We are excited you are enrolling in Van Alstyne High School. Below are some of the requirements

to get you started with the enrollment process. Please bring them with you when you enroll. A student may be enrolled by the following: A parent with legal custody A person who is a resident of Van Alstyne with a written notarized statement giving them limited power of

attorney

************************************************************************************************************************* The following must be provided:

Shot Records Birth Certificate Social Security Card (copy) Proof of Residency (utility bill or tax statement) Withdrawal Form from previous school Transcripts/Report Card from previous school * Testing information * Copy of legal guardian / enrolling person’s drivers license

* Information can be requested from previous school with a signed records release form Forms (Enrollment Packet) to be filled out and returned:

Enrollment Form Student Code of Conduct Form / Computer Use Agreement Directory Information - Release of Student Information Ethnicity Questionnaire Drug / Alcohol Screening Form Student Residency Questionnaire Home Language Survey 2016-17 Family Survey Release of Records Form Please let us know if you have any questions. We will be happy to help. The main High School number is

903-482-8803. We look forward to having your student be a part of Van Alstyne High School.

Van Alstyne Independent School District

New Student Enrollment Packet

NEW STUDENT ENROLLMENT CHECKLIST:

Van Alstyne High School Registration Form for School Year 2016‐2017

Campus Address: 1722 N. Waco, Van Alstyne, TX 75495 Campus Phone: (903) 482‐8803 Campus Fax: (903) 482‐8885

Student First Name:_____________________________ Middle: ________________ Last: _________________________

DOB: ___/____/____ SSN:___ ___ ___‐___ ___‐___ ___ ___ ___ Legal Orders regarding student? ____YES ____ NO

Gender: M or F Birth Place: ___________, _____ Age as of 9/1/16: ________ Enrolling in Grade: ________

Physical Address: ________________________________________ City: ___________________ Zip Code: ____________

Mailing Address: _________________________________________ City: ___________________ Zip Code: ____________

PREVIOUS SCHOOL DISTRICT

Name of previous school: ___________________________________ City/ST: _______________ District: _____________

Services Provided: ____SPED ____Dyslexia ____Speech ____504 ____ESL/Bilingual ____Gifted/Talented

Has your child been suspended, expelled, or experience legal problems at previous school? ___Yes ___No

Has your child been retained? ____Yes ___No

PARENT/GUARDIAN INFORMATION

#1 will receive campus communication via email)

1.Name:________________________________________ 2.Name: ___________________________________________

Address:________________________________________ Address: ___________________________________________

City, State, Zip: __________________________________ City, State, Zip: ______________________________________

Relation: __________________________ Relation: __________________________

Cell #: (__ )__________‐______________ Cell#: (__ )__________‐______________

Home: (__ )__________‐______________ Home#: (__ )__________‐______________

Work#: (__ )__________‐______________ Work#: (__ )__________‐______________

Email: __ ________________________________________ Email: __ __________________________________________

EMERGENCY CONTACT INFORMATION (not listed above)

1.Name:_______________________________________ 2.Name: ___________________________________________

Address:_______________________________________ Address: ___________________________________________

City, State, Zip: _________________________________ City, State, Zip: ______________________________________

Relation: __________________________ Relation: __________________________

Cell #: (__ )__________‐______________ Cell#: (__ )__________‐______________

Home: (__ )__________‐______________ Home#: (__ )__________‐______________

Work#: (__ )__________‐______________ Work#: (__ )__________‐______________

Email: __ _____________________________________ Email: __ __________________________________________

Right to Transport: Y/N Right to Transport: Y/N

EMERGENCY CONTACT INFORMATION (not listed above)

3.Name:________________________________________ 4.Name: _______________________________________

Address:______________________________________ Address: ___________________________________________

City, State, Zip: ________________________________ City, State, Zip: ______________________________________

Relation: __________________________ Relation: __________________________

Cell #: (__ )__________‐______________ Cell#: (__ )__________‐______________

Home: (__ )__________‐______________ Home#: (__ )__________‐______________

Work#: (__ )__________‐______________ Work#: (__ )__________‐______________

Email: __ ____________________________________ Email: __ __________________________________________

Right to Transport: Y/N Right to Transport: Y/N

Van Alstyne High School Medical Information for School Year 2016‐2017

Campus Address: 1722 N. Waco., Van Alstyne, TX 75495 Campus Phone: (903) 482‐8803 Campus Fax: (903) 482‐8885

Student First Name:________________________________ Middle: _________________ Last: ______________________

