Vista Education Campus

Post-High Programs

STAR | STEPS | MAPS | STRIDE

97 South 200 East

Farmington, Utah 84025

801.402.5975

2014 Combined Registration Documents Packet

This booklet contains the forms (required and optional) that are part of registration. There are

additional parts of registration that are not in a form on our site. We include those links below.

We are pleased that you – or your student, if you are a guardian – will be attending VEC this

coming year and look forward to working with you. Thank you to those who gave us feedback

last fall. We hope you like the improvements.

Have a great summer to recharge your batteries and play. We’ll get right to work in the fall.

Item that is not a form which is required for registration:

2014 Student Demographic Form - Print-off this required form from within your MyDSD

Login.

Select MyDSD Link and follow directions below.

Login with your Guardian User ID and Password

Select the Student you are registering in the left column.

Click on Reports

Click on Student Demographic Form. Print both pages of this form.

Please review the information and update any info that has changed with a non-black pen.

Sign and return with other required forms.

Items that are not forms, which are optional for registration:

Fee Waiver Information (Click Here) and Application (click

here http://www.schools.utah.gov/law/School-Fee-Forms.aspx)

(Available after July 1, 2013 for the 2013-2014 School Year) Free & Reduced Breakfast

and Lunch Information and Application (click here

http://www.davis.k12.ut.us/site/Default.aspx?PageID=1126)

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star | steps | maps | stride VISTA EDUCATION CAMPUS

801.402.5975 801.402.5976 97 South 200 East, Farmington, Utah, 84025 www.davis.k12.ut.us/dsd/Vista

Gláucia Brown James Gordon Tammi Bradford Jennifer Izatt Vonnie Steele Principal Assistant Principal STEPS Coordinator STAR Coordinator MAPS Coordinator

Child Find - Birth through 21Years of Age

The Davis School District is responsible for Child Find identification and evaluation for all students suspected of having a disability residing in Davis County. This includes children (birth through 21 years of age) who are in public schools, private schools, are being home schooled, or are kindergarten eligible, but not enrolled. Early identification and intervention is essential to help ensure school success. If your child or a child you know is having significant difficulty with vision, hearing, speech, behavior, is experiencing slow development typical for his/her age, physical impairments, or learning difficulty, he/she may be a child with a disability. If you suspect your child or a child you know may have a disability, please contact your child’s school or, if not yet enrolled, the following school district personnel so we can initiate the process for referral and assessment.

Children from Birth to Preschool (801) 402-0678 (Amy Garlick) Kindergarten through 21 years of age (801) 402-5477 (Cheryl Orme)

Please help us to help others by sharing this information with others in our community.

There is so much we can do, when we know a child needs extra help.

star | steps | maps | stride VISTA EDUCATION CAMPUS

801.402.5975 801.402.5976 97 South 200 East, Farmington, Utah, 84025 www.davis.k12.ut.us/dsd/Vista

Davis County School District PARENT APPROVAL FOR COMMUNITY BASED PROGRAMMING

SCHOOL YEAR 2013-2014

Dear Parent/Guardian/Student:

In order to help each student meet the priority goals and objectives of his/her current Individualized Educational

Program, we will be providing instruction in out-of-school sites as well as in the classroom during the coming school

year. This type of instruction is called “Community-Based Programming.” It provides students with disabilities the

opportunity to acquire functional skills and to interact with non-disabled individuals. Exposure to shopping centers,

restaurants, banks, neighborhood grocery stores, etc., will provide your son/daughter with the opportunity to learn to

function more independently in the world.

We will be communicating with you periodically by phone or letter throughout the school year to inform you about

some of the various community activities in which you/your student will participate. At times, you may choose to send a

small amount of money to cover the cost of a special activity, such as lunch at a fast-food restaurant or shopping.

All out-of-school activities will be under our direction. Supervision will be provided by educators and/or other

authorized, responsible adults. Various means of transportation will be used: walking, public buses, school buses, etc.

Please note that school staff are not allowed to use personally owned automobiles to transport students.

Please sign the parent/guardian approval form below so that your son/daughter/self may participate in out-of-school

instructional activities. This activity does not constitute a change of placement, but an extension of the school site.

Please SIGN and return to school with registration items: School Phone: 801-402-5975

PARENT APPROVAL FOR COMMUNITY BASED PROGRAMMING FORM

I give my permission for me/my student,__________________________________________, to take part in community-

based programming during the current school year. I understand that out-of-school activities planned by and under the

direction of the special education staff, are consistent with the priority goals and objectives specified in my student’s

Individual Education Program. (IEP)

________________________________________ ___________

Signature of Parent/Guardian/Student (if own legal guardian) Date .

