Pre-Boarding Week ChecklistPaperwork for 5th- 8th Parents Only

The following documents can be delivered by August 2nd, 3rd, or 4th from 9am-3pm OR can bebrought Friday, August 6th at our ‘Meet The Teacher’ event. ALL documents must be completed

upon physical delivery.Please note that proof of residency MUST be attached!

This is a checklist of the things you will need to email or bring with you. Please PRINT this checklist tocomplete and bring with your required documents. If you have children in multiple grades, please submiteach student’s paperwork to their assigned grade level classroom.

Student Name:____________________________________________ Grade ________

Parent(s) Name(s):__________________________________________________

T-Shirts: My child’s T-shirt size is: (circle one)

Youth Sizes: XS/2-4 S/6-8 M/10-12 L/14-16Adult Sizes: XS S M L XL

Please complete and turn in the following:STUDENT INFORMATION PACKET: (available on our webpage)❑ School-Parent-Student Compact Form❑ Permissions & Authorizations Form❑ Dismissal Directive Form❑ Annual Medical Alert Form❑ Authorization for the Administration of Medication (if applicable)❑ Free/Reduced Meal Application (if applicable)❑ Home Language Survey (New students only)❑ Chromebook Contract❑ Chromebook Checkout❑ After School Care Form (if applicable to your student)❑ Proof of Residency (current utility bill, mortgage or lease)

Also, please review the following documents found on the John Rex website under theResources tab:❑ Student Handbook❑ School Calendar❑ School Supply list❑ Dress Code

School-Parent-Student Compact

As a school, we will:• Provide a clearly articulated school mission through which the staff shares a commitment to continuous

improvement. We can make a difference and see the results!• Create a climate of high expectations in which the staff demonstrates that all students can attain mastery of

essential skills. We control enough of the variables to assure all students experience success.• Model positive attitudes and possess the influence necessary to shape the attitudes of students.• Be knowledgeable and skillful in research-based high-yield strategies, learning theory, and teaching methods that will

enable students to achieve success. We will differentiate instruction and provide specific interventions as well asopportunities for enrichment.

• Build instructional leaders who share leadership with the staff. Together with teachers, the administrators willadvance teamwork by providing job-embedded opportunities for teachers to collaborate and grow professionally.

• Measure student academic progress frequently. A variety of assessments will be used and the results of the will beused to improve student performance and to improve the instructional program.

• Give all students the opportunity to learn. Learning is the constant—time and support are the variables! Lack ofprevious opportunity will not be interpreted as a lack of ability to learn. We will allocate a significant amount ofclassroom time to instruction in literacy and math.

• Develop a safe, orderly, and caring atmosphere that is free from threat or harm. Our climate will be conducive to learning.• Recognize student accomplishments and provide opportunities for students to develop leadership and citizenship.• Partner with parents so that they will understand and support our school’s mission. Parents will be given the

opportunity to play an important role in helping our school achieve our mission.• Empowered all stakeholders to take the risks necessary for growth when encompassed in a climate of mutual

respect, care, and compassion in which mistakes are seen as opportunities to learn and their ideas and effortsare appreciated. The entire staff will extend the same respect to students that we desire to receive from themand each other.

As a parent, I will:• Support my child’s learning by ensuring that he/she has proper rest, nutrition, and maintains excellent attendance and

punctuality.• Provide transportation to and from school. JRCS does not provide transportation for students; nevertheless, we will

work with families through transportation concerns that may arise on a case-by-case basis.• Abide by the Student Handbook, procedures, and policies of JRCS.• Obtain the required uniform(s) and ensure my child abides by the Uniform Dress Code of JRCS.• Support my child’s learning by reading with him/her 20 minutes each day, set a positive tone for learning at home,

and provide “protected” time for homework completion.• Strive to make positive use of my time with my child (“quality” one-on-one time).• Participate in decisions relating to my child’s education through a mutually respectful relationship with school staff.• Provide a mutually respectful relationship between all parties (students, parents, teachers, and volunteers).• Support my child’s class/school (i.e. helping in class/school, volunteering in my child’s classroom/school,

communicating with my child’s teachers, attending school events when possible, etc.).

