2020-2021 Preschool Registration Information For the Preschool Programs in the High Schools

Thank you for your interest in Jordan School District’s integrated Preschool Program in our high schools. We are currently accepting registration for the 2020-2021 school year.

These classes provide a preschool program promoting a child’s cognitive, communication, social emotional, adaptive and motor development. Students are instructed by a Certified Educator, Instructional Assistants and high school students currently enrolled in Early Childhood Education classes. The preschool implements The Creative Curriculum and Learning Without Tears; both follow the Utah State Board of Education Early Childhood Core Curriculum.

2020-2021 Preschool Program Information Children must be 4 years old on or before September 1, 2020. Classes are held Monday/Wednesday or Tuesday/Thursday. Tuition for our two-day program is $85.00 per month (7 months). December (month 8) tuition is $42.00. Non-Refundable Registration Fee of $40.00. To hold a spot, return the original completed registration packet (copies of the packet will not be accepted)

and pay the non-refundable registration fee to the high school where your student will attend.

Bingham High School Mini Miners 2160 W 10400 S, South Jordan Teacher: Janae Dunn janae.dunn@jordandistrict.org Website: https://www.binghamminers.org/preschool/

Copper Hills High School Copper Cubs 5445 New Bingham Hwy, West Jordan Teacher: Sherrie Eloff sherrie.eloff@jordandistrict.org Website: http://copperhillshigh.org/works/daycarepreschool/

Herriman High School Mini Mustangs 11917 S Mustang Trail Way, Herriman Teacher: Kristi Johnson kristi.johnson@jordandistrict.org Website: https://herrimanminimustangs.weebly.com/preschool.html

Mountain Ridge High School Mini Sentinels 14100 S Sentinel Ridge Blvd, Herriman Teacher: Katie Trump katie.trump@jordandistrict.org Website: https://minisentinels.weebly.com/

Riverton High School Silver Pups 12476 S Silverwolf Way, Riverton Teacher: Erin Dea erin.dea@jordandistrict.org Website: http://rivertonhigh.org/silverpup-preschool/

West Jordan High School Junior Jags 8136 S 2700 W, West Jordan Teacher: Rachel Stephenson rachel.stephenson@jordandistrict.org Website: https://www.westjordanhigh.org/juniorjagpreschool

Page 1 of 2

2020-2021 Preschool Registration Form For the Preschool Programs in the High Schools

Select School Bingham High School Copper Hills High School Herriman High School Mountain Ridge High School Riverton High School West Jordan High School

Select Schedule Monday/Wednesday Tuesday/Thursday All days/Monday-Thursday

Child’s Full Legal Name Date of Birth Gender M F Federal Race Home Address City Zip

Guardian 1 Full Legal Name Relationship Phone Home Cell Work Email Address Does this guardian have legal custody? Yes No Is this guardian allowed to pick the student up from school? Yes No Should this guardian also be considered an emergency contact? Yes No

Guardian 2 Full Legal Name Relationship Phone Home Cell Work Email Address Does this guardian have legal custody? Yes No Is this guardian allowed to pick the student up from school? Yes No Should this guardian also be considered an emergency contact? Yes No

Are there other Legal Guardians who live at a different address*? Yes No Full Legal Name Relationship Phone Home Cell Work Email Address Does this guardian have legal custody? Yes No Is this guardian allowed to pick the student up from school? Yes No Should this guardian also be considered an emergency contact? Yes No *If legal guardians live at a different address, we will need a copy of the most recent legal documents that outline custody.

Emergency Contact (outside of your home) Name Relationship Cell Phone

Please continue to page 2.

Page 2 of 2

Please list other children in the home. This information is used to match families in Skyward. Child’s Name Date of Birth School Child Attends

Is your child currently under an IEP (Individual Education Plan)? Yes No

Please let any medical concerns. If none, write “None”.

