Southwest Licking Local School District 927-A South Street, Pataskala, Ohio 43062

Phone - 740-927-3941 Fax-740-927-4648 www.swl.k12.oh.us

Enrollment Requirements

With limited exceptions, Ohio law states that the parent(s) or legal guardian(s) of a student must live in a school district in order for their child or children to attend school in that district. The law also requires nonresident students to pay tuition unless the district is an open enrollment district. The Southwest Licking Local School District does not participate in open enrollment. Therefore, only students whose parent(s)/guardian(s) are true residents of the district are entitled to enroll in the Southwest Licking Local School District. Questions involving enrollment may be directed to the District Office at 740-927-3941. Under Ohio law, nonresident student(s) may be enrolled for a limited period of time if their parents are buying or building a home in the district. In the Southwest Licking Local School District, this period has been established as ninety (90) days. Families who wish to take advantage of this 90-day exception need to provide a sworn statement explaining the situation, revealing the location of the house being built or purchased and stating the parent’s intention to reside in this house upon completion. Families will also need to obtain a notarized statement from the builder confirming the construction of the new house, the location of the new house, and anticipated completion date. If the house is being purchased, families will be required to provide a copy of the executed purchase agreement with approximate closing date. All of the Southwest Licking Local School District Registration forms are available on our website at www.swl.k12.oh.us. To register your Kindergarten or New Student in the Southwest Licking Local School District please complete the following Registration forms and bring them with the additional documents listed below:

• Registration form • Residency form • Request for release of or access to student records • Emergency Medical Authorization form • Health History • Home Language Survey • Transportation Information

Please also bring the following documentation with you:

• Official birth certificate • Immunization records • Proof of residency (2 required) • Custody documents (if applicable) • Registration forms (listed above)

To provide proof of residency please include a copy of your current lease agreement and copy of current utility bill, including current address, or a copy of deed or closing statement and copy of current utility bill, including current address, or copies of two current utility bills in the parent(s)/guardian(s) name at the current address.

We would like to take a moment to welcome you to Southwest Licking Local Schools! As a new parent or guardian to the school district, we would like to answer a few common questions regarding transportation to and from school. Please review the following procedures prior to establishing your student’s transportation routine.

• Students who are eligible to ride a bus must have the same pick-up point each school day and the same drop –off point each school day. However, the morning pickup location may be different from the afternoon drop-off location.

• For elementary and kindergarten students only: Transportation can be provided to and from a daycare/sitter only if the student and daycare/sitter are in the same elementary school boundary area. If the daycare/sitter is outside the student’s school boundary area, the parent is responsible for arranging transportation.

• Kindergarten students: A parent or emergency contact designee must be visible to the driver before the student is released from the bus. Please have your ID available.

• Students are only permitted to ride their assigned bus to their assigned drop-off point. Temporary (one day) changes, such as riding another bus to a friend’s house or to a relative’s house, are not permitted. In such cases, parents should make arrangements for their child to be picked-up from school or at their normal bus stop.

• When a permanent transportation change is needed, a parent/guardian must go to the Transportation Office at 10653 Hazelton-Etna Rd., in person, with a photo ID and complete the appropriate forms before a change can take place.

• Please allow two (2) working days for changes to take place. No route changes or adjustments, except for new residents, will be made until two weeks after the first day of school.

• In the case of an early dismissal or emergency release, the district will utilize the automated calling system to notify parents in addition to local radio and TV stations. The District strives to notify parents at least 1 hour prior to dismissal.

• Please have a Family Plan in place to meet your child at your home by his or her regular mode of transportation. Keep in mind, if the school has loss of power or phone service, contact with the school office is interrupted emphasizing the need for a Family Plan.

• Transportation Department office hours are Monday through Friday, 6:00 a.m. to 5:00 p.m.

• The Transportation Office telephone number is 740-927-5901.

Thank you for helping us as we make the safe transportation of students our highest priority!

