to: Insert your school district mailing address here “I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the information. I am aware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.”

Street Address (if available) Apt # City State Zip Daytime Phone and Email (optional)

Printed Name OR Signature of Adult Completing this application—REQUIRED Today’s Date Mo./Day/Yr.

INSTRUCTIONS Source of Income

Sources of Income for Children Sources of Income for Adults Sources of Child Income Example(s) Public Assistance / Alimony / Pensions / Retirement / Earnings from Work Child Support All Other Income - Gross earnings from work - A child has a regular full or part-time job where they earn a salary or wages - Gross salary, wages, cash bonuses - Unemployment benefits - Social Security (including railroad - Net income from self-employment (farm or - Worker’s compensation retirement and black lung benefits) - Social Security - A child is blind or disabled and receives Social business); FARM—refer to line 18 of the - Supplemental Security - Private pensions or disability - Disability payments Security benefits 1040 or line 34 from Schedule F; Income (SSI) benefits - Survivor’s benefits - A parent is disabled, retired, or deceased, and their BUSINESS—refer to line 12 of 1040 or - Cash assistance from State - Regular income from trusts or child receives Social Security benefits line 31 from Schedule C. or local government estates - Income from person outside - A friend or extended family member regularly If you are in the U.S. Military: - Alimony payments - Annuities the household gives a child spending money - Basic pay and cash bonuses (do NOT - Child support payments - Investment income include combat pay, FSSA, or privatized - Veteran’s benefits - Earned interest - Income from any other - A child receives regular income from a private housing allowances) - Strike benefits - Rental income source pension fund, annuity, or trust - Allowances for off-base housing, food and - Regular cash payments from clothing outside household

OPTIONAL Children’s Racial and Ethnic Identities

We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.

Ethnicity Check one Hispanic or Latino Not Hispanic or Latino Race Check one or more American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White The Richard B. Russell National School Lunch Act requires the information on this application. You do Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large not have to give the information, but if you do not, we cannot approve your child for free or reduced price print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for meals. You must include the last four digits of the social security number of the adult household member who benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal signs the application. The last four digits of the social security number is not required when you apply on Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary English. Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) household member signing the application does not have a social security number. We will use your found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to information to determine if your child is eligible for free or reduced price meals, and for administration and USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call enforcement of the lunch and breakfast programs. We MAY share your eligibility information with (866) 632-9992. Submit your completed form or letter to USDA by: education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their Mail: U.S. Department of Agriculture programs, auditors for program reviews, and law enforcement officials to help them look into violations of Office of the Assistant Secretary for Civil Rights program rules. 1400 Independence Avenue, SW Washington, D.C. 20250-9410 In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights Fax: (202) 690-7442; or regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in Email: [email protected]. or administering USDA programs are prohibited from discriminating based on race, color, national origin, This institution is an equal opportunity provider. sex, disability, age, or reprisal or retaliation for prior civil rights activity conducted or funded by USDA.

Do not fill out For School Use Only Annual Income Conversion: Weekly x 52, Bi-Weekly (Every 2 Weeks) x 26, Twice a Month x 24, Monthly x 12

How often? Household Categorical Eligibility Total Income Weekly Bi-Weekly 2x Month Monthly Yearly Size Eligibility Free Reduced Denied Date Denied Reason for Denial or Withdrawal

Determining Official’s Signature Date Mo./Day/Yr. Confirming Official’s Signature Date Mo./Day/Yr. Verifying Official’s Signature Date Mo./Day/Yr.

Required for Verification Required for Verification

For schools participating in CEP only: Are all students on this application from a CEP school? YES NO If YES, the processing of this application cannot be paid for by the nonprofit school food service account. Only non-CEP applications are used for selecting the verification sample, conducting an independent review of applications, and the Certification and Benefit Issuance portion of the Administrative Review.

