9-12 Registration Form

Registration

9th-12th Grade
Welcome to Tri-Valley!

Please allow yourself enough time to complete the registration form in one sitting. Once started you will not be able to save and return to the packet at a later time.

The form should take approximately 30-45 minutes to complete. If you have more than one child you will need to complete a separate form for each child based on their grade level.

Submission of this completed registration form does not guarantee your child’s enrollment in school. You must also provide the following required documentation to the district’s registrar:
- Your Child’s Original Birth Certificate (or certified copy) or other satisfactory proof of age
- Custody Papers (if applicable)
- Parent/Guardian’s Photo ID
- Two Proofs of Residency (deed, lease, utility bill, driver’s license or other photo identification card with address, voter registration, income tax return, current paycheck with address on it, affidavit, third party statement, or government issued document)
- Any other information regarding your child, such as a recent report card, IEP, testing results, etc.
- Recent Physician’s Physical (form included in General Registration Packet)
- Recent Dental Health Certificate (form included in General Registration Packet)
- Immunization Record signed by physician
Upon submission, this form will be sent directly to the District’s Registrar. If you have any questions regarding registration please feel free to contact the Registrar by phone at (845) 985-2296 ext 5405 or email registration@trivalleycsd.org.

Thank you!

34 Moore Hill Road, Grahamsville, NY 12740 * Phone (845)-985-2296 * Fax (845)-985-0310 * https://www.trivalleycsd.org *
If you suspect that your child may have a physical, cognitive, or emotional disability, you have the right to refer your child to the Tri-Valley Committee on Special Education for an evaluation, and a determination as to whether your child is eligible to receive special education services and programs. More information regarding your rights is set forth in the New York State Education Department's Parent Guide to Special Education Services in New York State for Children, available at

http://www.p12.nysed.gov/specialed/publications/policy/parentguide.htm

To refer your child to the Committee on Special Education, or to obtain more information regarding the District's special education services and programs, please contact:

Danielle Cornish- - Director of Pupil Personnel Services- (845) 985-2296 Ext 5516 or e-mail daniellecornish@trivalleycsd.org

Faith Dymond - Secretary to the Director- (845) 985-2296, Ext. 5308 or e-mail faithdymond@trivalleycsd.org

Other Household Members

List all the people living in the same household as the child.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child
I have additional household members to add.
Name

First NameLast Name
Age
(if child)
Grade
(if child)
Gender
Relationship to Child

Request for Records
Student Name*

First NameLast Name
Grade*
Date of Birth*

MonthDayYear
has enrolled in the Tri-Valley Central School District. Please forward copies of the information listed to the address(es) below:
- academic records
- birth certificate
- immunization records
- attendance records
- standardized testing
- health and dental records
Tri-Valley Central School
Registration Office
34 Moore Hill Road Grahamsville,
NY 12740
Phone: (845) 985-2296 x 5405
Email: registration@trivalleycsd.org

Psychological evaluations and special education recommendations (if any), should be sent to the address below:

Tri-Valley Pupil Personnel Services
34 Moore Hill Road
Grahamsville, NY 12740
(845) 985-2296 x 5308
Fax: (845) 985-2481
Date*

MonthDayYear
Requesting records from a previous school?*

YesNo
School Name:
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Requesting records from a physician?*

YesNo
Physician Name
Fax Number
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Signature

Clear
Tri-Valley Central School District Registrar
Date

MonthDayYear
(Parent permission is no longer required when records are requested by authorized school personnel. (Family Educational Rights and Privacy Act, Final Rule on Education Records, Federal Register, June 17, 1976, Vol. 41, NO> 118, page 24673)

Physical Exams Offered at TVCS
I, Parent/Guardian*, would like my child or ward: Student Name* to have a:
Private Physical (obtained at a doctor's office)A cost free SCHOOL PHYSICAL performed by Crystal Run Healthcare (obtained at theTri-Valley Central School District Health Office), during their enrollment
Educational Law and Regulations of the Commissioner of Education require physical exams of children when they:
- Are entering the school district for the first time
- Are in Grades Pre-K or K, 1, 3, 5, 7, 9, and 11 (NYS Screening & Health Exam Requirements are posted on the school website under health services)
- Are referred by/to the Committee on Special Education
- Are signing up to participate in interscholastic sports
It is required to provide a physical to the health service department within 30 days from the first day the student starts school. After 30 days a notice will be sent to you. If a physical is not promptly provided, the student will be scheduled for a school physical with the medical director.

I understand that all reasonable precautions and care will be taken in giving health physicals to my child. The physical exams are done by the school district's Medical Director and with the assistance of a registered nurse. The School Nurse will repo1i to the parents in writing all significant findings which may require further professional attention. The medical evaluation consists of the history and physical exam.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
I UNDERSTAND THAT ALL REPORTS, TESTING, AND MEDICAL ISSUES WILL BE SHARED ONLY WITH NECESSARY PERSONNEL (IE: teachers, administrators, coaches).
Parent/Guardian Signature*

Clear

New York State Migrant Education Program

Education & Recruitment Office Parent Survey
The Migrant Education Program (MEP) is authorized by Title I, Part C of the Every Student Succeeds Act (ESSA). The MEP provides a variety of educational services to families who work in agriculture, regardless of their nationality or legal status. This program is Free of charge to all eligible families and may include tutoring, free lunch eligibility, educational field trips, summer programs, parent involvement activities, emergency needs and referrals to other services as needed.

Please take a few minutes to complete this questionnaire.

Have you or has someone in your family worked on a farm?

Have you moved during the past 3 years?
Check all that apply:

Any agricultural, farm, or fishing work (such as hay, dairy, fruit or vegetable crops, poultry, fishing, nursery/greenhouse, etc.)Work related to logging, harvesting, or initial processing of trees.Work at food processing plant, (such as meat or poultry processing plants, packing fruits or vegetables, etc.)
Parent/Guardian Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Best time to be reached

Hour Minutes

AM/PM Option
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Name

First NameLast Name
Age
Grade
Do you have another student?

YesNo
Student Name

First NameLast Name
Age
Grade
Should be Empty:

Registration

Student Registration

For Office Use Only

Transportation Information

Legal Custody Information

Parent/Guardian Information

Other Household Members

Emergency Contacts

Student Background

Request for Records

Home Language Questionnaire (HLQ)

Student Residency Questionnaire

Physical Exams Offered at TVCS

New York State Migrant Education Program