Todd Liston,

Director of Transportation

Phone: (740) 927-5301

Fax: (740) 964-3234

www.swl.k12.oh.us

10653 Hazelton-Etna Rd

Pataskala, OH 43062

S M T W T F S S M T W T F S S M T W T F S S M T W T F S1 2 3 1 3 4 5 6 7 1 2 3 4 5 1 2

4 5 6 7 8 9 10 8 9 10 12 W 14 6 7 8 10 11 12 3 4 5 6 ♦ 8 911 12 13 14 15 ▲ 17 15 16 17 18 ● 20 21 13 14 15 χχχχ ▼ 19 10 11 ● ♦ 15 1618 Q ■ 21 22 23 24 22 23 24 25 26 27 28 20 21 22 23 24 25 26 17 18 19 20 21 22 23

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

▲ = All Teacher Orientation = Labor Day No School = 2 Hour Delay Students = 2 Hour Delay StudentsQ = Teacher Plan Day = 2 Hour Delay Students = No School ♦ = K-8 Conferences

■ = First Day W = Waiver Day (Students) χχχχ = End of 1st Quarter = Thanksgiving-No Sch.▼ = Inservice - No School

Interim Reports Issued 20th Grade Cards Issued on 25th Interim Reports Issued 29th

9 Student Days 19 Student Days 21 Student Days 18 Student Days11 Teacher Days 20 Teacher Days 22 Teacher Days 19 Teacher Days

(1 Conference Day)

S M T W T F S S M T W T F S S M T W T F S S M T W T F S1 2 3 4 5 6 7 W ▼ 4 1 18 9 10 12 13 14 5 6 7 9 10 11 2 3 ● 5 ♦ 7 8 2 3 4 6 7 815 16 17 18 19 χχχχ 21 12 13 14 15 16 17 18 9 10♦ 13 15 9 10 11 12 13 14 1522 28 19 21 22 23 24 25 16 18 19 20 21 22 16 17 18 19 χχχχ ▼ 2229 26 27 28 29 30 31 23 24 25 26 27 28 23 29

30 31

= 2 Hour Delay Students = Christmas - No School = 2 Hour Delay Students = 2 Hour Delay Students = Christmas - No School = MLK Day - No School ♦ = K-8 Conferences χχχχ = End of 3rd Quarterχχχχ = End of 2nd Quarter = 2 Hour Delay Students ● = 9-12 Conferences ▼ = Inservice - No School

= No School 2/14 = Spring Break - No SchoolW = Waiver Day (Students) = President's Day-No Sch

Interim Reports Issued 7th 15 Student Days15 Student Days Grade Cards Issued on 10th 18 Student Days 16 Teacher Days15 Teacher Days 19 Student Days 19 Teacher Days

21 Teacher Days (1 Conference Day)

S M T W T F S S M T W T F S S M T W T F S1 2 3 4 5 1 2 3 1 ▲ 3 4 5 6 7

6 7 8 ● 11 12 4 5 6 7 8 9 10 8 9 10 11 12 13 1413 14 15 16 17 19 11 12 13 15 16 17 15 16 17 18 19 20 2120 W 22 23 24 25 26 18 19 20 21 22 23 24 22 23 24 25 26 27 2827 28 29 30 ● 27 28 29 ☼ 31 29 30

W = Waiver Day (Students) = 2 Hour Delay Students = 2 Hour Delay Students ● = Graduation ▲ = Teacher Work Day● = 9-12 Conferences = Mem. Day - No School

No School ☼ = Last Day of SchoolGrade Cards Mailed 6th

Grade Cards Issued on 4thInterim Reports Issued 2nd

20 Student Days 21 Student Days21 Teacher Days 21 Teacher Days 1 Teacher Day

175 Student Days + 3 Waiver Days = 178186 Teacher Days

▼= Inservice - No School

The maximum number of calamity days allowed by law is five (5). If five (5) or less calamity days are used, no make-up days will be required. In the event more than five (5) calamity days are used SWLS has the ability to

use 3 days of online instruction.

