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North Pike School District Returning Student Registration Packet

2019-2020

Student Name: ________________________________________________ Grade: __________________________

PLEASE HAVE THE FOLLOWING DOCUMENTS WITH YOU AT THE TIME OF REGISTRATION: RETURNING STUDENTS (any student who completed the previous school year in the North Pike School District): 1. Legal home address of parent/legal guardian 2. Two proofs of residency with street address*** 3. Allergies or medical conditions notification (New Certificate of Compliance will be required for any student entering the 7th grade) ** Certificates of Compliance can be obtained at the following location: Pike County Health Department ***When using utility bills as proof of residence, the bill must be dated within 30 days prior to registration. Please make sure that any bills you bring as proof of residence show your physical address. NO CONVICTED OR REGISTERED SEX OFFENDERS will be allowed on school property at any time students are present. If it is necessary for these individuals to have a conference with school personnel, an appointment must be made before or after school hours.

Parent Signature/Guardian: _____________________________________ Date: ____________________________

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North Pike School District Residency and Registration 2019-2020

________________________________________________ _________________________ _________ ____________ Address City State Zip ( P.O. Box Number is not acceptable; if route, give physical location direction on back)

I hereby certify that the information given above on this form is a true and correct statement of my legal residence. Should my legal residence change while the above listed student is enrolled in the North Pike School District, I will promptly notify the appropriate officials of the North Pike School District. Further, I understand that a pupil is not legally enrolled until this form is completed and signed by the parent, guardian, or other adult with whom the student may be living. I understand that a pupils(s) admitted under information is not legally enrolled and is subject to penalty. ______________________________________ _____________________ _____________________ Signature of Parent, Guardian, or Other Adult Date Telephone

TO BE COMPLETED BY THE SCHOOL DISTRICT

A. Proofs of Residency Provided to North Pike School District by Parent, Guardian, or Other Adult:

*Filed Homestead Exemption Application Form (Required with an additional proof) *Mortgage Documents/Property Deed/Home Insurance (Required with an additional proof) *Apartment/Home Lease (Handwritten receipts will not be accepted) (Required with an additional proof) Residency Bills (Electric/Water/Gas/Home Phone/Cable/Internet)

*NO CELL PHONE BILLS WILL BE ACCEPTED* WASTE MANAGEMENT BILLS WILL NOT BE ACCEPTED* Automobile Registration/Insurance Dated Official Government Documents (SSI/SNAP/DHS) Affidavit of Residency/Representative Personal Visit Verification of 30 Mile Rule Exemption

B. North Pike School District Employee _________ In District __________Out of District C. Student is living with legal guardian and a certified copy of the Court Decree, or petition if pending, was received

declaring the district resident to be the legal guardian of the student further declaring that guardianship was formed for a purpose other than establishing residency for school district attendance purposes.

Date:_________________ School Representative Signature:______________________

Student Name:____________________________ Parent/Guardian Name:_____________________________

School: _________________ Grade:_______ Student Resides With:______________________________

Sibling Name:________________ Grade:_______ Sibling Name:________________ Grade:_______

Sibling Name:________________ Grade:_______ Sibling Name:________________ Grade:_______

Sibling Name:________________ Grade:_______ Sibling Name:________________ Grade:_______

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North Pike School District Student Registration Form 2019-2020

Today’s Date: ____________________ Student’s Legal Name: (Last) (First) (Middle) (Name MUST match birth certificate unless legal document of name change is presented at time of registration.) Social Security Number (optional): ______-______-______ Birthdate: ___________/__________/___________ Birthplace: ______________________________________________ Birth Certificate Number: ____________________ (City) (County) (State) Primary Race: (check one): ___AS = Asian ___ PI = Pacific Islander ____B = Black ______ H = Hispanic ___ NA = Am. Indian ____W = White Any Other Race That Applies: ___ AS = Asian ____PI = Pacific Islander _ ___B = Black ____H = Hispanic ____ NA = Am. Indian ____W = White Gender: (check one) ____Male ____Female Foster Child: (check one) ____Yes _____No Foreign Exchange Student: (check one) ____Yes _____No Transportation Information: (Check one) ______Car ______Bus

Residence Information 911 Address: Mailing Address: (if different) ____________________________________________ ____________________________________________

