Victor Central School District

Student Registration

Student Namerequired

REMINDER . . .

During the registration process you will be asked to provide the following paperwork.

Proof of Residency (1) – Mortgage Statement/Lease Agreement/Utility Bill
Child's Birth Certificate
Proof of your child's immunization

The three different options for submitting this documentation are:

Email your documents: overfieldc@victorschools.org

Fax your documents: 585-742-7020

Upload your documents: you will see "attach file" during registration process. If uploading your files it is recommended that you have them ready before starting.

Residency Questionnaire

The answer you give below will help the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Students who are protected under the McKinney-Vento Act are entitled to immediate enrollment in school even if they don't have the documents normally needed, such as proof of residency, school records, immunization records, or birth certificate. Students who are protected under the McKinney-Vento Act may also be entitled to free transportation and other services.

Where is the student currently living?

Please check ONLY ONE box.

In a Shelter With another family or other person because of loss of housing or as a result of economic hardship (sometimes referred to as "doubled -up") In a hotel/motel In a car, park, bus, train, or campsite Other temporary living situation In permanent housing

Please describe

Please submit evidence establishing you and your child’s physical presence in the school district. Please attach one of the following:

Utility or other bills
Lease
Proof of ownership of a house or condominium, such as a deed or mortgage statement.

Options for Submitting your documentation:

Email your documents: overfieldc@victorschools.org
Fax your documents: 585-742-7020
Upload your documents: see "attach file" below

How will you be getting us the documents?required

This is so we know how to expect it.

Attach File

Max file size: 10 MB

Student Information

First Namerequired

Middle Name (Optional)

Last Namerequired

Genderrequired

Birthdaterequired

mm/dd/yyyy

Graderequired

Home Address (City, State, Zip)required

Mailing Address (City, State, Zip) (If different from mailing address)

Home Phone

Student Cell Phone

County of Residencerequired

Proof of Student's Age

The District will require documentation and/or information establishing your child’s age. Please supply a certified transcript of a birth certificate or record of baptism (including a certified transcript of a foreign birth certificate or record of baptism) giving the date of birth. Where such documentation is not available, a passport (including a foreign passport) may be used.

Where birth certificate or passport is not available, the District may consider certain other evidence, which has been in existence two years or more. Other evidence may include, but will not be limited to the following:

official driver’s license;
state or other government issued identification;
school photo identification with date of birth;
consulate identification card;
hospital or health records;
military dependent identification card;
documents issued by federal, state or local agencies (e.g., local social service agency, federal Office of Refugee Resettlement);
court orders or other court-issued documents;
Native American tribal document; or
records from non-profit international aid agencies and voluntary agencies.

Options for Submitting your documentation:

Email your documents: overfieldc@victorschools.org
Fax your documents: 585-742-7020
Upload your documents: see "attach file" below

How will you be getting us the documents?required

This is so we know how to expect it.

Attach File

Max file size: 10 MB

Is this student transferring from another school?*

Yes No

School Records

Authorization for Release of Student Information
(This link will take you to the Release of Student Information Form. It will open in a new window but you may want to save your registration form)

Options for Submitting your documentation:

Email your documents: overfieldc@victorschools.org
Fax your documents: 585-742-7020
Upload your documents: see "attach file" below

How will you be getting us the documents?required

This is so we know how to expect it.

Attach File

Max file size: 10 MB

Student Services

Has your child ever been identified as having an educational disability?required

If yes, please describe

Check which applies

Student has a current Individualized Education Plan (IEP) Student has a 504 Accommodation Plan

Please describe any Special Education Services that your child has received: (i.e. speech, occupational therapy, physical therapy, rescue, special class, remedial instruction)

Has your child received any other services (i.e. gifted/talented and/or English as a Second Language)?required

If yes, please describe

Are there any significant health problems?required

Other

In accordance with New York State’s Public Health Law, the District must also receive evidence that your child has been immunized in accordance with the New York State Department of Heath Immunization Bureau’s Immunization Requirements for School Entrance/Attendance. These records will be necessary to ensure your child’s continued attendance. Additionally, please provide us with records of any recent physical examination your student has received. New York State mandates that each new student entering a public school is required to have a physical examination upon entering the District. A physical completed no more than twelve months before the first day of the school year in question will meet this requirement.

Options for Submitting your documentation:

Email your documents: overfieldc@victorschools.org
Fax your documents: 585-742-7020
Upload your documents: see "attach file" below

How will you be getting us the documents?required

This is so we know how to expect it.