As a student, I will:• Respect and obey those in authority.• Proudly follow the behavioral standards expected at our school and abide by the Code of Conduct, school creed,

expectations, procedures, and policies of JRCS.• Ask questions and seek out additional support when I am not sure about a lesson or learning objective.• Make good choices like paying attention in class, staying on task, doing my best, and working hard at my schoolwork.• Be the very best that I can be each and every day.

Parent Signature: ______________________________________________ Date: _________________________

Child’s Name/Signature: _________________________________________ Date: _________________________

John Rex Charter SchoolPermissions & Authorizations

Parents please read & initial each statement below

_______INITIAL: CHARTER SCHOOL I understand that by enrolling my child at JRCS, I am waiving my right to attend thelocal, non-charter public school._______INITIAL: AFFIRMATION OF MISSION STATEMENT I understand and agree to support the mission statement ofJRCS of, “To offer quality educational opportunities to children in the heart of downtown Oklahoma City through an innovativepublic-private partnership.” I also agree to support the Head of School and Faculty in pursuing this mission._______INITIAL: TRANSPORTATION I understand that JRCS does not provide transportation services for students to and/orfrom school. I further understand that it is my responsibility to provide or arrange for transportation for my child to and/or fromschool each day. I will comply with state compulsory attendance laws. JRCS will work through transportation issues and needswith families on a case-by-case basis._______INITIAL: WALKING FIELD TRIPS I hereby grant permission for my child to participate in walking field trips fromJRCS to nearby locations (e.g. Downtown Library, Myriad Gardens, etc.) Teachers will notify parents about regularlyscheduled trips. Teachers will also notify parents of any additional walking trips at least 24 hours in advance._______INITIAL: PHOTOGRAPHS I understand that student photographs may be used in yearbooks, newsletters, websites,and other school-related publications (e.g. PTA publications.) If I do not want my student’s photograph used or released forthese purposes or for news media, I must contact the school office to submit a written request. This form must be completedeach year._______INITIAL: SCHOOL DIRECTORY I understand that the PTA may publish a school directory and share contactinformation with classroom representatives that could include: student name, grade level, classroom teacher, parent/guardiannames, and contact information. If I do not want my name and contact information released for these purposes, I must contactthe school office to submit a written request. This form must be completed each year._______INITIAL: INTERNET USAGE I understand JRCS provides computer network resources via Oklahoma City PublicSchools. The use of electronic resources shall be consistent with the purpose, mission, and goals of JRCES and used only foreducational and professionalpurposes._______INITIAL: COMMITMENT OF INVOLVEMENT I acknowledge and affirm parental involvement in a child’s education isof primary importance. The role of parents/guardians is to reinforce and assist the teacher in academics, as well associal/emotional, learning in the classroom and at home. Parents are encouraged to demonstrate this involvement bybecoming an active member of the JRCS PTA._______INITIAL: PROMPTNESS, ATTENDANCE: I understand that JRCS begins the school day at 7:50 a.m. and dismissesat 3:15 p.m. Attending and being on time every day is very important. I pledge to support promptness/attendance at JRCS.Failure to maintain satisfactory attendance & punctuality in accordance to the JRCS Student Handbook may result inrevocation of the transfer, if applicable, or other disciplinary actions._______INITIAL: UNIFORM DRESS CODE I pledge to support the published uniform dress code. Failure to maintainsatisfactory dress in accordance to the Uniform Policy may result in revocation of the transfer, if applicable, or otherdisciplinary actions._______INITIAL: DISCIPLINE AND ACADEMIC WORK I acknowledge that my child will follow the JRCS Code of Conduct andExpectations as well as Leveled Discipline Plan. In order to have a climate conducive to learning, each child is responsible forhis/her own behavior and learning. Complying with the published rules is mandatory. Failure to do so will result in revocation of thetransfer, if applicable, or other disciplinary actions. Additionally, my child and I are committed to academic work, homework, dailyclass assignments and maintainingcontinual academic growth._______INITIAL: STUDENT HANDBOOK I acknowledge that my child and I understand the JRCS Student Handbook andthat it is available online at the JRCS website. We will read and comply with the policies contained therein. Paper copies willbe made available uponrequest.

Parent Name (please print) Parent Signature

____________________________________ __________________ _________________Student Name Grade Date

JRCS Dismissal Parent Directive: 5th-8thThe information below assists our staff in making sure your child is in the right location for dismissal

procedures. It is our goal that every child is safely dismissed from John Rex School. Your child's teachermust know the directions from you, the parent, in order to carry them out successfully each day. Changing

this information can be confusing to students and teachers. Please remember, all students are onlyreleased to adults with Student Number Match Card.

