Online Registration Form | Troy City School District

Name of School

Grade

Name of Student

First Middle Last

Gender

Male

Female

Non-binary

Date of Birth

Address

Street Address Address Line 2 City State ZIP Code

Phone

Is this a cell phone

Yes

Housing Questionnaire

Where is the student currently living? Please check one box.

In permanent housing

In a shelter

In a motel/hotel

With another family or person because of loss of housing or economic hardship

In a car, park, bus, train, or campsite

Other temporary living situation (describe below)

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

Description

Student Registration Information

What language is spoken in the student's home?

Are translation services needed?

Yes

What language does the student speak and understand the most?

Is the student Hispanic, Latino or of Spanish origin?

Yes, Hispanic

No, not Hispanic

Race

Black/African American

White

Asian

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Place of Birth

City State / Province / Region Country

Has the student previously attended a school in Troy?

Yes

Which School

Registering for Grade

If applicable, what was the entry date into the USA

Has the student attended school in the USA

Yes

Number of years in US Schools

Does the student have a parent or guardian on active duty in the Armed Forces?

Yes

Parent/Guardian Information

Mother/Guardian

First Middle Last

Relationship to student

Resides in home?

Yes

Custodial Parent?

Yes

Receive Correspondance?

Yes

Child pickup?

Yes

Mailing Address (if different from address listed above)

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

Please rank phone numbers in order of priority

Email Type

Personal

Work

Father/Guardian

First Middle Last

Relationship to student

Resides in home?

Yes

Custodial Parent?

Yes

Receive Correspondence?

Yes

Child Pickup?

Yes

Mailing Address (if different from address listed above)

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Work Phone

Please rank phone numbers in order of priority

Email Type

Personal

Work

Are there other children living in the household?

Yes

Name

First Last

Date of Birth

Gender

Male

Female

Nonbinary

Past Troy CSD Registrant?

Yes

Name

First Last

Date of Birth

Gender

Male

Female

Nonbinary

Past Troy CSD Registrant?

Yes

Emergency Contacts

Emergency Contact #1 Name

Other than parent/guardian

Relationship to student

Home Phone

Work Phone

Cell Phone

Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact #2 Name

Other than parent/guardian

Relationship to student

Home Phone

Work Phone

Cell Phone

Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact #3 Name

Other than parent/guardian

Relationship to student

Home Phone

Work Phone

Cell Phone

Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact #4 Name

Other than parent/guardian

Relationship to student

Home Phone

Work Phone

Cell Phone

Address

Street Address Address Line 2 City State ZIP Code

Relocation Due to Crisis or Disaster

Was the student relocated due to a natural, civil or health disaster?

Yes

Please check one of the boxes below and provide the name of the crisis or disaster that led to the student relocating

Natural Disaster (hurricane, tropical storm, tornado, wildfire, landslide, tsunami, sinkhole)

Civil Disaster (war {asylee, refugee}, fire accident, industrial accidents)

Health (pandemics and/or epidemics)

Other

Name of the crisis or disaster

Legal Information (if applicable)

If parents are divorced or separated, is there a court-approved custody document?

Yes

Who retains legal custody?

Relationship to child

Joint Custody?

Yes

Who has Residential (physical) Custody?

Relationship to child

Legal guardianship document provided?

Yes

Is the student in the care of a guardian(s) other than their mother or father?

Yes

Name of legal guardians

Relationship to child

Is the student in foster care?

Yes

If yes, please provide a copy of placement order (DSS-299)

Additional Services (if Applicable)

Special Education Services

Does the student currently have an IEP (Individualized Education Plan)?

Yes

Does the student receive any of the following types of services?

Consultant Teacher

Self-Contained Classroom

Resource Room

Out-of-District Class (Questar III or other BOCES)

Related Services

Speech and Language Therapy

Occupational Therapy (OT)

Physical Therapy (PT)

Counseling

Other

Please Describe

Academic Intervention Services (AIS/Remedial)

Math

English Language Arts

Science

Social Studies

Other Services

504 Plan

English as a Second Language (ESL)

Other

How many years of ESL service?

If other, please describe

Has the family moved within the past three (3) years to obtain migratory employment?

Yes

Please complete the MIgrant Education Form available here

Request for Records

I give permission for the release of information concerning my child.