Street Address:______________________________________________________________

City, State, Zip:______________________________________________________________

Home Phone:___________________ Work: __________________Cell:_________________

Recommended Items for Community Activities The following items are recommended when students accesses the community:

1. Wallet, backpack, purse, or fanny-pack

2. UTA Reduced Fare Card

3. Pertinent UTA bus schedules (provided by school)

4. Original or photocopy of Utah State ID, UT Driver’s License, or School Identification Card.

5. Emergency money: Up to $10.00 (in $1 bills, if needed).

6. If needed, a 3”x5” card with:

Emergency phone number

Names of people to contact

Medication/medical information, if needed

School bus number/UTA route, if applicable

...and School Information:

Vista Education Campus

97 South 200 East

Farmington, Utah 84025

801-402-5975

7. Pen or pencil

8. School Planner

9. Water bottle (in warm weather)

Vista Education Campus Davis School District

2014 Vista Education Campus Policies and Procedures Signature Page Post-High Transition Programs — STAR | STEPS | MAPS | STRIDE

Student Name Student Number Date:

Are you your own guardian? Yes No

Parent or Guardian Signature — (This & initials only needed, if student is not her/his own guardian) ___________________

Safe School Policy (Click here for policy)

I have read and agree to the summary of the Davis School District’s Safe School Policy

related to Policy 5S-100 Student Conduct & Discipline. I understand the importance of

reporting safety problems for the safety of all persons.

Acceptable Use Agreement (Click here for policy) I have read and agree to follow

acceptable standards and to

report any misuse of the

electronic information resources

to my principal, teacher/

supervisor or systems

administrator.

Locker Policy (click here for policy)

I understand and agree that I am

responsible to secure my

personal belongings and follow

the rules of the Locker Policy.

Required Registration Items

1. Policies & Procedures Form,

read and completed with initials

and required signatures.

2. The VEC Fees Receipt

3. Payment, MyDSD Receipt, or

Application for Fee Waiver

(with Required Documentation).

4. Student Demographic

Information Form — from

printed from MyDSD (with

updates marked in non-black ink).

5. VEC Transition Inventory

6. Community Permission Form.

7. Guardianship form if new or

changed.

Handbook—Policies & Procedures (click here for policy) I acknowledge that we know that

policies and procedures are found in the

student handbook and the school

website. I have read and agree to follow

the policies and procedures in that

Handbook.

Electronic Device Policy (Click here for policy)

I understand and agree that I will be held accountable for the information outlined in the

Cell Phones and Electronic Devices policy.

Financial Responsibility

I understand that students are responsible to

pay for any loss, breakage, or damage they

cause. Loss, breakage, or damage is not

subject to the waiver requirements. Official

transcript may be withheld if costs for loss,

breakage, or damage are not paid as outlined in

UCA§53A-11-806.

Memo to Students Regarding

Interview/Photography/Video Tape (Click here for policy) Mark one of the choices below.

___ Yes, I may be photographed,

videotaped, interviewed, and/or included in

worksite newsletters or publications at the

school, work-site, or community outings by

the public media, Davis School District,

and/or Vista Education Campus.

___ Yes, I may be photographed,

videotaped, and/or interviewed at the school,

work-site, or community outings, but only

by the Davis School District and/or Vista

Education Campus for school or district

purposes.

___ No, I do not want to be photographed,

videotaped, and/or interviewed for any

purpose.

Davis School District and Vista Education Campus Policies and Procedures Please read each policy and initial in each area in the squares below that you understand and accept each policy. Students who

are not their own guardians will also need a parent/guardian to read these, initial and sign. This completed form is required for

registration. Your time to completely review these in advance is helpful and appreciated. Thank you.

Required Signatures Thank you for completing this form. Please

print, sign, and return with registration

materials. We appreciate your effort to

prepare for the coming year by being

informed about these very important policies.

I (if own guardian) / We have reviewed

and initialed that I will comply with the

terms and conditions of each of the

policies linked on this page and required

for enrollment in Davis County School

District and Vista Education Campus,

Post-High Transition Programs.