DOB: ___/____/____ Grade: ________________

Is your child covered by medical insurance: ___ Y___N Physician Name:_____________________________________

Physician Phone: _______________________

My child has or has had:

Asthma Diabetes Seizures Brain or neurologic problems Heart problems

Stomach or intestinal problems Bleeding disorder or hard to stop bleeding Bone or joint problems

Glasses or contacts Hearing aid(s) School attendance or behavior problems Depression

ADHD, ADD, or hyperactivity Other psychological problems Activity or gym restrictions (Dr. note required)

Other medical problem(s):____________________________________________________________________________________

Additional information on issues listed above: _______________________________________________________________________

Non‐Prescription Medications:

Do school personnel have permission to administer non‐prescription medication on “as needed” basic?: YES

NO If yes, please check the boxes you agree to for headache, fever, menstrual cramps, dental discomfort, muscle aches:

Acetaminophen Ibuprofen Benadryl

In the event you cannot be contacted, do you consent for a qualified physician to perform any medical or surgical

procedures he/she deems advisable to the welfare of this applicant while he/she is participating in school supervised

events. Further, this authorization permits said physician to hospitalize, secure appropriate consultation, to order

injections, anesthesia (local, general or both) or surgery for this applicant. The undersigned does hereby assume and agree

to pay any indebtedness or physician’s and surgeon’s fee and hospital charges for such services.

Agree Do not agree Signature: _________________________________________

Please list medications your child takes on a regular basis:

______________________________ _____________________________________ ______________________________

______________________________ _____________________________________ ______________________________

Please list medications your child will take at school on a regular basis:

______________________________ _____________________________________ ______________________________

______________________________ _____________________________________ ______________________________

Parent Signature: _________________________________________________ Date: _______________________________

Computer Acceptable Use Agreement

Student Last Name: ________________________ First Name: ______________ MI: _____ DOB: __/___/____

You are being given access on the VAISD computer system. Through this system, you will have access to information and data from all over the

world. With this educational opportunity comes responsibility. Inappropriate system use will result in the loss of the privilege to use this

educational tool. While the District will take reasonable steps to restrict access to inappropriate material (i.e. filtering server, monitoring), it is

not possible to absolutely prevent such access. It will be your responsibility to follow the rules for appropriate use.

RULES FOR APPROPRIATE USE *If you are assigned an individual account, you are responsible for not sharing the password for that account with others. *If you are not assigned an individual account, you will have access through a general user account *The account is to be used for identified educational purposes. *You will be held responsible at all times for the proper use of your account, and the District may suspend or revoke your access if you violate the rules. *A student who gains access to materials that are abusive, obscene, sexually oriented, threatening ,harassing, damaging to another’s reputation, or illegal is expected to discontinue the access as quickly as possible and to report the incident to the supervising teacher.

INAPPROPRIATE USES *Using the system for any illegal purpose *Borrowing someone’s account without permission *Posting personal information about yourself or

others (such as addresses and phone numbers) *Downloading or using copyrighted information without permission from the copyright holder.

*Posting messages or accessing materials that are abusive, obscene, sexually oriented, threatening, harassing, damaging to another’s

reputation or illegal. *Wasting school resources through the improper use of the computer system. *Gaining unauthorized access to restricted

information or resources. *Attempting to harm or maliciously destroy District equipment or data or data of another user of the district’s

system, or any of the agencies or other networks connected to the Internet is prohibited. Deliberate attempts to degrade or disrupt system

performance are violations of District policy and administrative regulations and may constitute criminal activity under applicable state and

federal laws. Such prohibited activity includes, but is not limited to the uploading, installing or creating of computer viruses. *Accessing or

participation in any chat room or newsgroup accessed on the Internet is not permissible for students. *Downloading and or installing programs

without permission.

As the parent or guardian do you give permission for your child to participate in the District’s computer system and agree

to abide by the terms and conditions listed above? ____YES ____ NO

I understand that VAISD computer use is not private and that the district will monitor activity on the computer system. I have read the District’s computer system policy and administrative regulations and agree to abide by their provision I understand that violation of these provisions may result in suspension or revocation of system access as well as other disciplinary or legal action as outlined in the Student Code of Conduct. Printed Name of Student:________________________________________________Grade: _______________ Student Signature: _____________________________________________________ Date: ________________ Printed Name of Parent: ________________________________________________________ Parent / Guardian Signature: _____________________________________________ Date: ________________

ACKNOWLEDGMENT OF STUDENT CODE OF CONDUCT – Electronic Distribution

As required by state law, the Board of Trustees has officially adopted the Student Code of Conduct in order to promote a

safe and orderly learning environment for every student.