Child's Name _______________________ Dismissal Number (completed by office): ________

Grade: _______ Teacher: ______________________________

Please indicate by placing an X in the respective column for each day how your child will go home at the end ofthe day and leave this form with your child's teacher.

CarRider

DayCareBus/VanRider

Walker(outside

northdoors)

Authorized Persons for Pick-upPlease list the names of those authorized to pick upyour child on a regular basis.

Monday ● _________________________● _________________________● _________________________● _________________________● _________________________

Tuesday

Wednesday1:45

dismissal

Thursday

Friday

DAYCARE - If your child will be riding a Daycare Bus/Van, please list the following:Daycare Name: _____________________________

Address:___________________________________________________________Phone: ____________________ Contact Person: _________________________

Print Parent Name_________________________ Phone #_________________

Parent Signature____________________________ Date ___________________

ANNUAL MEDICAL ALERTJohn Rex Charter School

STUDENT NAME ________________________________________ DATE OF BIRTH ______________

PARENT/LEGAL GUARDIAN __________________________ SCHOOL YEAR 2021-2022 GRADE _____

A signed copy of this form must be turned in to the office as part of the annual enrollment.

If prescription medication is to be administered at school, it must be in the original prescription container andthe form Authorization for the Administration of Medication must be signed by the prescribing physician andparent/legal guardian.

Please mark one of the following:______ My child does not have any medical conditions.

______ My child does have a medical condition(s). Please check and explain any medical conditions yourchild has that you would like the school and faculty and staff to be informed of

Conditions TreatmentAllergies❑ Hay Fever❑ Reactions to insect bites/stings❑ Medications❑ Foods❑ Other

Asthma

Diabetes

Seizure Disorder Action plan required. See office.

Hearing Problems Action plan required. See office.

Visual Problems (including wearing glasses/contacts)

Other (please explain):

PHYSICAL EDUCATION CLASS:______ My child can participate in P.E. with NO restrictions.______ My child can participate in P.E. with certain restrictions.

If yes, EXPLAIN: _______________________________________________________________________ My child CANNOT participate in P.E. because of medical restrictions. (Physician's note required)

If yes, EXPLAIN: _________________________________________________________________

Parent/Legal Guardian Signature _____________________________________ Date ________________

John Rex Charter SchoolAuthorization for the Administration of Medication

Authorization and Request for the Administration of Medication at school to be used when a physicianorders:

A. Prescription Medication that is to be given for longer than a 10 day period.B. Medication that is to be given only when needed.C. Non-prescription or “over-the-counter” medication.

Student Name __________________________________ Date of Birth __________________Phone Number _______________________ Teacher ____________________ Grade _______School John Rex Charter School Phone 405-587-8100 Fax 405-587-8105Date form received by the school ____________________________

TO BE COMPLETED BY THE PHYSICIAN OR AUTHORIZED PRESCRIBER:1. Reason for medication__________________________________2. Name of medication__________________________________3. Dosage/amount to be given__________________________________4. Specific time to be administered__________________________________5. Duration (week, month, indefinite, etc.)__________________________________6. Anticipated reaction to medication (symptoms, side effects, etc.)

7. Form of medication/treatment:____ Tablet ____ Liquid ____ Inhaler ____ Injection ____ Nebulizer ____Other

8. Special storage requirements: ____None ____Refrigerate

Physician’s Name Physician’s Signature Date

Address Phone Fax********************************************************************************************************************

TO BE COMPLETED BY THE PARENT/GUARDIAN:I hereby request and give my permission for the above named school to administer the medicationprescribed on this form to my child. If the medication is prescribed by a physician, the pharmacylabel must be attached to the medication. If this medication is an “over the counter medication” itmust be brought in the original container/box. I further understand that I will be responsible forpicking up any medication at the end of the school year. Any medication left at school after June 1will be discarded utilizing proper procedure.

Parent/Guardian Signature Date

Student Technology Contract1. I understand that Chromebooks, iPads, and iMacs are property of John Rex Charter School andas such is a privilege that can be revoked at any time.