Name of Person Completing Form – Printed Signature of Person Completing Form Date

Registration Checklist All items must be included when submitting the registration packet. A spot will not be held for your student until all items are completed and received. Copy of Birth Certificate (copy must be made at the school from original document) Copy of Immunization Record (must have student’s name and date of birth on document) Completed and signed

o Registration Formo Policy Lettero Permission to Evaluateo Student Family Residency Questionnaireo Home Language Survey

Pay non-refundable Registration Fee

2020-2021 Preschool Policy Letter For the Preschool Programs in the High Schools

Please sign the bottom of this Policy Letter verifying that you have read and agree to the following policies.

PAPERWORK. Prior to entrance into one of the high school preschool programs, the following items must be submitted.

Copy of Birth Certificate (copy must be made at the school from original document) Copy of Immunization Record Completed and signed

o Registration Formo Policy Lettero Permission to Evaluateo Student Family Residency Questionnaireo Home Language Survey

Pay Registration Fee

IMMUNIZATIONS. Utah State law requires that all children be properly immunized prior to entering the Jordan School District Preschool programs. Jordan School District is required to maintain a current immunization record, or an exemption form from the Health Department, for all children who attend our preschool programs.

For immunization requirements and information, please visit the Utah Department of Health Immunization Program website at https://immunize.utah.gov/school-early-childhood-program-requirements/

DTaP (Diphtheria, Tetanus, and Pertussis) Polio Hepatitis A Hepatitis B

MMR (Measles, Mumps, Rubella) HIB (Haemophilus Influenzae type b) Varicella (Chicken Pox) Pneumococcal (PCV7)

TUITION. Do not give tuition money to your child’s teacher. Cash, debit or credit cards are accepted. Tuition payments are due the first of each month, and should be mailed or dropped off to the main office of the

school your child is attending. There is no reduction in tuition for children who are unable to attend due to illness or vacation. Paid tuition is non-refundable. A full month’s tuition is expected for any month that your child attends at least one class with the exception of

December. The tuition for the month of December is $42.00.

WITHDRAWAL FROM PROGRAM. The Jordan School District requires a written notice of your intent to withdraw your child from the program. Monthly tuition payments are expected until written notice is received and accepted by the school your child is

attending.

Parent/Guardian Name Printed Parent/Guardian Signature Date

Immunization Requirements

Early Childhood Programs

Children enrolled in Early Childhood Programs (licensed day care center, nursery or

preschool, child care facility, family home care, or Head Start Program) must be

immunized appropriately for their age with the following immunizations:

Proof of immunity to disease (s) can be accepted in place of vaccination only if a document

is presented to the early childhood program from a healthcare provider stating the child

previously contracted the disease.

For children whose parents claim an exemption to immunization for medical, religious, or

personal reasons, their legally responsible individual must complete an online immuniza-

tion education module at www.immunize-utah.org or in-person consultation at a local

health department. A copy of the certificate must be presented to the child care official.

For a medical exemption from the required immunizations, a completed vaccination ex-

emption form and a written notice signed by a licensed healthcare provider must be pre-

sented to the school.

For questions regarding your child’s immunization status, contact your child’s health care

provider, local health department or the Immunization Hotline at 1-800-275-0659.

This may be copied and distributed.

Hepatitis A

Hepatitis B

Pneumococcal

Varicella(chickenpox)

Polio (3 doses, if 3rd dose was given on/after the 4th birthday)

Haemophilus influenzae type b (Hib)

DTaP (Diphtheria, Tetanus, and Pertussis)

MMR (Measles, Mumps, Rubella)

Rev 02/2019

Permission to Evaluate

Dear Parent/Guardian,

To ensure we meet your child’s development and learning needs throughout the year, Jordan School District staff will complete regular assessments and screenings of your child’s development and learning. These assessments and screenings focus on your child’s growth and progress in the areas of social and emotional development, language, vocabulary, early literacy, mathematics, and early concept development. Your child’s participation in these assessments and screenings will help us learn how our program can better meet the needs of your child and other children.