____________________ __________

Student Signature Date ____________________ __________

If Parent/Guardian Signature Date

Student Initials If Guardian Initials Needed

Student Initials If Guardian Initials Needed

Student Initials If Guardian Initials Needed Student Initials If Guardian Initials Needed Student Initials If Guardian Initials Needed

Student Initials If Guardian Initials Needed

Student Initials If Guardian Initials Needed

Please read all policies, initial necessary boxes, print a hard-copy, sign where needed, and submit with registration. → After clicking and reading a policy, use your browser’s back arrow to return to this form. ←

 

 

 

 

 

 

 

 

Dear Parent, 

Electronic media and communica on are important learning tools in today’s classrooms.  Providing a safe and produc ve educa-on experience while using these tools is vital.  To assist us in mee ng this goal, every student and his/her parent or guardian 

must annually review the expecta ons for use contained in the Davis School District Technology Resources Acceptable Use Agreement (AUA) and acknowledge receipt of this informa on.  You may review and verify receipt of the AUA either online by following the direc ons below or by reques ng a printed copy of the AUA from your student’s school and returning the signature page to your student’s school office. 

Online  

www.davis.k12.ut.us 

                       This is the same link that takes you to the Student System to check your student’s a endance, grades, lunch, etc. 

Log In — An Informa on box should appear  

  

By following this link, you will be directed to the applicable AUA.    A er reviewing the AUA, select the acknowledge-ment box and your student’s school will receive no fica on of your comple ng the ac on.  There is no need to return a paper signature page if you acknowledge acceptance online. 

More than one child a ending DSD schools?  If you have more than one child a ending Davis School District, you will be able to access AUAs for all of your children from this one log-in.  When you acknowledge acceptance of each child’s AUA, the informa on will automa cally be made available to the applicable school. 

For ques ons or to request a printed copy of the AUA, call the Vista Educa on Campus at 801.402.5975. 

“You have files that need your a en on.  Please Click Here   

Technology Resources Acceptable Use Agreement (AUA) 

Parent Instruc ons for Online Access and Acknowledgement 

 

 

 

 

 

 

 

 

Dear Parent, 

Electronic media and communica on are important learning tools in today’s classrooms.  Providing a safe and produc ve educa-on experience while using these tools is vital.  To assist us in mee ng this goal, every student and his/her parent or guardian 

must annually review the expecta ons for use contained in the Davis School District Technology Resources Acceptable Use Agreement (AUA) and acknowledge receipt of this informa on.  You may review and verify receipt of the AUA either online by following the direc ons below or by reques ng a printed copy of the AUA from your student’s school and returning the signature page to your student’s school office. 

Online  

www.davis.k12.ut.us 

                       This is the same link that takes you to the Student System to check your student’s a endance, grades, lunch, etc. 

Log In — An Informa on box should appear  

  

By following this link, you will be directed to the applicable AUA.    A er reviewing the AUA, select the acknowledge-ment box and your student’s school will receive no fica on of your comple ng the ac on.  There is no need to return a paper signature page if you acknowledge acceptance online. 

More than one child a ending DSD schools?  If you have more than one child a ending Davis School District, you will be able to access AUAs for all of your children from this one log-in.  When you acknowledge acceptance of each child’s AUA, the informa on will automa cally be made available to the applicable school. 

For ques ons or to request a printed copy of the AUA, call the Vista Educa on Campus at 801.402.5975. 

Technology Resources Acceptable Use Agreement 

Parent Instruc ons for Online Access and Acknowledgement 

“You have files that need your a en on.  Please Click Here   

Electronic Device Policy

SCOPE

Electronic devices have become a common means of communication and information access in today’s society. How-ever, these devices have the potential of disrupting the orderly operation of the school. The school has therefore creat-ed this policy to govern the possession and use of electronic devices on school premises, during school hours, at school sponsored activities, and on school transportation.

DEFINITION: For purposes of this policy “Electronic Device” means a privately owned wireless and/or portable electronic handheld equipment that include, but are not limited to, existing and emerging mobile communication systems and smart tech-nologies (cell phones, smartphones, walkie-talkies, pagers, etc.), portable internet devices (mobile managers, mobile messengers, BlackBerry ™ handset, etc.), Personal Digital Assistants (PDAs) (Palm organizers, pocket PCs, etc.), handheld entertainment systems (video games, CD players, compact DVD players, MP3 players, iPods ©, Walkman ™ devices, etc.), and any other convergent communication technologies that do any number of the previously men-tioned functions. Electronic Device also include any current or emerging wireless handheld technologies or portable information technology systems that can be used for word processing, wireless Internet access, image capture/recording, sound recording and information transmitting/receiving/storing, etc.

POSSESSION AND USE Students may possess and use electronic devices at school subject to the following: Students may carry or possess electronic devices at school and school-sponsored activities. Electronic devices must be turned off & kept out of sight during class time. Electronic devices may not be left on

in vibrating mode. At no time may electronic devices be used in restrooms or locker rooms. Students may use electronic devices before school, after school, and during breaks.