2. I understand Chromebooks, iPads, and iMacs are electronic tools for learning first and foremost.

3. I understand that Chromebooks, iPads, and iMacs are for my sole purpose as designatedby my signature below.

4. I understand under no circumstances should any device leave the premises of John RexCharter School without consent from the parent/guardian and teacher.

5. I understand that I am not permitted to remove any device from the johnrexschools.orgdomain.

6. I understand that I am not permitted to alter the design of any device (no stickers ormarkings may be removed or added).

7. I understand that any device is school property and if I damage or destroy a device, I am

responsible for those damages.

8. I agree to the JRCS internet usage policy.“The use of electronic resources shall be consistent with the purpose, mission, and goals of JRCS and usedonly for educational and professional purposes.”

I have read and understand all terms of the Chromebook contract. I will adhere to JRCS internetusage policy as well as the above listed agreements.

Student’s Full Name____________________________ Student Signature ____________________________

Date _____________________________I have discussed this contract with my child and will support the school by reinforcing mychild’s correct use of technology in our school.Parent’s Full Name____________________________ Parent Signature ____________________________

Date _____________________________

Chromebook Checkout Form

Student Name__________________________________ Student Grade Level/Teacher____________________

This form must be filled out for any John Rex student who wants to check out a Chromebook. The followingguidelines must be initialed and signed by both the student and their parents.

I understand that I am only to use the Chromebook for school related activities.________(parent initials) ________(student initials)

I understand that my use of the Chromebook, including websites and documents, can be monitored.

________(parent initials) ________(student initials)

I understand that, as a parent, I am responsible for monitoring my child’s usage of the Chromebook and willsupervise my child while he/she is accessing the internet.

________(parent initials) ________(student initials)

I understand that I am financially responsible for any damages that occur to the Chromebook while it is in mypossession.

________(parent initials) ________(student initials)

I understand that failing to return the Chromebook will result in purchasing the Chromebook for $200.

________(parent initials) ________(student initials)

I agree to the above guidelines for the use of a loaned Chromebook owned by John Rex Charter School.

_______________________________________________(Parent Signature)

_______________________________________________(Student Signature)

John Rex Middle School After-Care Program

1. CHILD INFORMATIONFirst & Last Name: _________________________________Address:___________________________________________________________Birthdate: ___________________Grade: _____Allergies ormedications:______________________________________________________________________________________________________________

2. FAMILY INFORMATION: Parent(s) or Guardian(s):Name: __________________________Address:_______________________________________________________Work Phone: ________________ Cell Phone: _________________Email address: ______________________________________

Name __________________________Address_____________________________________________________________Work Phone: ________________ Cell Phone :_________________Email Address: ______________________________________

3. ATTENDANCE: Please mark all sessions that your child willattend.

Days: Mon _____ Tues _____ Wed _____ Thurs _____ Fri _____Occasional Care: ____________________________________________________

4. PERSON(S) AUTHORIZED TO PICK UP MY CHILD (other than parent orguardian): Name: Relationship: Cell Phone Number:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

After-care is from 3:45 until 6 PM Monday, Tuesday, Thursday, Friday, andWednesdays from 2 until 6 PM. The cost of after-care is $15 daily with a maximum

of $50 a week. Students who have not been picked up by 3:45 on Monday,Tuesday, Thursday, Fridays and 2 PM on Wednesdays will be considered after-care

participants.

5. Parent Signature _____________________________ Date ___________________

MIDDLE SCHOOL (5th-8th Grade) SUPPLY LIST

24 - Mechanical pencils1 - Package of markers (Crayola prefered)1 - Package of crayons (Crayola prefered)1 - Package of highlighters1 - Package of colored pencils (Crayola prefered)2 - Packages of notebook paper2 - Package of copy paper2 - Box of tissue1 - Package of pencil cap erasers1 - Pencil eraser1 - 1 ½ inch 3-ring binder1 - Package of dividers (8 tabs)1 - Bottle of hand sanitizer1 - Clorox wipes1 - Pencil box1- Scissors (6-8 in)

Hyperlinks are strictly examples, not recommendations of purchase to this particular store