Information about your family and your child’s scores on the assessments is completely confidential. Your child’s name, demographic information and assessment scores will be entered into and stored in a secure electronic database. This database will be stored at the Jordan School District Administrative Offices. These scores will be used in the following ways:

1) By your child’s classroom teaching staff to meet your child’s learning needs.2) By program administrators and early childhood specialists to identify ways to improve

early childhood programs to better meet the needs of all children and families.3) By evaluation staff to report the progress of all children as a group.4) By classroom teaching staff and administrators to address the needs of students and

the Jordan Child Development Center.

You and your child are not required to participate in these assessments. If you decide not to participate, it will not affect you or your child’s standing in the Jordan Child Development Preschool in any way. You can choose to withdraw your child from the evaluation at anytime. If you have any questions, please do not hesitate to contact your child’s teacher or the program coordinator.

Jill DurrantProgram Coordinator 801-567-8512Jordan Child Development Centerjill.durrant@jordandistrict.org

Jason SkidmoreCTE Director801-256-5951CTEjason.skidmore@jordandistrict.org

CTE-2/7/2020

Permission to Evaluate

I have read or have had explained to me the evaluation process used by the Jordan Child Development Center. Please check the first two items if you are willing to allow your child to fully participate in the evaluation process.

YES (Mark these two)

! I give permission for my child to participate in these assessments and screenings.! I give permission for my child to be videotaped/photographed for instructional purposes.

NO (Mark these two)

! I do not give permission for my child to participate in these routine assessments andscreenings.

! I do not give permission for my child to be videotaped/photographed for instructionalpurposes.

_____________________________________________ ________________  

Child’s First, Middle and Last Name (PLEASE PRINT) Date of Birth (DOB)

_____________________________________________ ________________

Signature of Legal Parent/Guardian Date

CTE-March 7, 2018

 

                                                                      

                                    

                                                                                  

                                     

         

         

         

         

         

                                                                      

                                     

  

           

 

     

 

         

      

            

        

       

 

       

                                                      

                                              

   

                                                          

   

Student/Family  Residency  Questionnaire Your child may be eligible for additional educational services through Title I­Part A, Title I­Part C­Migrant and/or the Federal

McKinney­Vento Assistance Act (42 U.S.C. 11435). Please complete this form and return it to your child’s school.

1. Presently,  are  you  and/or  your  family  living  in  any  of  the  following  situations?  Check  all  that  apply.  

❏ 1.  Student  is  sharing  the  housing  with  one  or  more  families  due  to  loss  of  housing,  economic  hardship,  or  similar  reason. ❏ 2.  Student  is  temporarily  living  in  a  motel  or  hotel  due  to  loss  of  housing,  economic  hardship,  or  similar  reason. ❏ 3.  Student  is  living  in  a  shelter  (family  shelter,  domestic  violence  shelter,  youth  shelter,  or  transitional  housing.) ❏ 4.  Student  is  living  in  a  car,  park,  campground,  abandoned  building,  or  public  place. ❏ 5.  Student  is  living  in  a  place  without  adequate  facilities  (not  designed  for  heat,  electricity,  water  services,  etc.) ❏ 6.  Student  is  seeking  enrollment  without  an  accompanying  parent  (unaccompanied  youth).  

If any of the above conditions were checked, please return this completed form to your child’s school office.

2. Please list ALL children currently living with you that are attending any elementary, middle, or high school in Jordan SchoolDistrict. Please also list preschool age children who will be 3 or 4 years old by September 1st of the current year.

First Middle Last M/F Birthdate Grade School Name

Presenting a false record or falsifying records is an offense under Section 73.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition ofother costs. TEC Sec. 25.003(3)(d). The McKinney Vento Homeless Education Assistance Act ensures rights for students who are homeless.

3.

Name of parent(s)/legal guardian(s) Signature Date

Address City/Zip Phone

Person completing this form:❏ Parent❏ Student

❏ Guardian❏ Other (please specify

____________________

❏ School Personnel (Date/Method):__________________________________(Phone conversation, personal knowledge,etc.)

Parents(s), Guardians(s), or Student:

✓ Please notify the school if your living status changes.✓ If your children qualify for services under the McKinney­Vento Assistance Act they have the right to additional services andsupport which could include school placement, school supplies, intervention, etc.