PROHIBITIONS Electronic devices shall not be used in a way that threatens, humiliates, harasses, or intimidates school-related individ-

uals, including students, employees, and visitors, or violates local, state, or federal law. Report violations to your teacher, in order to be addressed promptly and properly.

CONFISCATION If a student violates this policy, his/her electronic device may be confiscated. When an employee confiscates an elec-tronic device under this policy, he/she shall take reasonable measures to label and secure the device and turn the de-vice over to a school administrator as soon as the employee’s duties permit. The electronic device will be released/returned to the student and/or parent or guardian after the student has complied with any other disciplinary consequence that is imposed.

(continued on next page) Page 1 of 2

Vista Education Campus Davis School District 

CONFISCATION (continued) Policy may include, but is not limited to, any or all of the following POTENTIAL DISCIPLINARY ACTIONS:

Violation of this policy can result in discipline up to and including suspension or expulsion, and notification of law enforcement authorities.

A student who violates this policy may be prohibited from possession of an electronic device at school or school-related events.

Confiscation of device for increasing periods of time for subsequent violations. Disciplinary consequences consistent with a school wide discipline program such as demerit

points. Notification of law enforcement, at school’s discretion, if circumstances warrant such notification.

SECURITY OF DEVICES Students shall be personally and solely responsible for the security of electronic devices brought to school. The school shall not assume responsibility for theft, loss, damage, or unauthorized calls made with an electronic device. If devices are loaned to or borrowed and misused by non-owners, device owners are jointly responsible for the misuse or policy violation(s).

REPORTING Individuals wishing to report a violation of this policy should contact a school administrator.

PROHIBITIONS ON AUDIO RECORDING Camera or audio recording functions of electronic devices may pose threats to the personal privacy of individuals, used to exploit personal information, and or compromise the integrity of educational programs. Accordingly, the use of the audio recording or camera functions of electronic devices is strictly prohibited on school premises at all times.

EXCEPTIONS With prior approval of the principal, the above prohibitions may be relaxed under the following circumstances:

the use is specifically required to implement a student’s current and valid IEP;

the use is at the direction of a teacher for educational purposes;

the use is determined by the principal to be necessary for other special circumstances, health-related reasons, or

emergency.

After reviewing this, please initial the 2014 Vista Education Campus Policies and Procedures Signature Page.

Page 2 of 2 

Student Locker Policy

The Vista Education Campus (VEC) provides lockers for students’ personal belongings. Please enjoy using the lockers for convenience. Please respect and take care of them.

□ Security: For protection of your property, keep your personal belongings in the lockers when you are not using them. Be sure your locker is locked each time you leave it. Keep your key with you and do not loan your locker key to other students. The school cannot be responsible for loss of valuables and we strongly urge students to leave valuable items at home.

□ Keys: Lockers are keyed for easier use. Please keep the key with you on a key ring. Replacement keys are $5. Personal padlocks are not permitted. Some teachers may have students keep their keys at school with their teams.

□ Jammed Lockers: Lockers occasionally become jammed because heavy items such as jackets or bags become wedged in the door. If your locker does become jammed, try pushing the locker in as you gently pull the latch up. If this does not unjam your locker, report to your class and ask your teacher for assistance. If further assistance is required, your teacher will contact the main office for help.

□ Property Rights: Lockers are school property and can be opened and checked by authorized school personnel for safety and security reasons.

□ Locker Condition: Lockers at the VEC are in very good condition. Please keep the locker clean and organized. Use magnets instead of tape. Do not write on the lockers. If you would like to write a reminder, please

use a magnetic whiteboard in your locker. Be careful to avoid bent latches, dents, or scratches. Vandalism, or intentional damage, shall not occur. Student shall be required to pay for repair of any

intentional damage. Report any problems with the locker to your teacher right away.

After you have read this policy introduction, initial the locker information section on the 2014 Vista Education Campus Policies & Procedures Signature Page.

Vista Education Campus Davis School District

Safe School Policy Review To Provide a Safe School Environment for YOU, the Board of Education of Davis School District wants you to know that one’s committing any of these prohibited activities may result in one being suspended or ex-pelled from school, changed to another school, and/or referred to the police:

Arson – Graffiti – Vandalism The willful burning, defacing, or destruction of student, staff, or school district property (includes student lockers).

Assault – Hazing – Harassment Physical aggression, intimidation, or initiation of a school district employee, student, or volunteer, whether at school, a school related activity, or other locations which affect the environment at school.

Controlled Substances The possession, solicitation, sale, distribution, or use of controlled substances or substances represented to be controlled substances or any associated paraphernalia.