APRIL MAY JUNE

BOARD APPROVED: 1/17/13

● = 9-12 Conferences

NOVEMBER

Southwest Licking Schools - 2013-2014 School Calendar For Grades K-12

MARCH

AUGUST SEPTEMBER OCTOBER

● = 9-12 Conferences

DECEMBER JANUARY FEBRUARY

EMERGENCY MEDICAL AUTHORIZATION R.C. 3313.71.2

STUDENT NAME (Last, First, Middle): ____________________________________________________________________________________________ STREET ADDRESS _________________________________________PO BOX # ________ CITY _______________________ ZIP _______________ EMERGENCY PHONE (HOME OR CELL) _______________________ OR________________________ BIRTHDATE _______________________ SCHOOL: Etna Kirkersville Pataskala WMS WMHS Grade: _______ Teacher: ______________________

STUDENT’S CUSTODIAL FAMILY STATUS (check one)

Biological Parental Status: Never Married____ Parents Married ____ Parents Separated ____ Parents Divorced ____ Spouse Deceased ____

STUDENT’S CUSTODIAL FAMILY RESIDENCY INFORMATION (c heck one)

___Mother & Father ___Mother Only ___Father Only ___Mother & Stepfather ___Father & Stepmother

___Court Appointed Guardian(s)/Grandparent(s) ___Foster Parent ___Host Parent ___Other (specify)____ FEMALE: MALE:

__Biological Mother __Step-Mother __Indicate Other Relationship_________ __Biological Father __Step-Father __Indicate Other Relationship___________ Last Name: _____________________ First Name:_______________________ Last Name:____________________ _First Name:_________________________ Address if different than student’s: ___________________________________ Address if different than student’s: _____________________________________ ________________________________________________________________ _________________________________________________________________ Home Phone: ( )______________Cell Phone: ( )________________ Home Phone: ( )________________Cell Phone: ( )________________ Email Address: ___________________________________________________ Email Address: ____________________________________________________ Work Place: _____________________________________________________ Work Place: _______________________________________________________ Work Place Phone Number: ( )_______________________Ext.________ Work Place Phone Number: ( )__________________________Ext._______

NON-CUSTODIAL PARENT ______________________________________MAY BE CONTACTED AT ( ) _______________________ IF I CANNOT BE REACHED. IN THE EVENT REASONABLE ATTEMPTS TO CONTACT THE ABO VE STATED PARENT(S) AND /OR GUARDIAN(S) HAVE BEEN UNSUCCESSFUL, THE FOLLOWING FRIENDS, NEIGHBORS OR NEARBY RELATIVES HA VE AGREED TO PROVIDE TRANSPORTATION AND ASSUME TEMP ORARY CARE OF MY CHILD WHEN A MINOR ILLNESS OR INJURY OCCURS.

1. Name ____________________________________________ Home Phone ( )______________________________ Cell Phone ( )_________________

2. Name ____________________________________________ Home Phone ( )______________________________ Cell Phone( )__________________

3. Name ____________________________________________ Home Phone ( ) ______________________________Cell Phone( )__________________

**In the event of an emergency situation and reasonable attempts to contact the above stated parent(s) and/or guardian(s) have been unsuccessful, I hereby give my consent for:

(1) The administration of any treatment deemed necessary by the practitioner listed below. Preferred physician _____________________________________________ at (_____)______________________________

Preferred dentist ______________________________________________ at (_____)______________________________ However, if the practitioner is not available, you may contact another licensed physician or dentist.

(2) If necessary, transfer of my child to _____________________________________________ or any hospital reasonably accessible. Preferred hospital

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in necessity for such surgery, are obtained before surgery is performed. Signature of Legal Guardian____________________________________________________________________ Date _________________________ KNOWN ALLERGIES: _______________________________________________________________________________________________________ CURRENT MEDICATIONS: ______________________________________________________________________________________________________ HEALTH CONCERNS (Diabetes, Asthma, surgical history etc.): __________________________________________________________________________ PHYSICAL IMPAIRMENTS: ______________________________________________________________________________________________________ DATE OF LAST TETANUS BOOSTER (IF KNOWN): _________________________________________________________________________________

I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the school authorities to TAKE NO ACTION OR TO ________________________________________________________________________________

_________________________________________________________________________________________________________________________ Signature of Legal Guardian ____________________________________________________________________Date _________________________

NAME OF BABY-SITTER OR CHILD CARE PROVIDER IF APPLICABLE: (AM) Name ____________________________________________ Address ________________________________________ Phone ( ) _____________________

(PM) Name ____________________________________________ Address _________________________________________ Phone ( ) _____________________

Southwest Licking Local School District

Start

Date: School: Grade/Teacher:

Student Name: Date of Birth:

Name of brother(s)/sister(s) in the building:

Address:Number Street City State Zip

Parent/Guardian 1 2

Contact Numbers: Home Home

Cell Cell

Work Work

A.M. Transportation: Pick-up address

Mode of transportation: (Bus numbers assigned by transportation dept)

SWL school bus # Walk

Automobile Other

Daycare VanDaycare Name

P.M. Transportation: Drop-off address

Mode of transportation: (Bus numbers assigned by transportation dept)

SWL school bus # Walk

Automobile Other

Daycare VanDaycare Name

Parent/Guardian Signature

**Students who are eligible to ride a bus must have the same pick-up point each school day and the same drop-off

point each school day. Morning pick-up location may be different from the afternoon drop-off location. Parents

are responsible for transporting their child to/from school when temporary (1-2 day) changes from this plan occur.

Transportation Information

Ohio Department of Health • School and Adolescent Health

Health HistoryStudent’s name Sex Date of birth

a Male a Female / /

Family Health History Please list allergies, heart problems, diabetes, cancer or other serious health conditions.Father

Mother

Brothers and Sisters

Birth and Developmental History a No unusual birth or developmental history

Did the mother have any unusual physical or emotional illness during this pregnancy? a Yes a No

Was infant born full term? a Yes a No Did the infant have any sickness or problems? a Yes a NoBriefly explain illness or problems.

How does the child’s development compare to other children, such as his or her brothers/sisters or playmates?

a About the same a Delayed a Advanced

Student Health Conditions

a YES,my child receives regular medical/health care for the following conditions: a NO medical conditions

a Allergies a Diabetes a Seizure disorder

a Asthma a Depression a Sickle cell anemia

a ADD/ADHD a Ear problem/hearing difficulty a Skin conditions

a Autism a Emotional concerns a Speech problems

a Behavior concerns a Headaches a Traumatic brain injury

a Birth/congenital malformations a Heart problems a Vision problems (glasses, contacts)

a Bone/muscle/joint problems a Hemophilia a Other_________________________________

a Blood problems a Juvenile arthritis a Other_________________________________

a Bowel/bladder problems a Lead poisoning a Other_________________________________

a Cancer a Migraines a Other_________________________________

a Cystic fibrosis a Neuromuscular disorder a Other_________________________________

Please explain any conditions above or any reasons for hospitalizations.

Please indicate any allergies your child may have.

Allergy type Reaction School restrictions or recommended actions

a Bee/Insect

a Food

a Medication

a Other

HEA 4240 8/06

Health History continued

Please list any prescription and over the counter medication that your child takes on a regular basis.

Medication and dose Time Reason

Do any health and/or medical conditions require school restrictions, modifications, and/or intervention?

a Yes a No If YES, please explain.

Does the student require any special procedures and/or treatments for their health condition(s)?

a Yes a No If YES, please explain.

Please indicate any other information about your child’s health or development that you think would be helpful for the school to know.

Form completed by Relationship to student Date

/ /

Southwest Licking Local School District Residency Form/Change of Address

Copies to Student File, Curriculum Office, and Transportation 6/7/12

To establish residency within the Southwest Licking Schools, a parent or guardian must provide the following:

1. Name & Building of student(s) 1. _________________________ 3. ______________________________

2. _________________________4. _______________________________

Parent/Guardian name(s) __________________________________________________________

2. Former address: __________________________________________________________

3. Current address & Phone # __________________________________________________________

Verify current address by attaching a copy of the following documents:

Copy of current lease agreement, including current address and utility bill or

Copy of deed or closing statement, including current address and utility bill or

Copies of two current utility bills in the parent/guardian’s name at the current address.

5. ONLY COMPLETE THE SECTION BELOW IF YOU ARE UNABLE TO PRODUCE THE DOCUMENTS SPECIFIED IN

#4, because you are living with family or friends. You must provide the information requested below (in

a, b, and c) at the time of registration each school year.

(a) Name of person with whom you are residing _________________________________________________

Relationship to the person with whom you are residing _________________________________________ Are you residing with the above person(s) due to ( ) Loss of Housing, ( ) Economic Hardship or ( ) A Similar Reason?