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si

gns

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last

four

dig

its o

f the

soc

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ecur

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umbe

r is

not r

equi

red

whe

n yo

u ap

ply

on

beha

lf of

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list

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uppl

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num

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ld o

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u in

dica

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m

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ning

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appl

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soci

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umbe

r. W

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ill u

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our i

nfor

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ram

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hel

p th

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valu

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fund

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aud

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prog

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INST

RUCT

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So

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Inco

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OPT

ION

AL

Chi

ldre

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Rac

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thni

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not fi

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t Fo

r Sch

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se O

nly

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klyBi-

Wee

kly2x

Mon

thMo

nthly

Free

Redu

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Denie

d

Info

rmac

ión

de c

onta

cto

y fir

ma

de u

n ad

ulto

Nom

bre

del a

dulto

que

firm

a el

form

ular

io

Fi

rma

del a

dulto

Fech

a de

hoy

Dir

ecci

ón (s

i est

á di

spon

ible

)

Apa

rtam

ento

n.º

Ciud

ad

Es

tado

Cód

igo

post

alTe

léfo

no d

uran

te e

l día

y c

orre

o el

ectr

ónic

o (o

pcio

nal)

"Cer

tifico

(pro

met

o) q

ue to

da la

info

rmac

ión

de e

sta

solic

itud

es v

eraz

y q

ue h

e de

clar

ado

todo

s lo

s in

gres

os. E

ntie

ndo

que

esta

info

rmac

ión

se d

a en

rel

ació

n co

n la

rec

epci

ón d

e fo

ndos

fede

rale

s, y

que

las

auto

rida

des

esco

lare

s pu

eden

ver

ifica

r (c

ompr

obar

) la

info

rmac

ión.

Soy

con

scie

nte

de

que

si h

e da

do in

form

ació

n fa

lsa

con

cono

cim

ient

o de

cau

sa, m

is n

iños

pue

den

perd

er la

pre

stac

ión

de a

limen

taci

ón y

se

me

podr

ía p

roce

sar

con

arre

glo

a la

s le

yes

fede

rale

s y

esta

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rtin

ente

s".

PASO

4

PASO

3D

ecla

rar

los

ingr

esos

de

TOD

OS m

iem

bros

de

la v

ivie

nda

(Om

ita e

ste

paso

si s

u re

spue

sta

es "S

í" en

el P

ASO

2)

Últi

mos

cua

tro

dígi

tos

del n

úmer

o de

la S

egur

idad

Soc

ial

(SSN

- So

cial

Sec

urity

Num

ber)

del

sus

tent

o pr

inci

pal

u ot

ro m

iem

bro

adul

to d

e la

viv

iend

a

M

arqu

e si

no

tiene

SSN

A. I

ngre

sos

del n

iño

A v

eces

, los

niñ

os d

e la

viv

iend

a tie

nen

ingr

esos

. Inc

luya

los

ingr

esos

TO

TALE

S ob

teni

dos

por

todo

s lo

s m

iem

bros

de

la v

ivie

nda

enum

erad

os e

n el

PA

SO 1

aqu

í.

Ayud

a pú

blica

/ man

uten

ción

infa

ntil

/ pen

sión

alim

entic

iaPensión/jubilación/

otros

Nom

bres

de

los

mie

mbr

os a

dulto

s de

la v

ivie

nda

(nom

bre

y ap

ellid

o)

Tota

l de

mie

mbr

os d

e la

viv

iend

a (N

iños

y a

dult

os)

XX

XX

X

Ingr

esos

pro

fesio

nale

s

$ $ $ $ $

¿Con

qué

frec

uenc

ia?

$In

gres

os d

el n

iño

Sem

anal

esQu

ince

nale

s Bi

men

sual

es

Men

sual

es

¿Con

qué

frec

uenc

ia?

B. T

odos

los

adul

tos

mie

mbr

os d

e la

viv

iend

a (in

clui

do u

sted

)

En

umer

e a

todo

s lo

s m

iem

bros

de

la v

ivie

nda

que

no a

pare

zcan

en

el P

ASO

1 (i

nclu

ido

uste

d), a

unqu

e no

rec

iban

ingr

esos

. Por

cad

a m

iem

bro

de la

viv

iend

a en

umer

ado,

si r

ecib

en in

gres

os, d

ecla

re e

l ing

reso

tota

l bru

to

(ant

es d

e im

pues

tos)

por

cad

a fu

ente

en

dóla

res

en n

úmer

os e

nter

os (s

in c

enta

vos)

sol

amen

te. S

i no

reci

ben

ingr

esos

de

ning

una

fuen

te, e

scri

ba '0

'. Si

esc

ribe

"0" o

dej

a al

gún

cam

po e

n bl

anco

, est

á ce

rtifi

cand

o (p

rom

etie

ndo)

que

no

hay

ingr

esos

que

dec

lara

r.