Misuse of Electronic Devices Using electronic devices to photograph, view, receive, or distribute pornographic material. Misuse of electronic devices also refers to sending harassing or threatening messages to staff or students – whether in or out of school.

Robbery – Extortion Taking anything of value from another by use of force or threat.

Weapons Possession, use, transmittal, or concealment of ANY weapon or facsimile of a weapon. Weapons are defined as fire-arms, knives, explosives, flammable materials (which includes matches, lighters, or the like), or any items that may cause injury, death, threat, or intimidation.

Gang Activity Engaging in any form of gang activity on or about school property, or at any school activity. Gang indicators and/or activities may include, but are not limited to: wearing, possessing, using, distributing, displaying, or selling items which evidence membership or association with gangs; committing acts which demonstrate membership or affiliation with a gang, such as flashing signs, soliciting membership, or requesting a person to pay for protection or claiming turf. In addition to school discipline, committing the above acts may result in criminal prosecution.

REPORTING VIOLATIONS OF THE SAFE SCHOOL POLICY IS CRITICAL! Every student and staff member is part of making Vista Education Campus a safe place. You make a difference! If you know of a safety problem, please go to an adult or supervisor to address the problem immediately. Your safety is of the utmost importance to us! When you have completed reviewing this, please initial that 2014 Vista Education Campus Policies and Procedures Signature Page.

We ask that you retain this copy for your records because this is a very important document. Thank you. 

Vista Education Campus Davis School District

Dear Parents,

Part of the communication efforts of the Davis School District and your child’s school is to let the general pub-lic know about the educational activities occurring within the walls of our schools.

Because of that effort, we often invite reporters to the schools to cover educational activities and events. Thereare also times when reporters contact the district or the school regarding a story.

Anytime the media wishes to highlight work or activities within our district or schools, we work with them sothey can accomplish their job and so our efforts or viewpoints can be communicated.

The main focus of education, of course, is students, and during the vast majority of time, the media will wantto focus on students as the subject of their stories.

For that reason, we are seeking your permission ahead-of-time for your student(s) to be interviewed,photographed or videotaped in the event such an opportunity surfaces during the school year.

If you DO NOT want your student to be involved in media coverage — be photographed, interviewed

or videotaped by the media — please fill out this form and return it to the school.

Please note, your permission will be assumed if the school does not have this completed form on file.

Student Name(s):

Parent(s) Name:

Address:

Phone:

Signature

MEMO TO PARENTS REGARDING STUDENTINTERVIEW/PHOTOGRAPH/VIDEOTAPE

Updated 5 May 2013, Page 2 of 2

STUDENT NAME___________________________________________ DATE_________________

2014 Vista Education Campus Annual Transition Inventory Please have or help your registering student complete/update this Transition Inventory

by answering each of the following questions with realistic appraisals.

Independent Living Do you have a personal Cell Phone? Yes / No If Yes: What is your current Cell Phone # ______________________

With whom do you live? Please mark the appropriate □.

□ Parent or guardian □ On your own or with roommates

What skills or experience do you have cooking? (Circle “N” = None, “S” = With Support, “I” = Independently)

Non- Cooked Snacks/Foods N / S / I ⟐ Microwave or Simple Recipes without Stove-Top N / S / I ⟐ Oven/ Baking N / S / I

Simple Stove-Top Recipes N / S / I ⟐ Complex Stove-Top Recipes N / S / I ⟐ Job-Site Cooking Responsibilities N / S / I

Are you your own legal guardian? Yes / No

If No: Who is your legal guardian? ______________________________________________________________

What are your responsibilities at Home? _________________________________________________________________

Do you have a current driver’s license? Yes / No

If No: Are you interested in obtaining a driver’s license? Yes / No

Do/can you use public transportation? Yes / No

If No: Arrange Yellow Bus.

Do you use a planner/calendar to schedule and keep track of your own appointments? Yes / No

If Yes: How long have you been using it? _________ What kind of calendar do you use? _________________

Employment Do you currently have a job? Yes / No

If Yes: Where do you work and what is your supervisor’s name?

Place of employment _________________________________________________________________________

Supervisor __________________________________________________________________________________

What other employment experience have you had?

Name of Work Place How long were you employed? What was your reason for leaving?

1) _____________________________ ______________________________ ___________________________

2) _____________________________ ______________________________ ____________________________

3) _____________________________ ______________________________ ___________________________

Do you need a job right now? Yes / No Why? __________________________________________________________

What are three career areas you may be interested in? (Please list in order of preference.)