(Street Address) (Street Address / PO Box) ____________________________________________ ____________________________________________ (City) (Zip Code) (City) (Zip Code) Parent/Guardian Primary Phone Number: ____________________________________________________

Parent / Guardian Information Child lives with: Check ALL that apply __Father __ Mother ___Stepfather __Stepmother ___Legal Guardian (Legal Papers Required) Parent /Guardian Active/Reserve Military? ____Yes ____ No If yes, please provide Parent/Guardian Name:_________________________________ 1st Parent/Guardian ________________________________________________________________________________________________________

(Last Name) (First Name) (Middle) (Relationship) Physical Address:____________________________________________________ Mailing Address:__________________________________

(Full address if different than student)

Employer: _________________________________________________________ Work Phone:_____________________________________

Email Address: _____________________________________________________ Cell Phone:_________________________________________ 2nd Parent/Guardian:_______________________________________________________________________________________________________

(Last Name) (First Name) (Middle) (Relationship) Physical Address:____________________________________________________ Mailing Address :_________________________________

(Full address if different than student)

Employer: _________________________________________________________ Work Phone:_____________________________________

Email Address: _____________________________________________________ Cell Phone:_________________________________________

North Pike Elementary: (Check One) __K ___1st ___2nd ___3rd

North Pike Middle School: (Check One) ___ 6th ___7th ___8th

North Pike High School: (Check One) ___9th ____10th ___11th ___12th

North Pike Upper Elementary: (Check One) __4th ___5th

Verified

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Emergency Contact and Check In / Check Out Information 2019-2020

Contacts should NOT be the parents / guardians listed on previous page. Emergency Contacts are included in the Check In/Check Out List.

Emergency Contacts Name: Relationship: ____________________________ Home Phone: Work Phone: Cell Phone: Address: __________________________________________ City: __________________ Zip ______________ Name: Relationship: ___________________________ Home Phone: Work Phone: Cell Phone: Address: __________________________________________ City __________________ Zip _______________

Check In / Check Out Name: ___________________________________________________ Relationship: _______________________ Home Phone: Work Phone: Cell Phone: Name: Relationship: Home Phone: Work Phone: Cell Phone: Name: Relationship: Home Phone: Work Phone: Cell Phone: Name: ___________________________________________________ Relationship: _______________________ Home Phone: Work Phone: Cell Phone: Name: Relationship: Home Phone: Work Phone: Cell Phone: Name: Relationship: Home Phone: Work Phone: Cell Phone: I am aware that by signing this packet I am giving my permission for North Pike School District to use the Emergency/Check In/Check Out Contacts listed above when I cannot be reached. I also acknowledge that anyone not on this list or unable to provide valid identification will not be allowed to check my child in or out of school nor have any contact with my child. In the event, I would like to add or delete a contact during the school term I understand I must visit my local school office to update this information. I recognize these procedures are in place for the safety and protection of my child. _______________________________________________________ __________________________ Signature of Parent/Guardian Date

Student Name:____________________________ School:_____________________________ Grade:________

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North Pike School District Policy and Procedures

Student Name: I hereby give permission to have all pertinent records on the above named student be sent to the North Pike School District.

Emergency Policy: If I cannot be reached, the school has my permission to secure the most readily available medical services and if necessary, have my child transported to the nearest emergency care facility. I understand that I will be responsible for any cost related to this action. ___ Initials

Students' Name/Picture/Video in Publications/News Media: The school district will publish the name and/or pictures of a student in school-related activities/events when the administration deems such activities or events to be appropriate. I have been notified that this information is in the student handbook. I understand that if I do not wish to have my child's name and/or picture to be used in school-related publications or in news media I must inform the administration in writing of specific news media or school-related publications in which I do not wish to have my child's name and/or picture appear. ___ Initials

Textbook Policy The school district provides textbooks at no charge to students. It is the responsibility of the parent to see that all student textbooks are returned to the school prior to transfer or end of the school year. (The replacement cost of the textbook will be charged to the custodial parent for textbooks not returned.) ___ Initials

Fines, Fees and Damages I understand that I am responsible for the payment of all fees, fines and damages to school property, which are incurred by my child. I further understand that my child will not receive a final grade for his/her courses until all fees, fines and damages are cleared. ___ Initials