August 2017

Mon Tue Wed Thu Fri Sat

1 2 3 4 5

7 8 9 10 11 12 5:30pm FB @ Fall River

14 15 16 17 18 19

Board Meeting 230pm FB 7pm @ UW Paltteville

21 22 23 24 25 26

3pm JV FB 5pm JV FB 7pm FB TBD VB @ Owen-Withee @ New Glarus @ Home @ Monticello w/Potosi

28 29 30 31 5pm JH VB Open 6pm VB 530pm JV FB @ New Glarus House @ Juda @ Home 4-7pm w/Potosi 6pm VB @ Home w/Monticello September 2017

Mon Tue Wed Thu Fri Sat

1 2 Classes Begin

7pm FB @ New Lisbon

4 5 6 7 8 9 5pm JH VB 7pm FB 9am Varsity VB No School 6pm JV FB @ Home @ Pecatonica @ Lancaster @ Home w/Argyle w/Argyle 6pm VB @ Pecatonica 11 Late Start 12 13 14 15 16 5pm JH VB 5pm JH VB 5pm JH VB 7pm FB @ (H) w/Albany @ Home @ Monticello @ Belmont 530pm JV FB w/Pecatonica @ Pecatonica Board Meeting 6pm VB 7pm @ Barneveld 18 19 20 21 22 23 530pm JV FB 6pm VB 6pm VB 7pm FB @ Belmont @ Home @ Monticello @ Home w/Albany w/Benton Lifetouch Pictures Elem & MS Lifetouch Pictures Elem & HS 25 26 27 28 29 30 5pm JH VB 5pm JH VB 5pm JH VB 7pm FB @ Home @ Belleville @ Juda @ River Ridge W/Barneveld Usgaard Field 530 JV FB 6pm VB 6pm VB @ Home @ Home @ Argyle w/Benton w/Juda BREAKFAST MENU– September

Mon Tue Wed Thu Fri

1 “This institution is an equal opportunity Provider” Assorted Cereal Yogurt, Juice, Milk

4 5 6 7 8 Poptart Berry French Toast Strudel Stick Mini Maple No Cinnamon Grahams Pineapple Tidbits Yogurt Pancakes School Apple, Milk Milk Diced Peaches, Milk Apple Sauce, Milk

11 12 13 14 15 Assorted Muffins Cinnamon French Pancake Wrap Cinnamon Roll Mini Strawberry Yogurt Toast Yogurt Diced Peaches Pancakes Applesauce, Milk Apple, Milk Diced Pears, Milk Milk Juice, Milk

18 19 20 21 22 Cereal Bar French Toast Sticks Blueberry Waffle Apple Filled WG Donut Cheezits Diced Peaches Yogurt Breadstick Juice Apple Milk Diced Pears, Cinnamon Grahams Milk Milk Milk Applesauce, Milk 25 26 27 28 29 Nutrigrain Bar Strudel Stick Sausage Patty Pancakes Choc Chip French Yogurt Yogurt Egg Round Applesauce Toast Fruit Cocktail Apple WG English Muffin Milk Diced Pears Milk Juice, Milk Milk LUNCH MENU-September

Mon Tue Wed Thu Fri

Milk Choice 1% White, 1 Chocolate or Strawberry Hamburger/Bun WG-Whole Grain Whole Wheat Bread, Peanut Butter & Jelly Salad Bar Served Daily Cheese Slice Served Daily Corn, Fruit Cocktail 4 5 6 7 8 No Chicken Patty/Bun French Bread Pizza Mini corn Dogs Pulled Pork/Bun School Cheeseballs Cinnamon Gripz Sweet Potatoes WG Animal Crackers Steamed Cauliflower Steamed Broccoli Juice Green Beans Diced Pears Applesauce Pineapple Tidbits 11 12 13 14 15 Chicken Strips Taco/WG Shell Hot Dog/Bun Spaghetti Pizza Dippers/Sauce Cinnamon Gripz Baked Scoops Pretzels Meatballs Pretzel Goldfish Steamed Broccoli Corn, Applesauce Baked Beans, Mixed Garlic Toast Steamed Cauliflower Fruit Apple Carrots, Juice Diced Peaches 18 19 20 21 22 Breaded Pork Patty/ Cheese Quesadilla Hot Ham Slice/Bun Chicken Nuggets Pizza Bun Steamed Cauliflower Yogurt Cheeszits Cheezits Steamed Carrots Blue Raspberry Cinnamon Goldfish Green Beans, Corn, Pineapple Tidbits Slushie Broccoli, Apple Diced Peaches Mandarin Oranges 25 26 27 28 29 Brat/Bun Ham Slice Cod Square/Bun Beef Ravioli Sloppy Joe/Bun Pretzels Scalloped Potatoes Steamed Broccoli Goldfish Crackers Yogurt Steamed Carrots, WG Breadstick, Doritos Juice Green Beans Steamed Cauliflower Apple Applesauce Diced Pears Diced Peaches School District of Black Hawk P. O. Box 303 South Wayne, WI. 53587