1)______________________________________________________________

2)______________________________________________________________

3)______________________________________________________________

What is your long-term employment goal? _____________________________________________________________

Updated 5 May 2013, Page 2 of 2

What training do you need to reach your goal? __________________________________________________________

What classes or training have you completed toward your career goal? You may include high school classes, internships

and work experiences.

__________________________________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Education Did you attend the Davis Applied Technology College (DATC) last school year? Yes / No

If yes: What program were you enrolled in? _______________________________________________________

How much of the program did you complete _______________________________________________________

___________________________________________________________________________________________

If No: Have you considered attending the DATC? Yes / No

What Programs are you familiar with at the DATC? _________________________________________________

Why are you interested in this program? __________________________________________________________

___________________________________________________________________________________________

Do you plan on attending community college or university following graduation? Yes / No

If Yes: Where do you plan to attend? _____________________________________________________________

___________________________________________________________________________________________

What steps do you personally need to take in order to attend college? ___________________________________

___________________________________________________________________________________________

What do you plan on studying in college? _________________________________________________________

Leisure and Community Access Participation

Do you belong to any organizations or attend regularly scheduled activities? (Social, Religious, Community, Other.)

__________________________________________________________________________________________________

How do you get to social or other activities? ______________________________________________________________

Where do you get the money for your leisure activities? _____________________________________________________

What do you like to do for fun?

1)______________________________________________________________

2)______________________________________________________________

3)______________________________________________________________

Are you currently connected with Vocational Rehabilitation? Yes / No

IF Yes: Who is your counselor? ________________________________________________________________

What other services or agencies, if any, are you currently working with? (Some examples are: Davis Behavioral Health,

Youth in Transition, Division of Services for People with Disabilities, Department of Workforce Services, and the Social

Security Administration.)

1)______________________________________________________________

2)______________________________________________________________

3)______________________________________________________________

Vista Education Campus FeesRegistration Fee Form - 2013-1014 School Year

Student Name Student Number Date

Please type in student name, student number, and date, then print this form to complete.

For those paying via MyDSD on-line:

The corresponding required and chosen optional fees must also be selected in MyDSD .

Required Basic Fees - All ProgramsActivity Fee

Curriculum Fee

Locker Rental - Security for Personal Items

School Planner / Policy Folder

Total Basic Required

○ Cash or Check

Required Fees for Specific Programs , √ ○ MyDSD Online Receipt

Art Lab (STAR, STEPS, STRIDE, MAPS) ○ Fee Waiver Application (with req. documentation)

Computer Fee (STAR, STEPS, STRIDE)

Food Lab (STAR, STEPS, STRIDE)

Work-Based Learning Experience (STAR & STEPS)

(Select fees per your student's program.)

Completely Optional Fees √

Choir Vista Education Campus

Parking Permit 97 South 200 East

School T-Shirt Farmington, Utah 84025

Circle Size(s): Small Medium Large X-Large 2X 3X (801) 402-5975

Write in Color (s):

Yearbook (STEPS, MAPS, STRIDE)

For Office Use Only

Totals - Transfer Subtotals from above □ Check # _____ □ Fee Waiver‡ Pending

Subtotal Required Fees for All Programs □ Cash □ Fee Waiver Approved

Subtotal Required Fees for Specific Program □ On-Line Verification

Subtotal Completely Optional Fees Received By: _________________________

Total Fees

Refund Schedule for Basic Required Fees

Prior to Sept. 25, 2013 @ #

Sept. 25 - Dec. 11, 2013 @ #

Dec. 11, 2013 - Feb. 19, 2014 @ #

Feb. 19 - April 16, 2014 @ #

After April 16, 2014 @ # $0.00

100% $71.50

75% $53.63

‡Any mandatory payment for student participation in a

class, program, or activity is a fee and is subject to the fee

waiver requirements.

50% $35.75

25% $17.88

0%

* This deadline ensures that we can arrange yellow bus

service in time for school to start.

$12.00

$5.00

$12.00

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t

If you have questions or need assistance, please call

VEC's Main Office during business hours. $20.00

$15.00

$15.00 □ Check here, if you would like a signed, school-verified copy

of the receipt returned to you for your records. $35.00

Please mail or bring all completed registration

materials to VEC by August 5, 2013*.

$2.50 Please print this completed page (all totaled) and submit

it with your payment option.$4.00

$71.50 Payment options:

$15.00

$32.00 Payment must be included

with registration materials. $33.00

STUDENT GUARDIANSHIP STATUS FORM 2013-2014 NOTE: A new form is only required when a new student enters VEC, or when a change in guardianship has occurred

since the prior form was submitted. We must have this file accurate & on file to assist your student correctly.

“Guardianship is a legal term which describes a court-established relationship between two people, a guardian and a ward.