We urge you to read this publication thoroughly and to discuss it with your family. If you have any questions about the

required conduct and consequences for misconduct, we encourage you to ask for an explanation from the student's

teacher or appropriate campus administrator.

The student and parent should each sign this page in the space provided below.

We acknowledge that we have been offered the option to receive a paper copy of the Van Alstyne ISD Student Code of

Conduct and Student Handbook for the 2016-2017 school year or to electronically access them on the district's website at

www.vanalstyneisd.org. We understand that students will be held accountable for their behavior and will be subject to

the disciplinary consequences outlined in the Code.

We have chosen to:

___ Receive a paper copy of the Student Code of Conduct and the Student Handbook.

___ Accept responsibility for accessing the Student Code of Conduct and the Student Handbook on the district's website.

Printed Name of Student:________________________ Student Signature:___________________________

Printed Name of Parent: _________________________Parent Signature:____________________________

Date: ___/____/______ Campus:______________________ Grade: ___________________________

Notice Regarding Directory Information and Parent Response

Regarding Release of Student Information

State law requires the district to give you the following information:

Certain information about district students is considered directory information and will be released to anyone who follows the

procedures for requesting the information unless the parent or guardian objects to the release of the directory information

regarding their student. If you do not want VAISD to disclose directory information from your child’s educational records without

your prior written consent you must notify the district in writing within ten school days of your child’s first day of instruction for

the current school year.

This means that the district must give certain personal information (called “directory information”) about your child to any person

who requests it, unless you have told the district in writing not to do so. In addition, you have the right to tell the district that it

may or may not, use certain personal information about your child for specific school sponsored purposes. The district is

providing you with this form to communicate your wishes.

I request that directory information for my child NOT be released as checked below:

_______ Withhold directory information from all VAISD. If you check this choice, we will not be able to post your child’s

picture on our school site, school social media pages, local newspaper, yearbook or honor award lists.

_______ Withhold directory information from all outside agencies and outside organizations.

Printed Name of Student:________________________ Student Signature:___________________________

Printed Name of Parent: _________________________Parent Signature:____________________________

Date: ___/___/_______ Campus: ____________________ Grade: ______________________________

Texas Education Agency

Texas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local education institutions to

collect data on ethnicity and race for students and staff. This information is used for state and federal

accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal

Employment Opportunity Commission (EEOC).

School district staff and parents or guardians of students enrolling in school are requested to provide

this information. If you decline to provide this information, please be aware that the USDE requires

school districts to use observer identification as a last resort for collecting the data for federal reporting.

Please answer both parts of the following questions on the student’s or staff member’s ethnicity and

race. United States Federal Register (71 FR 44866)

Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)

Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or

other Spanish culture or origin, regardless of race.

Not Hispanic/Latino

Part 2. Race: What is the person’s race? (Choose one or more)

American Indian or Alaska Native - A person having origins in any of the original peoples

of North and South America (including Central America), and who maintains a tribal affiliation

or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast

Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,

Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the black racial groups of

Africa.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original

peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or

North Africa.

________________________________

Student/Staff Name (please print)

________________________________

(Parent/Guardian)/(Staff) Signature

________________________________

Student/Staff Identification Number

________________________________

Date

Texas Education Agency – March 2009

Agencia de Educacion de Texas Cuestionario de Información de Datos Raciales y de Etnicidad de Estudiantes/Miembros de Personal