$ $ $ $ $

¿Con

qué

frec

uenc

ia?

$ $ $ $ $

Bim

ensu

ales

¿Con

qué

frec

uenc

ia?

PASO

2

¿Alg

ún m

iem

bro

de s

u vi

vien

da (i

nclu

ido

uste

d) p

artic

ipa

actu

alm

ente

en

uno

o m

ás d

e lo

s si

guie

ntes

pro

gram

as d

e ay

uda:

¿SN

AP,

TAN

F o

FDPI

R?

En c

aso

NEG

ATI

VO >

Vay

a al

PA

SO 3

.En

cas

o A

FIR

MA

TIVO

>

Escr

iba

aquí

un

núm

ero

de e

xped

ient

e y

vaya

al P

ASO

4 (N

o re

llene

el P

ASO

3)

Escr

iba

solo

un

núm

ero

de e

xped

ient

e en

est

e es

paci

o.

Núm

ero

de e

xped

ient

e:

PASO

1

Enum

erar

a T

ODOS

los

mie

mbr

os d

e la

viv

iend

a qu

e se

an b

ebés

, niñ

os y

est

udia

ntes

has

ta e

l 12.

º gra

do in

clus

ive

(si s

e re

quie

ren

más

esp

acio

s pa

ra n

ombr

es a

dici

onal

es, a

djun

te o

tra

hoja

de

pape

l)

Nom

bre

del n

iño

A

pelli

do d

el n

iño

Inic

ial d

el

segu

ndo

nom

bre

¿Est

udia

nte?

Sí

No

Niñ

o en

ré

gim

en

de a

cogi

da

Sin

hoga

r,

mig

rant

e,

fuga

do

Marque todo lo que corresponda

Gra

doD

efini

tion

of H

ouse

hold

M

embe

r: “A

nyon

e w

ho is

liv

ing

with

you

and

sha

res

inco

me

and

expe

nses

, eve

n if

not r

elat

ed.”

Child

ren

in F

oste

r ca

re a

nd

child

ren

who

mee

t the

de

finiti

on o

f Hom

eles

s,

Mig

rant

or

Run

away

are

el

igib

le fo

r fr

ee m

eals

. Rea

d H

ow to

App

ly fo

r Fr

ee a

nd

Redu

ced

Pric

e Sc

hool

Mea

ls

for

mor

e in

form

atio

n.

Defi

nici

ón d

e m

iem

bro

de la

vi

vien

da: "

Cual

quie

r pe

rson

a qu

e vi

va c

on u

sted

y

com

part

a in

gres

os y

gas

tos,

au

nque

no

esté

n em

pare

ntad

os".

Los

niño

s en

rég

imen

de

acog

ida

y

los

que

enca

jan

en la

defi

nici

ón

de p

erso

nas

sin

hoga

r,

mig

rant

es o

fug

ados

tie

nen

dere

cho

a re

cibi

r co

mid

as g

ratis

. Le

a Có

mo

solic

itar

com

idas

es

cola

res

grat

is o

a p

reci

o re

duci

do p

ara

obte

ner

más

in

form

ació

n.

¿No

está

seg

uro

de q

ué

ingr

esos

incl

uir

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?

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e la

vue

lta a

la p

ágin

a y

cons

ulte

las

lista

s tit

ulad

as

"Fue

ntes

de

ingr

esos

" par

a ob

tene

r m

ás in

form

ació

n.

La li

sta

"Fue

ntes

de

ingr

esos

de

niñ

os" l

e ay

udar

á en

la

secc

ión

Ingr

esos

del

niñ

o.

La li

sta

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ntes

de

ingr

esos

de

adu

ltos"

le a

yuda

rá e

n la

se

cció

n To

dos

los

mie

mbr

os

adul

tos

de la

viv

iend

a.

Rea

lice

la s

olic

itud

en lí

nea

en

Prot

otip

o de

sol

icitu

d pa

ra fa

mili

as d

e co

mid

as g

ratis

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pre

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itud

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.

