Note: Please complete ALL fields below. If a field does not apply to you, please enter an N/A. Make sure you have ALL of your information available before filling out this form, as you will not be able to save a partially completed form. A separate form must be filled out for each student.


Will your child be a new or returning student to Alcova Elementary?



1. Student Information

*Please enter student's legal name

First Name:
Middle Name:
Last Name:
Suffix:(II, III, Jr., Sr., etc.)
Nick Name:
Grade:
      Gender:
      Birth Date:
  
 


Social Security Number or
Parent Initials in lieu of:
      Country of Birth:

      Date student first entered USA school:

   

Note: The federal government requires that the following 2-part question be answered. If you do not answer these questions the school is mandated to identify and assign a race based through an observer identification process.


PART 1: Is this student Hispanic or Latino?


PART 2: Please select student's race from choices below. At least one box must be selected 'yes' below.

*American Indian or Alaska Native - Peoples of North, South, and Central America
*Asian - Peoples of Far East, Southeast Asia or Indian Subcontinent - including Cambodia, Malaysia, Pakistan, Thailand, Vietnam
*Black or African American - Peoples of Black racial groups of Africa
*Native Hawaiian or Other Pacific Islander - Peoples of Hawaii, Guam, Samoa, or other Pacific Islands
*White - Peoples of Europe, the Middle East or North Africa

      
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White

2. Student's Address

Address (street number and name):
 Apartment #:
City:
 State:
 Zipcode:

Apartment Complex/Subdivision name:


Mailing Address (if different):

*Please include street number, street name, city, state, and zip code

3. Parent/Guardian #1 Information

(this should be the parent who is completing the enrollment process)


Note: If you are a legal guardian, you must present guardianship court documents to the main office. Also, step-parent information should be entered at section #6, not in section #3 or #4.


Relationship to student:


First Name:
 Last Name:
Check this box if Parent #1 Address and Student Address are the same.
Address (street number and name):
 Apartment #:
City:
 State:
 Zipcode:


Home Phone:
 Work Phone:
 Cell Phone:
Email Address:


Can Parent #1's email address be used for teacher and school communication?

Does student reside with parent #1?

Is parent #1 responsible for student?

4. Parent/Guardian #2 Information

Note: If you are a legal guardian, you must present guardianship court documents to the main office. Also, step-parent information should be entered at section #6, not in section #3 or #4.


Relationship to student:


First Name:
 Last Name:
Check this box if Parent #2 Address and Student Address are the same.
Address (street number and name):
 Apartment #:
City:
 State:
 Zipcode:


Home Phone:
 Work Phone:
 Cell Phone:
Email Address:


Can Parent #2's email address be used for teacher and school communication?

Does student reside with parent #2?

Is parent #2 responsible for student?

Is student allowed contact with this person?



5. Custodial Arrangements

Note: If there are custodial issues, legal documentation must be provided to the main office.

Is there a parent the student IS NOT allowed to have contact with?



6. Medical Emergency Information & Student Checkout Authorization

Doctor's name:
 Doctor's phone number:

Does this student have any known allergies?


List any medical conditions the school should be aware of:

List any medications taken on regular basis and reason for taking:


Does this child need a specific written health plan?

I understand that in the event the parent/guardian cannot be reached, the school has my permission to take appropriate emergency action including calling 911. I understand it is also my responsibility to update the school as needed regarding any medical information which may impact my child during the school day.
Parent Electronic Signature for Medical Consent
(type name here):

Emergency Contact info to be used if parent cannot be reached:

Note: For security reasons, only contacts that you have marked 'allowed to check out student' will be permitted to checkout your child. Contact must bring a photo ID.

Emergency Contact #1
Name:
 Phone:
 Relationship to student:
   Allowed to check out student?

Emergency Contact #2
Name:
 Phone:
 Relationship to student:
   Allowed to check out student?

Emergency Contact #3
Name:
 Phone:
 Relationship to student:
   Allowed to check out student?

Emergency Contact #4
Name:
 Phone:
 Relationship to student:
   Allowed to check out student?

7. Siblings in Gwinnett County Schools


(1) Name:     School:     Grade:

(2) Name:     School:     Grade:

(3) Name:     School:     Grade:

(4) Name:     School:     Grade:

(5) Name:     School:     Grade:


8. Special Services


Does this student or any family member require handicapped access? 

Has this student received any of the following special services previously?

       ESOL/ESL/Bilingual
Remedial/Early Intervention Program
Gifted
Special Education
Speech
Title 1
Other
      



9. Communication

Language Background

Does your child speak a language other than English?

Is a language other than English spoken in your home?

If the answer to either question above is 'Yes', the law requires that the school assess your child's English language proficiency.


10. Previous Enrollment History


Has this student previously attended another school?



11. Transportation Home


What is your primary method of afternoon transportation?



12. Parent Authorizations

Alcova Elementary students will use school computers frequently to enhance learning. The computers at Alcova should be used for school purposes only and must support the AKS.  Students are only allowed to log in with their own username and password, and they should not share this information with any other students.  Students are not allowed to adjust the settings of the computer.  In addition, students may only visit Internet sites the teacher has approved.  If a student does not follow the rules above, he/she may lose computer privileges at school.  Please discuss this with your child and sign below if you agree to Alcova's Acceptable Use Policy.
By signing my name here I acknowledge the school's AUP from above:



Under Georgia state law, my child is not allowed to have more than 5 unexcused absences.  I also understand that when my child is absent from school, I need to submit written notice of why he/she was absent.  (Please note:  There is now a link on Alcova Elementary's Home page where absence excuses may be submitted.)
By signing my name I acknowledge the attendance policies:



I hereby give my consent to all photographs, audio-recordings, academic work, and/or video recordings taken of me or my minor child by Gwinnett County Public School staff or their designee.  I understand that any such material becomes the property of the local school or district & may be used for educational, instructional, or promotional purposes determined by the district in broadcast and media formats now existing or created in the future.
Please choose one option:


Alcova Elementary uses several web based educational programs (example Education City and TimezAttack), which require the release of students first and last names and teacher name to the vendor.  All vendors are under confidentiality contracts with the school. Do you agree to have your childs name released?
Please choose one option:

Alcova Elementary uses a contracted vendor to take Fall and Spring pictures. The Fall Pictures are used for our Yearbook. Our school is required to release student first and last names to this vendor for the picture taking process. This vendor is under confidentiality contract with the school.  
I agree to have my child's Fall and Spring picture taken:

I agree to have my child's picture and name published in the Yearbook:

My child's contact information may be included in a class or school directory:


13. Volunteer Opportunities


Are you interested in being a parent volunteer at the school:


14. The GA. Department of Education requires that the following questions from the parent occupational survey be completed for all students.  The reponses to these questions will help to determine if your child qualifies for additional services under Title 1, Part C.

Has your family moved in order to work in another city, county or state in the last 3 years?


Has anyone in your immediate family been involved in one of the following occupations; either full time, part-time, or temporarily during the last 3 years? More than one item may be selected:

Agriculture: Planting or Picking Vegetables
Planting, growing, or cutting trees/raking pine straw
Processing or packaging agriculture products
Dairy/Poultry/Livestock
Meat packing/Meat Processing/Seafood
Fishing or Fish Farms
Other-Please specify:

15. Verification

Are there any special circumstances the school needs to know about?


What do you want the teacher to know about this child?



By writing my name in below, I hereby certify that all the information I have provided is complete and true to the best of my knowledge:

Parent Electronic Signature
(type name here):