(b) Residency Affidavit – to be completed by person listed

in (a)

I certify by providing proof of residency as listed above in #4

that I am the owner or tenant of the dwelling located at the

address listed above in #3. I further certify that I am the

owner or tenant of the dwelling located at the address

listed above in #3. I further certify that the persons listed

above in #1 actually reside at this dwelling and are not

maintaining a separate residence, as that term is defined

for public school admission, elsewhere. I certify that the

above information is true and accurate and acknowledge

that the Southwest Licking Local School District may use any

legal means to verify my address. I realize that should any

of the above statements be false, I may be liable for any

penalties for which the law provides. I further acknowledge

that this certification is valid only for the

__________(current) school year.

__________________________ _________________

Signature of Owner/Tenant Date

________________________________________________

Print Name of Owner/Tenant and Phone Number

Sworn to and subscribed before me

Notary Public_____________________________________

This _________day of _____________________, 20_____.

Commission Expires: ______________________________

(c) Oath of Residency-to be completed by parent/guardian

registering the student

I, the parent/guardian of the students listed in #1 hereby

certify that I have established residency, on a full-time

basis, in the Southwest Licking Local School district and am

not maintaining a separate residence, as that term is

defined for public school admission, elsewhere. I am aware

that the Southwest Licking Local Schools may use any legal

means necessary to verify that I am living at the address

stated in #3 and acknowledge that if any of the above

statements are false, I am liable for any penalties that the

law may provide. Further, if any of this information is false

or if I move out of the district, I agree to pay the tuition

costs of $ _____________(per day/per student) to cover

the period during which any of the students listed in #1

illegally attended the Southwest Licking Local Schools.

_____________________________ __________________

Parent/Guardian Date

________________________________________________

Print Name of Parent/Guardian and Phone Number

Sworn to and subscribed before me

Notary Public _____________________________________

This __________ day of ____________________,20______.

Commission Expires: _______________________________

SOUTHWEST LICKING LOCAL SCHOOLS REQUEST FOR RELEASE OF OR ACCESS TO A STUDENT’S RECORDS

TO: _________________________________________________ DATE: ________________________ Previous School, Institution, or Individual’s Name _________________________________________________________________________ Address _________________________________________________________________________

It is requested that the school records as identified below of:

________________________________________________ ___________ ____/____/____ Student’s Name Present Grade Date of Birth

________________________________________________ (_______)________ - _____________ Address Telephone Number

________________________________________________

Records Requested (please check appropriate boxes): Official Administration Records including Grades Competency Test Scores Proficiency Test Scores Standardized Achievement Test Scores Intelligence and Aptitude Scores Medical/Immunization Records Attendance Records (Current Year) Student SSID Number

Be Released and Forwarded To (circle one):

Etna Elementary fax: 740-964-0129 Kirkersville Elementary fax 740-964-1103 Pataskala Elementary fax 740-927-7259 8500 Columbia Road 215 N. Fifth Street 395 South High Street Pataskala, Ohio 43062 Kirkersville, Ohio 43033 Pataskala, Ohio 43062 Watkins Middle School fax 740-927-2337 Watkins Memorial High School fax 740-964-1480 8808 Watkins Road SW 8868 Watkins Road SW Pataskala, Ohio 43062 Pataskala, Ohio 43062

___________________________________________________ Signature and Title of Southwest Licking School Official

------------------------------------------------------------------------------------------------------------------------------------------ PARENT/GUARDIAN AUTHORIZATION FOR RELEASE

I hereby authorize the school, institution, or individual indicated above to release and/or provide access to the records checked above. _______________________________________________ ____________________________________________________________ Signature of Parent, Legal Guardian or Adult Pupil Address if different from that indicated above

*Please note, if you do not release special education records from your office, please make a copy of this release form and send to the appropriate office.

The student is being enrolled for the reason indicated below: Parent/Guardian now resides in our district Foster/Court placed Following a teaching parent Board approved tuition student Board approved grandparent clause Board approved Superintendent’s agreement

Special Education Records Requested Be Released and Forwarded to: Southwest Licking Local School District Office of Pupil Personnel 927-A South Street Pataskala, Ohio 43062 Fax: 740-927-4648 (please check appropriate boxes)

IEP’s – both current & initial Psychological Evaluation ETR and/or MFE – both current and initial Other_____________________________