✓ Please call the Jordan School District Homeless Liaison at 801­567­8308 if you have questions.

School Personnel:

✓ Please return this form for SKYWARD identification purposes to the Jordan School District Homeless Liaison at AlternativeLanguage Services in the Auxiliary Services Building or call 801­567­8308 for questions.

Revised 3/17/2016

 

  de  Residencia  para  Estudiantes  y  Familias                                                     

                               

                                                                                                             

                                 

         

         

         

         

         

         

                                                                 

                                                   

 

               

           

 

      

  

      

 

            

         

 

                                                                      

                                              

                                                                                

     

   

CuestionarioSu estudiante puede ser elegible para los servicios adicionales a través de Tḭtulo I­parte A, Titulo I Parte C­ Migrante, y ó el Acto Asistente de

Mckinney­ Vento (42U.S.C. 11435), por favor complete este formulario y regreselo la escuela de su estudiante.

1.  Presentemente  están  ustedes  y/  o  su  familia  viviendo  en  cualquier  de  las  siguientes  situaciones?  Marque  todas  las  que   aplican.  

❏ 1.  El  estudiante  està  compartiendo  la  residencia  con  una  o  màs  familias  debido  a  la  pèrdida  de  residencia,  dificultad  econòmica  o  razones  similares  ❏ 2.  El  estudiante  está  viviendo  temporalmente  en  un  motel  u  hotel  debido  a  la  pérdida  de  su  residencia,  dificultades  o  razone  similares  ❏ 3.  .El  estudiante  está  viviendo  en  un  albergue  (albergue  familiar,  violencia  doméstica,  albergue  juvenil,  o  residencia  transitoria).  ❏ 4.  El  estudiante  está  viviendo  en  un  carro,  parque,  zona  de  campamento,  edificio  abandonado,  o  lugar  público. 

❏ 5.  El  estudiante  está  viviendo  en  lugar  que  carece  de  instalaciones  adecuadas  (calefacción,  agua  corriente,  etc.)  ❏ 6.  El  estudiante  está  solicitando  matricularse  sin  el  acompañamiento  de  sus  padres  (no  está  bajo  la  tutela  de  un  adulto).  

Si  a  marcado  algunas  de  las  de  las  condiciones  mencionadas  arriba,  regrese  este  formulario  completado  a  la  oficina  de  la  escuela  de  su  estudiante.  

2. Por favor mencione TODOS los niños que actualmente están viviendo con ustedes y están asistiendo en la Escuela Primaria, Secundaria o Preparatoria en el Distrito Escolar de Jordan. Tambíen por favor mencione los niños en edad pre­escolar quienes tendrán 3 o 4 años de edad para el 1er de Septiembre del presente año escolar.

Primero Medio Apellido M/F Fecha de Nacimiento

Grado Nombre de la Escuela

Presentar falsos documentos o documentos falsificados es una ofensa bajo la sección 73.10, còdigo Penal, o matricular a un estudiante menor con falsos documentos la persona es sujeta a la responsabilidad de la matrícula u otros gastos. TEC Sec. 25.003(3)(d). The McKinney Vento Act de Asistencia Educativa garantiza los derechos de los estudiantes desamparados

3.

Nombre de Padre (s) Guardián Legal Firma Fecha

Direccion Código de la Cuidád Teléfono

Persona Completando este formulario:

❏ Padre ❏ Estudiante

❏ Guardian ❏ Otro(por favor especifique ___________________

❏ Personal de la Escuela (Fecha/Método): __________________________________ (conversación telefónica o conocimiento personal)

Padre(s)  Apoderado  (s)  o  Estudiante 

✓ Please notify the school if your living status changes. ✓ Ii su estudiante califica para los servicios bajo el Decreto de Asistencia de Mejoramiento de Mckinney Vento ellos tienen el derecho de servicios adicionales y apoyo que

pueda incluir colocación en la escuela, material académico, intervenciones, etc. ✓ Por favor llame a la Liaison de los Desamparados 801­567­8308 si tiene alguna pregunta.