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anal

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ince

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men

suale

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ensu

ales

Men

sual

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man

ales

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cena

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anal

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ince

nale

s Bi

men

sual

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Men

sual

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Devu

elva

la so

licitu

d re

llena

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:

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klyBi

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Mon

thM

onth

ly

How

oft

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La le

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cion

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e co

mid

as e

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hard

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ll re

quie

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(Template)

School Year 2021 - 2022 Economically Disadvantaged Form

This application should be completed even if your student attends a Community Eligibility Provision or Provision School.

School: Grade: Student Number:

Student Name: _____________________________________

Signature: I certify that all information provided on this form is true to the best of my knowledge and that all household income is reported. I understand that this information will impact federal and state funding to the school.

Sign Here: Date: _______________________________

Print Name: _____________________________________________________________________________________

Qualified Not Qualified

Less than $23,828 Between $49,025 and $57,424 Between $82,621 and $91,020

Between $23,828 and $32,227 Between $57,424 and $65,823 Between $91,020 and $99,419

Between $32,227 and $40,626 Between $65,823 and $74,222 Between $99,419 and $107,818

Between $40,626 and $49,025 Between $74,222 and $82,621 Between $107,818 and $116,217

One (1) Five (5) Nine (9)

Two (2) Six (6) Ten (10)

Three (3) Seven (7) Eleven (11)

Four (4) Eight (8) Twelve (12)

Please select the income range that represents the total annual gross income:

Please select the total number of people in your household:

For Office use only:

Basic Uniform Dress CodeJohn Rex Charter School has school uniform dress code requirements for all students.Students are expected to adhere to the basic school dress code. Students found inviolation of the uniform policy will be sent to the office to call a parent or guardianto bring appropriate clothing to school. Students not in compliance with the uniformpolicy are subject to the JRCS Code of Conduct. Students found in repeated violation ofthe dress code are subject to further disciplinary action.

Basic Shirts● Polo-style shirts: School uniform short or long sleeve-solid white, light blue, or navy

polo-style pique or interlock shirts.● Oxford shirts: School uniform dress shirts-short or long sleeve, solid white or oxford blue

with collar.● School T-Shirts: Wednesdays only-students may wear school or PTA purchased t-shirts

instead of the regular school uniform shirt choices. All other school uniform dress code rulesapply to other garments.

● Layered clothing must also meet school uniform required colors (see above).● Shirts may not have visible insignias, logos, labels, words, or pictures except for the

approved school logo.

Basic Pants, Shorts, Skirts & Skorts● Pants/shorts: School uniform khaki or navy twill (chino) fabric (appropriate length).● Skirts/skorts: School uniform khaki or navy twill (chino) fabric (appropriate length).

Basic Dresses/Jumpers● Dresses/jumpers: School uniform khaki or navy twill (chino) fabric (appropriate length).● Polo-style dresses: School uniform pique navy, light blue, or white (appropriate length).

Basic Accessories● Belts must be solid, dark (brown/black) color.● Layered clothing must also meet uniform required colors. See above.● Ties: School uniform solid navy blue or Lands End “Clear Blue Plaid” (this is

the only approved plaid).

Basic Footwear● Shoes: students must wear closed-toe shoes at all times while on school property.

Shoes should be appropriate for playground and gym activity. Students may not wearflip-flops, beach, pool wear shoes, or house shoes (i.e. Crocs).

Other Basic Items● Sweaters & Jackets: Solid navy or white crew sweatshirts, long sleeve v-neck

sweaters, v-neck sweater vests, cardigan sweaters (button or zip), or fleece jackets(zip front), without hoods. These may not have visible insignias, logos, labels, words,or pictures except for the approved school logo.

● Coats/outerwear: student’s choice and are removed once inside the school.● Hair should be well groomed and students should refrain from using coloring

(including gels or sprays) or other hairstyles that could be deemed as a distraction inthe classroom.

Student Signature _________________________________________ Date __________Parent Signature __________________________________________ Date __________

Middle School Arrival/Dismissal Procedures:

Arrival:

● Students may enter the school beginning at 7:15am. Breakfast will be served from 7:15-7:45am.

● Drop off traffic must follow the layout shown in the map above. Please be aware that multiple

businesses use this parking lot. Remember to be courteous to workers from neighboring companies

that may need to cross our drop off line.

● Students will be dropped off in the staff parking lot identified on the map with a YELLOW star.