A ward is an individual who needs someone else to help him or her to make important decisions and meet basic needs. Once a person turns 18, he or she is considered to be his or her own guardian and is no longer considered a ward.

When a student turns 18, the rights of parents and their students change. Unless the court finds that an adult student cannot manage his or her own affairs and appoints a guardian, the school must assume that the student is capable of doing so.

Do not be confused by other legal terms that may lead you to believe that you have guardianship over your student. A representative payee or a protective payee is NOT a guardian.

Parents who have court-appointed guardianship must provide a copy of the court document to the school. STUDENT’S LEGAL NAME: _____________________________________________ DATE: __________________

Date of Birth: ________________________________________________________ AGE: __________________________

1. Is Student her/his own guardian? YES □ (If yes, stop here.) NO □ (If no, continue to next question)

2. If Student is not her / his own guardian:

a. Please list this student’s court appointed guardian( s):___________________________________________

____________________________________________

b. Please indicate for which area(s) guardianship was granted by the court:

□ Full Guardianship

□ Partial Guardianship (please mark which apply)

□ Education

□ Medical

□ Financial

□ Other (please describe): ___________________________________________________

For Office Use Only

Court Document Received: Yes □ No □ N/A □

Date Received: ______________________________________________ By Whom: _______________________

Vista Education Campus Davis School District

1. If the court has appointed a guardian, the school REQUIRES the most current copy of the court document with seal affixed on file with the school.

2. If you have not already provided this court documentation to the school, please submit a copy (court seal) of this documentation attached to this form. Thank you.

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836 SADDLE DROAKLEY, UT 84055

801.402.5975 801.402.5976 97 South 200 East, Farmington, Utah, 84025 www.davis.k12.ut.us/dsd/Vista

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——–—————–—————— For Office Use Only ——–—————–—–————

Approved: ________ Any Infractions? Date & Consequence: 1st ________________________ 2nd ________________________

Any parking exceptions? _________________________________ Reason: ___________________________________________

VEC PARKING PERMIT REGISTRATION 2013-2014

In order to maintain parking spaces for Vista Education Campus (VEC) staff and students, we will require permission to park on campus - except for guests and visitors. VEC cannot be responsible for damage to or theft from vehicles parked on campus. Please review & sign verifying acceptance of the following requirements, in order to park at VEC.

Have your assigned permit posted on the car you drive and park that day. A warning and/or fine may be incurred for violations. Repeated violations will result in loss of privileges.

Park only in the designated stalls when parking on campus. Parking violations may incur a $25.00 fine.

If the parking lot is full, park on 100 South (below 185 East or 200 East) or at the Farmington City Building. Do NOT park in the driveway, 300 East, the Davis Diagnostic Resource Center (DDRC), the Early Learning Center (ELC), or the Davis Education parking lot (unless specific permission has been obtained in writing).

For Safety, Avoid the following times to avoid buses in the driveway and bus loop:

Arrival—Monday- Friday…………..8:45 a.m. – 9:15 a.m.

Departure—Monday-Thursday….…1:45 p.m. – 2:15 p.m.

Departure—Friday………………....12:45 p.m. – 1:15 p.m.

Drive safely and courteously. Secure your vehicle.

Report any parking lot safety or facility problems to the office immediately. Your help is appreciated. 

By completing, signing and submitting the form below, I indicate that I have read and understand the parking expectations and requirements above. I know that violation of these regulations can result in parking fines, towing, and/or loss of parking privilege on campus. I understand that the Vista School cannot be responsible for any damage to my car or loss of property occurring on school property.  

Required Information *Date: ______________

* Name (print): ______________________________________ * Signature: __________________________________________ 

* If Student and Not “Own Guardian,” Parent/Guardian Signature is required:______________________________

* Check the correct box. □ Student (Student Number: ____________) □ Vista School Staff □ Other _________________

* Cell Phone #(s): _______________________________________________________________________

* Primary Car Make/Model: ________________________ * Color: ___________ * License Plate #: ____________

* Secondary Car Make/Model: ______________________ * Color: ___________ * License Plate #: ____________

* (and so forth) Car Make/Model: ____________________ * Color: ___________ * License Plate #: ____________ 

Office Use

*_________

* _________

* _________ 

Davis School DistrictAuthorization for School Personnel to Administer Medication

Dear Patron,

Davis School District recognizes that parents or guardians and children (in the case of olderstudents) have the primary responsibility for administering medication. However, from time totime a student will require assistance with medication during school hours due to amedical condition. In keeping with 53A-11-601, Utah Code, annotated 1953, the followingprocedures have been adopted by the Davis Board of Education in order to provide forthe administration of medication by school personnel. Your school principal or designee willprovide you with needed assistance should this help be required for your student.