Student Handbooks Our Student Handbook will be available on our website: www.npsd.k12.ms.us on the For Parents/Student Enrollment page. ___ Initials

Medical Information If there are any medical conditions or medications the school office should be aware of please list below: By my signature I hereby attest that I have read and understand the statements above. Signature of Parent/Guardian Date

__________________ _______________ Registering Year Student’s Grade

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North Pike School District HOME LANGUAGE SURVEY

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North Pike School District

Parent-Guardian/Student/Teacher Agreement Compact

Student Name: Grade: The faculty and staff from North Pike School District envision the highest level of success for each individual. We make the Commitment to motivate, challenge, and inspire each other to become the best we can possibly be. To accomplish this, parents, teachers, and students need to work together. We ask that you promise to do this by completing and signing the part of the agreement that applies to you. Parent/Guardian Checklist: I will do my personal best to: See that my child attends school regularly and on time. Support the school in developing positive behaviors. Establish a time for homework and review it regularly. Provide a home environment that encourages my child to learn. Encourage my child’s efforts and be available for questions. Stay aware of what my child is learning. Read with my child and let my child see me read. Communicate regularly with my child’s teacher. Parent’s/Guardian’s Signature: Date: Student Checklist: I will do my personal best: Attend school regularly. Come to school each day with pencils, paper, and other necessary tools for learning. Complete and return homework assignments. Observe regular study hours. Follow the school and classroom rules. Respect other people and the community. Student’s Signature: Date: Teachers Checklist: I will do my personal best to: Provide an environment conducive to learning. Help each child grow to his/her fullest potential. Provide meaningful and appropriate homework activities. Enforce school and classroom rules fairly and consistently. Maintain open lines of communication with each student and his/her parents. Demonstrate professional behavior and a positive attitude. Teacher’s Signature: Date: ____________________

_________ _____________________

Registering Year Student’s Grade

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North Pike School District

A Message from the Nurses

Our district currently employs full-time nurses at each of our campuses. Please remember that ANY MEDICATION (not listed below), whether prescription or non-prescription must have a permission form filled out by a physician and by a parent/guardian. The medication must be brought to the school in the original container by the parent/guardian. Students who take daily physician ordered medication at school will be able to receive that medicine while on a field trip with the exception of nebulizer treatments. If your student requires the use of a nebulizer, please be aware that they will not receive that treatment while on a field trip and consider that when deciding if you will allow them to participate. Should your child become ill or injured at school, we have a physician’s order that allows only the SCHOOL NURSE to provide your student with the following medications that she deems necessary:

Acetaminophen (Tylenol)

Ibuprofen (Advil, Motrin)

TUMS or Generic antacid tablets

Benadryl

Epi-Pen / Auvi-Q (ONLY for SEVERE ALLEGRIC REACTION)

Cherry Throat spray

Cough Drops

Neosporin or Generic antibiotic cream

Hydrocortisone cream or Generic anti-itch cream

Calamine, Caladryl or Calagel lotion

Vaseline Ointment

Carmex or Blistex Ointment

Topical anesthetic (First Aid) spray or hydrogen peroxide

Insect Sting Wipe

Orasol (Oragel) liquid or gel

Muscle rub cream

Anti-fungal cream

Visine or Generic Sterile Eye Irrigate Solution

YES my student MAY TAKE OR USE ALL of the above medications.

NO my student MAY NOT TAKE OR USE ANY of the above medications.

Parent/ Guardian Signature _______________________________ Date____________________________ Student Name___________________________________________________________________________

2019-2020

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NORTH PIKE SCHOOL DISTRICT BUS DISCIPLINE POLICY AGREEMENT

I request School Bus Transportation for the student(s) listed below. We will comply with the Bus Discipline Policy adopted by the North Pike School Board of Education for the 2019 – 2020 school year. I understand that violation of school rules and regulations may result in the loss of bus riding privileges. ONE PER FAMILY Medical Conditions

(ex: Allergies, Asthma, Seizures, Diabetes) 1. Student Name Grade 2. Student Name Grade 3. Student Name Grade 4. Student Name Grade 5. Student Name Grade Printed Name of Parent/Guardian Bus Number (Office Use) A.M. / P.M. Signature of Parent/Guardian A.M P.M. E911 Address Date Home / Cell Phone Work Phone Emergency Phone If you have any questions regarding Transportation of your child(ren) please call: 601-249-2400.