Student Name

First Last

Grade

Date of birth

Name of Former School District

City

State

Name of Former School

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Parent Consent to Release Medical Information

Parent Guardian Name

First Last

Health Services Information

Allergies

Food Allergies

Bees

Environmental

Medication

Eczema

Explain with date/medication

Asthma

Yes

Explain with date/medication

ADHD/ADD

Yes

Explain with date/medication

Behavior Concerns

Yes

Explain with date/medication

Diabetes

Yes

Explain with date/medication

Seizure Disorder (Epilepsy)

Yes

Explain with date/medication

Heart Murmur

Yes

Explain with date/medication

Cardiac Conditions/Surgery

Yes

Explain with date/medication

High/Low Blood Pressure

Yes

Explain with date/medication

Fainting during exercise

Yes

Explain with date/medication

Head Injury

Yes

Explain with date/medication

Migraine Headaches

Yes

Explain with date/medication

Anemia/Bleeding Disorder

Yes

Explain with date/medication

Sickle Cell

Yes

Explain with date/medication

Chronic Ear Infection

Yes

Explain with date/medication

Hearing Loss

Yes

Explain with date/medication

Hearing Aid

Yes

Explain with date/medication

Speech Concerns

Yes

Explain with date/medication

Vision Problems (glasses or contacts)

Yes

Explain with date/medication

Bladder/Kidney Condition

Yes

Explain with date/medication

Absence of Kidney

Yes

Explain with date/medication

Absence of Testicle

Yes

Explain with date/medication

Arthritis

Yes

Explain with date/medication

Fractures

Yes

Explain with date/medication

Scoliosis

Yes

Explain with date/medication

Chicken Pox

Yes

Explain with date/medication

Surgery (tonsils, hernia)

Yes

Explain with date/medication

Under current medical care

Yes

Explain

Please list any special medical problems, serious injuries or gym/physical education restrictions

Home Language Questionnaire

In order to provide your child with the best possible education, we need to determine how well he or she understands, speaks, reads, and writes in English, as well as prior school and personal history. Please complete these sections below entitled Language Background and Educational History. Your assistance in answering these question is greatly appreciated.

What language or languages are spoken in the child's home?

English

Spanish

Other

List other language(s)

What was the first language your child learned?

English

Spanish

Other

List other language(s)

What is the home language of each parent/guardian?

Parent 1

Parent 2

Guardian(s)

What language(s) does your child understand?

English

Spanish

Other

List other language(s)

What language(s) does your child speak?

English

Spanish

Other

Does not speak

List other language(s)

What language(s) does your child read?

English

Spanish

Other

Does not read

List other language(s)

What language(s) does your child write?

English

Spanish

Other

Does not write

List other language(s)

How many total years has your child been enrolled in school?

Do you think your child may have any difficulties or conditions that affect his/her ability to understand, speak, read, or write in English or any other language?

Yes

Not sure

If yes, please explain

How severe do you think these difficulties are?

Minor

Somewhat severe

Very Severe

Has your child ever been referred for a special education evaluation in the past?

Yes

Has your child received special education services in the past?

Yes

Services received

Age at which services were received (please check all that apply)

Birth to three (3) years (early intervention)

Three (3) to Five (5) years (Special Education)

Six (6) years or older (Special Education)

Does your child have an individualized education program (IEP)?

Yes

Is there anything else you think is important for the school to know about your child? (special talents, health concerns, etc.)

In which language(s) would you like to receive information from the school?

Networking Computing and Internet Safety Policy 4526

After reading the Networking Computing and Internet Safety Policy, please check the box below that you accept Policy 4526 and its terms. A copy with your User ID and Password will be issued to you when signed. The policy is available here

Student name

Building/School

Physical Examination Requirement

New York State Education Law requires that all children attending school in New York State have a physical examination and dental screening at the following grade levels: Pre-Kindergarten, Kindergarten, 1st grade, 3rd grade, 5th grade, 7th grade, 9th grade, 11th grade, and all new students who are entering the Troy City School District. As part of your child’s education and in recognition of a desirable health practice, the annual health examinations by your health care providers continue to be encouraged. The examiner that is familiar with your child’s health history is able to give a more thorough physical. They can immediately advice you regarding any condition that might be found. If your child has had a physical in the past year or you plan to have your child examined by his/her own doctor, please have the Health Certificate filled out by the doctor and returned to school. When we require that your child have a physical examination, we will be requesting a dental certificate as well. There is a sample certificate available for you to take to your child’s dentist. Once it is completed, it should be returned to the School Nurse as it will be filed in your child’s Cumulative Health Record. Please call the school’s health office if you have any questions or concerns. Thank you for your cooperation in this health endeavor. Please return the completed form to the Health Office of your child’s school. NYS School Health Examination Form