● Teachers will be located at the YELLOW star daily to greet each student.

● Students will enter the McAlpine Center/Middle School through the north doors.

● Lobby doors will be locked at 7:50am. Parents/Guardians must check-in any student arriving after

7:50am. Any child dropped off after 7:50am without an adult checking them in will remain in the front

office until a parent/guardian returns to check them in.

Dismissal:

● Students will be dismissed through the north doors beginning at 3:15pm on Monday, Tuesday,

Thursday, and Friday and at 1:45 on Wednesday.

● Car riders Pick up traffic must follow the layout shown in the map above. Please be aware that multiple

businesses use this parking lot. Remember to be courteous to workers from neighboring businesses

that may need to cross our pick up line. Once your child is in the car, please continue north on Walker

Ave.

● Walkers Parent/Guardian walking from home/work must inform the adult at the GREEN starwhich student they are picking up and provide the SafeSchool ID number assigned to thatstudent for verification. Students will be called to meet the parent/guardian at the northentrance.

John Rex Charter School Calendar: 2021-22July 2021 August 2021 September 2021 Date Event or Holiday

Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa August 3 Orientation for New Teachers1 2 3 1 2 3 4 5 6 7 1 2 3 4 August 4-6 & 9-10 All Teachers: Professional Development & Work Days

4 5 6 7 8 9 10 8 9 10 11 12 13 14 5 6 7 8 9 10 11 August 11 First day of school for students11 12 13 14 15 16 17 15 16 17 18 19 20 21 12 13 14 15 16 17 18 Sept 6 Labor Day Holiday (school closed)18 19 20 21 22 23 24 22 23 24 25 26 27 28 19 20 21 22 23 24 25 Oct 7 Parent Conference Day (no school for students)25 26 27 28 29 30 31 29 30 31 26 27 28 29 30 Oct 8 Teacher Prof Dev & Work Day (no school for students)

15 21 Oct 11-15 Fall Break (school closed) Nov 22-26 Thanksgiving Break (school closed)

October 2021 November 2021 December 2021 Dec 20-Jan 3 Winter Break (school closed) Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Jan 3 Teacher Prof Dev & Work Day (no school for students)

1 2 1 2 3 4 5 6 1 2 3 4 Jan 4 Classes resume for students3 4 5 6 7 8 9 7 8 9 10 11 12 13 5 6 7 8 9 10 11 Jan 17 MLK Jr. Day (school closed)

10 11 12 13 14 15 16 14 15 16 17 18 19 20 12 13 14 15 16 17 18 Feb 21 President's Days (school closed)17 18 19 20 21 22 23 21 22 23 24 25 26 27 19 20 21 22 23 24 25 March 10 Parent Conference Day (no school for students)24 25 26 27 28 29 30 28 29 30 26 27 28 29 30 31 March 11 Teacher Prof Dev & Work Day (no school for students)31 14 17 13 March 14-18 Spring Break (school closed)

April 28 & 29 Downtown Arts Festival Days (school closed)January 2022 February 2022 March 2022 May 25 Last day of school for students

Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa May 26 & 27 Teacher Record Day & Work Day (no school for students)1 1 2 3 4 5 1 2 3 4 5 May 30 Memorial Day (offices closed until August)

2 3 4 5 6 7 8 6 7 8 9 10 11 12 6 7 8 9 10 11 12 Holiday (No School)9 10 11 12 13 14 15 13 14 15 16 17 18 19 13 14 15 16 17 18 19 Breaks (No School)

16 17 18 19 20 21 22 20 21 22 23 24 25 26 20 21 22 23 24 25 26 2 Parent Conference Days (no school for students)23 24 25 26 27 28 29 27 28 27 28 29 30 31 10 Teacher Work Day (No School)30 31 19 19 16 1 New Teacher Orientation

171 Total Student Academic Days April 2022 May 2022 June 2022 [42]

Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa

1 2 1 2 3 4 5 6 7 1 2 3 4

3 4 5 6 7 8 9 8 9 10 11 12 13 14 5 6 7 8 9 10 11

10 11 12 13 14 15 16 15 16 17 18 19 20 21 12 13 14 15 16 17 18

17 18 19 20 21 22 23 22 23 24 25 26 27 28 19 20 21 22 23 24 25

24 25 26 27 28 29 30 29 30 31 26 27 28 29 3019 18