In the event that your student should require such help, you as the parent or guardian of thestudent must submit a completed, signed and dated "Authorization of School Personnel toAdminister Medication" form to the school principal. This authorization form also requiresinformation from the student's health care provider regarding the methods, amount, time schedule andpossible side effects of the prescribed medication.

Parents are responsible to bring the student's medication to the school principal/secretary/student'steacher, in a prescription bottle or properly labeled original container, along with a current picture ofthe student. This is to assure that the proper medication will be administered to your student. Parentsmust provide an adequate supply of medication to avoid interruption of treatment.

Authorization for administration of medication by school personnel may be withdrawn by the school atany time following notice to you as a parent or guardian. In addition, school personnel who provideassistance as described above in substantial compliance with the licensed health care provider's writtenstatement are not liable, civilly or criminally, for any adverse reaction suffered by the student as aresult of taking the medication, or for discontinuing the administration of the medication after soinforming the student's parent or guardian.

Your school principal will designate staff to administer medication. In addition, the schooladministration, in compliance with Board policy, will assume that only students with a current,completed, signed and dated “Authorization of School Personnel to Administer Medication” form willreceive help from the school staff in the administration of medication.

District policy does not prohibit a student from carrying his/her own medication to school in instanceswhere the student’s maturity level is such that his/she could reasonably be expected to appropriatelyadminister the medication on his/her own. In such instances, the student may carry one inhaler or oneday’s dosage of medication on their person. Any misuse of such medication by the student may besubject to disciplinary action under the District’s Safe and Orderly Schools policy.

If you have further questions or concerns, please contact your school principal.

Sincerely,

W. Bryan BowlesSuperintendent of School

DAVIS SCHOOL DISTRICT

Authorization of School Personnel to Administer Medications

Name of Student:__________________________________________ DOB:____________________

Parent / Guardian:__________________________________________ Home Phone:______________

Address:__________________________________________________ Cell Phone:_______________

________________________________________________________ Work Phone:______________

Emergency Contact:________________________________________ Phone:__________________

School / Teacher:_____________________________________________________________________

Name of licensed health care provider completing form: (Please Print) ________________________________________________________________________________________

Licensed Health Care Provider’s Statement:

1. Name / type of medication:_____________________________________________________

2. Dosage / amount to be given:___________________________________________________

3. Frequency / time(s) to be administered:____________________________________________

4. Duration (week, month, indefinite, etc.):____________________________________________

5. Anticipated reactions to medication (symptoms, side effects for underdose, overdose etc.): ___________________________________________________________________________

6. If PRN for mental health issues or needs, describe physical symptoms requiring administration:

_____________________________________________________ ___________________________ Signature of Licensed Health Care Provider Date

Parent / Guardian Request / Approval

I hereby request and give my permission for the above named student to receive the specified medication as stated in the above instruction from the health care provider. I understand that the school administration will designate specific staff to administer medication, train staff, assure proper identification and safekeeping of medication, and maintain records of such administration of medication.

I further understand that school personnel who provide assistance (administration of specified medication so noted) or employer of such staff are not liable, civilly or criminally for any adverse reaction suffered by my child as a result of taking the medication so indicated and discontinuing the administration of the medication in keeping with the procedure outlined above.

_______________________________________________________ __________________________ Signature of Parent / Guardian Date

(Form #2) 10/12/10

Fee Waiver Request Notice

NO EXCEPTIONS:

FEE WAIVER CANNOT BE ACCEPTED WITHOUT DOCUMENTATION.

To each Davis School District Student and Parent/Guardian:

If you request a fee waiver of registration fees, we will need to have the following documents to be able to pro-cess this fee waiver:

As required by HB 183 regarding documentation of eligibility for fee waivers, students or parents shall be re-quired to provide eligibility of documentation supporting their claim for fee waivers in the form of:

Verification of eligibility based on income. (You will need to fill out Section B on the back of the Fee Waiver Application and provide documentation of wages using check stub, bank statement, etc.)

Verification of receipt of Supplemental Security Income (SSI)

Verification of receipt of Aid to Families With Dependent Children (AFDC);

Verification that family receives public assistance (currently qualified for financial assistance or food stamps)

Verification that student is in Foster Care (under Utah or local governmental supervision)

Verification that student is in State Custody

Fee waivers cannot be processed until you provide this documentation.

If you have any questions about this process please call Pat Stevens, 402-5975.

Thank you,

Vista Education Campus Post-High Programs

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Vista Education Campus Davis School District