Attach File

Max file size: 10 MB

Parent/Guardian Information (fill out ALL that apply)

Namerequired

Home Address (City, State, Zip) (If different from Child's)

Home Phone

Cell Phonerequired

Work Phone

Work Ext.

Email Addressrequired

Name

Home Address (City, State, Zip) (If different from Child's)

Home Phone

Cell Phone

Work Phone

Email Address

Name

Home Address (City, State, Zip) (If different from Child's)

Home Phone

Cell Phone

Work Phone

Email Address

Name

Home Address (City, State, Zip) (If different from Child's)

Home Phone

Cell Phone

Work Phone

Email Address

Are there any custodial restrictions or an order of protection?*

Yes No

Please Explain

Attach file if necessary.

Attach File

Max file size: 10 MB

Emergency Contacts(beyond parent/legal guardian)

Name

Is this person allowed to pick up child from school:*

Yes No

Other

Home Phone

Cell Phone

Work Phone

Name

Is this person allowed to pick up child from school:*

Yes No

Other

Home Phone

Cell Phone

Work Phone

Transportation Form Link
(This link will take you to the Transportation Form. It will open in a new window but you may want to save your registration form)

Student Racial and Ethnic Identification

To the Parent/Guardian: The U.S. Department of Education and the New York State Department require the collection and recording of the racial and ethnic identity of students. The information will be used to:

Report required data to the State and Federal Education Departments.
Plan educational programs and make sure that they are readily available to all students.
Analyze differences in academics performance, attendance and completion of school.

This information will be kept secure and confidential in accordance with all State and Federal student privacy laws and regulations. If the information requested in not provided on this form on behalf of your child, a student records officer from the school or district will be required to identify the group to which the student appears to belong, identifies with, or is regarded in the community as belonging. Thank you for your cooperation.

Directions to Parent/Guardian

Please answer questions (1) and (2). Please read them before you respond.
(For question (1) select the one that best describes you child.)

1.

Is the student Hispanic, Latino, or of Spanish origin? Hispanic, Latino, or of Spanish origin means a person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.

2.

Select on or more races from the following five racial groups (For question (2) select all groups that apply to your child. Select at least ONE box.

All students between 5 and 21 years of age have the right to a free public education. Children may not be refused admission because of race, color, creed or national origin, sex, citizenship, handicapping condition, or immigration status.

Home Language Questionnaire Link
(This link will take you to the New York State Education Home Language Questionnaire on the NYS Education Department Website, You will need to print this form and fill it out. See below for options to send form to VCS. Please make sure you have saved your registration form)

Options for Submitting your documentation:

Email your documents: overfieldc@victorschools.org
Fax your documents: 585-742-7020
Upload your documents: see "attach file" below

How will you be getting us the documents?required

This is so we know how to expect it.

Attach File

Max file size: 10 MB

Medicaid Consent

Client Identification Number (CIN)

This is to ask your permission (consent) to bill your or your child's Medicaid Insurance Program for special education and related services that are on your child's individualized education program (IEP).

This consent allows the school district to bill of covered health-related services and to release information to the school district's Medicaid Billing Agent for that purpose.

Daterequired (mm/dd/yyyy)

Parents Namerequired

Child's Namerequired

I have received a written notification from the school district that explains my federal rights regarding the use of public benefits or insurance to pay for certain special education and related services.

I understand and agree that the School District may access Medicaid to pay for special education and related services provided to may child.

I understand that:

Providing consent will not impact my child's/my Medical coverage;
Upon request, I may review copies of records disclosed pursuant to this authorization;
Services listed in my child's IEP must be provided at no cost to me whether or not I give consent to bill Medicaid;
I have the right to withdraw consent at any time; and
The school district must give me annual written notification of my rights regarding this consent.

I also give my consent for the school district to release the following records/information about my child to the State's Medicaid Agency for the purpose of billing for special education and related services that are in my child's IEP. The following records will be shared.

Records to be shared (such as records or information about services your child receives)

IEP
Written Order/Referral
Evaluation Reports
Session Notes
Medication Administration Report
Special Transportation Log
Other Personally Identifiable Information
Any Other Specific Records Pertaining to the Student's Services or Program

I give my consent voluntarily and understand that I may withdraw my consent at any time. I also understand that my child's right to receive special education and related services is in no way dependent on my granting consent and that, regardless of my decision to provide this consent, all the required services in my child's IEP will be provided to my child at no cost to me.

Signature

I am the Parent / Legal Guardian*

Yes No

Daterequired (mm/dd/yyyy)

Verification By Subscription:

By selecting you are the parent/legal guardian you are stating that you have answered all this information correct.