de las Escuelas Públicas de Texas

El Departamento de Educación de Estados Unidos (USDE) requiere que todas las instituciones estatales y locales de educación, recopilen datos sobre etnicidad y raza de los estudiantes y de miembros de personal. Esta información es utilizada para los reportes estatales y federales así como para reportar a la Oficina de Derechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo (EEOC). Al personal del distrito escolar y los padres o representante legal de estudiantes que deseen matricularse en la escuela, se le require proporcionar esta información. Si usted rehúsa proporcionarla, es importante que sepa que el USDE requiere que los distritos escolares usen la observación para identificación como ultimo recurso para obtener estos datos utilizados para reportes federales. Favor de contestar ambas partes de las siguientes preguntas sobre la etnicidad y raza del estudiante así como del miembro de personal. Registro Federal de Estados Unidos (71 FR 44866). Parte 1. Etnicidad: ¿Es la persona Hispana/Latina? (Escoja solo una respuesta) _ Hispano/Latino – Una persona de origen cubano, mexicano, puertorriqueño, centro o sudamericano o de otra cultura u origen español, sin importar la raza. _ No Hispano/Latino Parte 2. Raza: ¿Cuál es la raza de la persona? (Escoja uno o más de uno) _ Indio Americano o Nativo de Alaska – Una persona con orígenes o de personas originarias de Norte y Sudamérica (incluyendo America Central), y que mantiene lazos o apego comunitario con una afiliación de alguna tribu. _ Asiático – Una persona con orígenes o de personas originarias del Lejano Este, Sureste de Asia o el subcontinente indio, incluyendo, por ejemplo a Cambodia, China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia y Vietnam. _ Negro o Áfrico-Americano – Una persona con orígenes de cualquier grupo racial negro de África. _ Nativo de Hawai u otras islas del pacífico – Una persona con orígenes o de personas originarias de Hawai, Guam, Samoa u otras Islas del Pacífico. _ Blanco – Una persona con orígenes de personas originarias de Europa, el Medio Este o el Norte de África. __________________________ Nombre del Estudiante/Miembro de Personal (por favor use letra de imprenta) __________________________ _____/___/______ Firma (Padre/Representante legal)/(Miembro de personal) Fecha

Van Alstyne Independent School District

Drug/Alcohol Screening Test

Parent/Student Consent to Test

_____________________________ is a minor student enrolled in the Van Alstyne Independent School District

(print name of student)

I, ___________________________ am the parent/guardian of this minor student enrolled in VAISD.

(print name of parent/guardian)

I represent that I have the authority to consent to drug/alcohol testing of my child. I understand Van Alstyne Independent School District’s

policy regarding illegal substances use and participation in VAISD sponsored extracurricular activities. I understand that it is the practice of

VAISD to conduct drug/alcohol tests for the purpose of carrying out this policy prior to student participation or continued participation in

extracurricular activities.

I understand that my child cannot be compelled to give a urine sample. I understand that if he/she gives a urine sample it will be tested for drugs

and/or alcohol. I understand that the giving of a urine sample, when requested by VAISD, is a condition of my child’s continued participation in

extracurricular activities. I understand that if a test of my child’s urine sample reveals an unexplained presence of a drug or alcohol, the VAISD

may take action against him/her up to and including termination from any participation in extracurricular activities, as specified in the policy. An

exception will be made for the use of legally prescribed medications taken under the direct supervision of a physician. Based on my

understanding of the above, I hereby authorize Accu-Chem Laboratories and other trained personnel, to collect urine samples from my child for

the purpose of testing for the presence of drugs and/or alcohol.

I further authorize the officers, employees, and agents of Accu-Chem Laboratories to communicate my child’s drug/alcohol test results both

orally and in writing to each other, and me, and VAISD administrators and personnel responsible for administering the testing program and

extracurricular activities, and to communicate to me prior to any VAISD administrative proceedings or disciplinary actions. I understand that no

physician/patient relationship is established by the collection of this urine sample by Accu-Chem Lab, and that no privilege of confidentiality will

attach to these test results.

I agree to allow my child to participate in this program as: (check one)

________ Student involved in extracurricular activities

________ Voluntarily

Listed below are the prescription and non-prescription drugs and dosages my son/daughter takes on a regular or permanent basis:

_______________________________________________ _____________________________________________

Drug Name Dosage Drug Name Dosage

I HAVE READ, UNDERSTOOD, AND AGREED TO THE ATTACHED VAN ALSTYNE DRUG TESTING POLICY. I HEREBY RELEASE AND HOLD HARMLESS

VAISD AND ACCU-CHEMLABS, AND THEIR TRUSTEES, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, AND MEDICAL STAFF MEMBERS FROM

ANY AND ALL LIABILITY. CLAIMS, DAMAGES, AND COSTST THAT MAY ARISE AS A RESULT OF ANY ACTION TAKEN ON AN UNFAVORABLE

OUTCOME THAT OCCURS AS A RESULT OF THE DRUG/ALCOHOL TEST.

THIS IS A LEGAL CONSENT AND RELEASE OF LIABILITY FORM. PLEASE READ IT CAREFULLY AND BE SURE YOUR QUESTIONS HAVE BEEN

ANSWERED BEFORE SIGNING.