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North Pike School District Summit, MS 39666

Mr. Dennis Penton, Superintendent 601-276-2216

Dear Parents: This is your child’s copy of the Student Handbook for North Pike School District. It contains the general philosophy and

procedures of our school system and is a guide for you and your child in adjusting to the policies, regulations, and procedures of our schools. Since this handbook has been reviewed by the North Pike School Board and includes the School Board’s policy on

discipline and attendance, we would like for you to read it carefully and become familiar with the procedures we will use during the school year. Please make a note that our Elementary and Middle School administer corporal punishment in the presence of another witness as a disciplinary measure (allowable by Mississippi Code 37-11-57) when an infraction warrants. If you are opposed to the use of corporal punishment, you must submit in writing a request for corporal punishment not to be administered to your child and an alternate discipline plan that will be used with your child that has been approved by school administration to the school office. Please sign below and return this letter so that we will know that you have had the opportunity of carefully reviewing our Student Handbook, and give your support in making the North Pike School District one of the best school systems that your child could attend. If you have any questions regarding this handbook or any of our schools, please feel free to come see us or call the following numbers: North Pike Elementary Grades: K-3 Mrs. Lori Harrell, Principal Mrs. Winona Dykes, Assistant Principal Mrs. Michelle Smith, Assistant Principal North Pike Upper Elementary Grades: 4-5 Mrs. Angela Benefield, Principal Mrs. Avery Peagler, Assistant Principal North Pike Middle School Grades: 6-8 Mr. Allen Barron, Principal Mrs. Angela Ellison, Assistant Principal Ms. Reshonda Woods, Assistant Principal North Pike High School Grades: 9-12 Mr. Scott Hallmark, Principal Mr. Blake Brewer, Assistant Principal Mr. Ron Fortenberry, Assistant Principal North Pike Career & Technical Center Grades: 9-12 Mr. Darryl Brock, Director

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Please Print Student’s Name

____________________________________ Student’s Signature

______________________________ Parent/Guardian’s Signature

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School

____________________________________ Grade

____________________________________

School Year

____________________________________ Homeroom Teacher

____________________________________

Date

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STUDENT INTERNET ACCEPTABLE USE POLICY FORM 2019-2020

* * * *TO BE KEPT ON FILE AT SCHOOL AND TRACKED THROUGH I-NOW* * * *

PUBLICATION OF PICTURE/SCHOOLWORK AGREEMENT: We ask your permission to use your child’s picture and/or schoolwork, or an edited selection of schoolwork, in the following

ways without liability to the North Pike School District: 1. On the District's Website.

The Web Site will use student’s first name and/or first name and last initial only. Personal information such as

home address, phone number, social security number, or names of family members will not be used. Any information that indicates the physical location of a student at a given time other than attendance at a particular school or participation in school activities will not be used. Schoolwork may include, but is not limited to, art, written papers, class projects, and computer projects.

2. In material printed by the District or printed by publishers outside the District. Printed material may include a child’s full name. Printed material may include, but is not limited to, brochures, newspaper articles, and print advertisements. 3. In videos. Videos may include videos produced and broadcast by the District or produced and broadcast by news organizations and others who receive approval from the District.

_____Yes, my child’s schoolwork or picture can be used on the District’s Web site, in printed publications

and/or videos. _____No, my child’s schoolwork or picture CANNOT be used on the District’s Web site, in printed publications

or in videos.

______________________________ _________________________________ Parent/Guardian Signature Date

* * * PLEASE SIGN AND RETURN THIS FORM TO YOUR CHILD’S SCHOOL* * *

For Students and Parents/Guardians: Please read the Acceptable Use Policy for Internet, Electronic Mail, and Equipment Responsibility that is attached. Signing below indicates the parent’s/guardian’s permission for the student to access the Internet and the student’s agreement to follow district

policy regarding computer usage and Internet usage. Inappropriate use will result in a cancellation of such privileges and/or disciplinary action. If a signed parental permission is not on file, the student will not be allowed to use on-line services. ______________________________ _________________________________ Student’s Name/Grade Teacher’s Name ______________________________ _________________________________ Parent/Guardian Signature Date

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