Personal  de  la  Escuela 

✓ Por favor regrese este formulario para SKYWARD para los propósitos de identificación para la Liaison de Familias Desamparadas del Distrito Escolar de Jordan y para el Servicio del Lenguaje Alternativo ubicado en el Edificio Auxiliar o llamar al 801­567­8308 por preguntas.

Revised 3/17/2016

Student Name  _____________________________________ 

Home Language Survey and Eligibility for Additional Services  

Home Language Survey 

1. Which language does your child most frequently speak at home? _________________________________________

2. Which language do adults in your home most frequently use when speaking with your child? ___________________

3. Which language(s) does your child currently understand or speak? _______________________________________

Questions 4-7a are optional, however if the answer is yes, your student may be eligible for additional services.

Refugee Students 

A refugee is defined as a student who has fled to another country to be resettled due to political, religious or social persecution.

4. Does your family come from a refugee background? ___________________________________________________

5. Is this student a refugee student? (Students CAN be both refugee and immigrant.) ☐ Yes☐ No

Immigrant Children and Youth 

Title III definition of ‘immigrant children and youth’ means students who:

● Are aged 3 through 21 ● Were not born in any one of the 50 United States; and ● Have not been attending one or more schools in any of the 50 United States for more than 3 full academic years; ● The term “State” means one of the 50 United States, the District of Columbia, and the Commonwealth of Puerto

Rico

6. Is this student an immigrant student? (Students CAN be both refugee and immigrant.) ☐ Yes☐ No

Migrant Students 

A migrant student has a parent who works in agriculture, forestry, meat processing plants, dairy or fisheries, and, in the last 3 years, has moved from one school district to another in order to work (temporary or seasonal) in agricultural activities.

7. Is your child a migrant student? ☐ Yes☐ No

a. If yes, what is the date that you moved to this area? (mm/dd/yy) ________________________________

Updated 5/11/2017

Nombre del estudiante  ________________________________________  

Encuesta de Elegibilidad del Idioma para Servicios Adicionales 

1. ¿Cuál idioma habla su hijo/a con más frecuencia en casa? ______________________________________________

2. ¿Cuando hablan con su hijo/a, cuál idioma usan los adultos en su hogar con más frecuencia? __________________

3. ¿Cuáles idiomas entiende o habla su hijo/a? _________________________________________________________

Preguntas de 4 a 7 son opcionales, sin embargo si la respuesta es sí , su estudiante puede ser elegible para servicios adicionales.

Estudiantes Refugiados 

Un refugiado es definido como un estudiante que ha huido a otro país para establecerse debido a la persecución política, religiosa o social.

4. ¿Históricamente, su familia viene de refugiados?

5. ¿Es el estudiante un estudiante refugiado? Los estudiantes PUEDEN ser ambos refugiados e inmigrantes ☐Sí ☐No

Niños y Jóvenes Inmigrantes 

Definición de Título III de “niños y jóvenes inmigrantes” significa que son estudiantes:

● Edad: entre 3 a 21 ● Nacieron en cualquiera de los 50 Estados Unidos; y ● No han estado asistiendo a una o más escuelas en cualquiera de los 50 Estados Unidos durante más de 3 años

académicos completos ● El término "Estado" significa uno de los 50 Estados Unidos, en el Distrito de Columbia y el Estado Libre Asociado

de Puerto Rico.

6. ¿Es este estudiante un inmigrante? Los estudiantes PUEDEN ser ambos refugiados e inmigrantes ☐ Si☐ No

Estudiantes Migrantes 

Un estudiante migrante tiene un padre que trabaja en la agricultura, la silvicultura, plantas de procesamiento de carne, productos lácteos o la pesquería, y, en los últimos 3 años, se ha mudado de un distrito escolar a otro con el fin de trabajar (temporal o estacional) en las actividades agrícolas

7. ¿Es su hijo un estudiante migrante? ☐Sí ☐ No

a. ¿Si es afirmativo, cuál es la fecha que se mudó a esta área? (mes, dia, año) ________________________

Updated 5/11/2017