Printed Name of Parent/Guardian: _________________________________________ Signature: ____________________________________

Printed Name of Student: _________________________________________________ Signature: ___________________________________

Date: ____/____/______

THIS AUTHORIZATION WILL BE VALID DURING THE STUDENTS ENROLLMENT AT VAISD

Student Residency Questionnaire (SRQ) 2016-2017 Van Alstyne ISD

549 Miller Lane

Van Alstyne, TX 75495

Name of Student/s:

____________________________________________________________________________________________________

Last First Middle Last School Attended

Name of Student/s:

_____________________________________________________________________________________________________

Last First Middle Last School Attended

Name of Student/s:

_____________________________________________________________________________________________________

Last First Middle Last School Attended

This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11434a(2). The

answers to this residency information help determine the services the student may be

eligible to receive.

1. Is your current address a temporary living arrangement? __ Yes __ No

2. Is this temporary living arrangement due to loss of housing or economic hardship? __ Yes __ No

3. How long have you lived at your current address? ______________________________________

If you answered YES to the above questions, please complete the remainder of this form.

If you answered NO, you may stop here.

Where is the student presently living? (Check one box.)

In a motel

In a shelter

With more than one family in a house or apartment

In a place not designed for ordinary sleeping accommodations such as a car, park, or campsite

Name of Parent(s)/Legal Guardians(s)

__________________________________________________________

Address________________________________________________ Zip __________

Phone_______________

Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the

child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d).

Signature of Parent/Legal Guardian _________________________________Date:_______________

2016-2017 Family Survey

District: VAN ALSTYNE ISD Campus:

Student Name: Age: Grade Level:

Dear Parents,

In order to better serve your children, our school district is helping the State of Texas identify students who may qualify to receive additional educational services.

The information provided below will be kept confidential. Please answer the following questions and

return this form to your child’s school.

1. Within the past 3 years have you moved from one city or state to another so that you or your family could work or look for work in agriculture or fishing?

NO (STOP here and return survey to your child’s school.) YES (Please check all that apply below

and continue to question 2)

Fruit, vegetables, soybeans, sunflower,

cotton, wheat, grain, sugar beets, agricultural farms or ranches, fields & vineyards

Working in a cannery

Working in a dairy farm

Working in a fishery

Working in a slaughter house

Working on a poultry farm

Working in a plant nursery, orchard, tree growing or harvesting

Other similar work, please explain:

2. Did the children in your family go with you or join you at a later date?

NO (STOP here and return survey to your child’s school.) YES (Please complete below)

Please complete the following information: (Please print) Best time to contact you:

Parent/Guardian Name: Home Address/Apt Name: City: Zip Code:

Telephone Number: Mailing Address: City: Zip Code:

Van Alstyne Independent School District Home Language Survey

To be completed by parent or guardian (or student in grades 9-12). The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public school. To be filled in by the Parent or Guardian:

Name of Student: ______________________________________________ Birthdate : ___________________ Address ___________________________________________________ Phone: ________________________ Campus: ______________________________________________ Grade: ___________________ I. Texas Public School Enrollment Questions

1. Did this student attend another Texas Public School last year? Circle: YES or NO 2. If YES, please complete the following information about the Texas Public School the student attended. Texas Public School Name: ______________________________ City: _____________________ Street Address (if known): ______________________________________________________ Phone (if known): ______________________ Fax (if known): ______________________ II. Home Language Survey Questions

1. What language is spoken in your home most of the time? ___________________________________

2. What language does your child speak most of the time? ____________________________________ III. Required Signature Printed Parent or Guardian Name: ________________________________________________________________ Parent or Guardian’s Signature: ______________________________________________ Date:___/____/______

Van Alstyne High School

Request for Release of Records

By signing this form, you as a parent or legal guardian, or as a student 18 years of age, give

Van Alstyne High School the authority to request records from other schools or to release

records for:

Request or Release records from another school / institution

Information concerning insurance reductions

College transcript requests

Scholarships

Requests from other educational institutions

I, the undersigned, authorize Van Alstyne High School to obtain school records or to send

school records for:

Student Name: ___________________________________________________________

By signing this release form, I relieve Van Alstyne High School of the responsibility of notifying

me that records are being transferred. This authorizes the transfer of all school records as

defined by the Family Educational Rights ad Privacy Act.

Parent/Guardian: _____________________________________

Date: _____________________________________

Name of school last attended:

______________________________________________________

Address

______________________________________________________

City State Zip

_______________________________ ___________________________________

Phone Fax