Age (Sept 1st, 2013)

Orig Entry Dt

Will your child be using bus transportation to get to school?

Birth PlaceDate of Birth

Campus Fax:Campus Phone:

Student Name

Campus Name: Dalhart High School (806) 244-7307

Gender

Dalhart High School Registration Form for School Year 2014 - 2015

PARENT INFORMATION

The above information is required for a permanent school record of your child and will be used by school personnel. Presenting false documents, recordsor information is a violation of state law and may subject you to tuition cost for your child. I certify that the information given above is correct. I authorizethe school to contact the person named on this form and the above named physician to render such treatment as may be necessary in an emergency ofsaid child. In the event parents, physician, or other persons named cannot be contacted, school officials are hereby authorized to take whatever action isnecessary in their judgment for the health of the above child. I will not hold the school district financially responsible for emergency care and/ortransportation.

(For Office Use Only)

DateDate of BirthParent or Guardian Signature

Gift:

Teacher Name:

Birth Certificate on File:

Soc Sec Copy on File:

LEP:

Address:

Mailing Address:

(806) 244-7300

BIL: ESL:

At Risk:

PK Par Mil:

Par Per:

Control No.:

Immunization on File:

Hm Lng:

Title I:

Eligibility Code:

PK Foster:

Migrant:

Econ:

Pacific Islander

Black

American Indian

WhiteLocal ID SSN

Hispanic

Asian

Grade Level

Student Home Phone:

STUDENT INFORMATION

Student Cell Phone:

Student Email:

Track

Prim:Special Education: Multi:Tert:Sec:

Svc Branch: Enrolling Person:

City, St, Zip:

Relation:

Svc Branch:

2. Guardian:

Enrolling Person:

Employer:

Rank:

Employer:

Relation:

Address:

Rank:

1. Guardian:

Address:

City, St, Zip:

Home Ph:Cell Ph: Bus Ph: Bus Ph:Home Ph:Cell Ph:

Emergency Contact:

Other Ph:

Email:

Phone Preference:

Receive Mailouts:

Phone Preference:Other Ph:

Email:

Vehicle Plate #: State:

Vehicle Make:

State:Right to Transport:

Model: Color:

Driver License #: Driver License #:

Vehicle Make: Color:

State:

Model:

Vehicle Plate #:

State:Right to Transport:

EMERGENCY CONTACT INFORMATIONHome Ph: Cell Ph:Relation: Bus Ph:1. Name:

State:Right to Transport:Phone Preference: Driver License #:

State:Color:Model:Vehicle Make: Plate #:Relation: Cell Ph:Bus Ph:Home Ph:2. Name:

Phone Preference: State:Driver License #:Right to Transport:

Plate #:Color:Vehicle Make: Model: State:

List any Allergies:

Bus Ph:Doctor:

Bus Ph:Hospital:

Dentist: Bus Ph:

Bus Ph:Other Medical:

SIBLING INFORMATION

SchoolSchoolBrothers/Sisters Grade Brothers/Sisters Grade

Yes No

Other Ph:

Other Ph:

Cell Home Business OtherBusinessHome OtherCell

NoYes

NoYes Yes NoReceive Mailouts:

NoYesEmergency Contact:

NoYes NoYes

Cell Home OtherBusiness NoYes

OtherHomeCell Business Yes No

Language Preference: English SpanishSpanishLanguage Preference: English

DISD – Parent/Student Acknowledgement of Cafeteria Services, Dress Code & Cell Phone Use Policies

We have reviewed the Cafeteria Services statements, Student Dress Code Policy and the Student Cell Phone Use Policy sections contained in the Dalhart High School Student Handbook. Our signatures certify that we have received the above publications or know that they can be accessed online at www.dalhart.k12.tx.us, including the DISD Student Code of Conduct, and that we understand the contents. Refer to the DHS Student Handbook for detailed information for each entry below.

Cafeteria Services The District participates in the National School Lunch Program and offers free and reduced-price meals based on a student's financial need. Information on this program can be obtained from the central office. Meals are served during 2 lunch periods during the designated times. • Students are not allowed to leave the campus during

lunch unless a signed out by a parent/guardian in theoffice. Parents/guardians/relatives may not sign out anystudents except for their own child. Signed out studentsmust sign in upon their return. Juniors and Seniors willhave open campus lunch privileges if a parent permissionform has been signed, and is on file in the office. Studentmust be in possession of their school issued ID card toleave campus.

• Allowed areas during lunch: the cafeteria, the patio areabehind the cafeteria, in the rest room near the studententrance.

• "Cutting" in line is not permitted and offenders may beprohibited from eating cafeteria meals, prohibited fromeating in the cafeteria, assigned cafeteria clean up, orcorrected in a manner deemed appropriate by theadministrators or duty staff.

• Students are expected to eat in the cafeteria in anorderly fashion. Inappropriate behaviors will result indisciplinary action.

• No food or drink is allowed to be brought on schoolcampus during school hours with the exception of foodbeing brought to a student by their parent during lunchperiod. This rule includes no food or drink before school.Students who are allowed to leave campus for lunch arenot allowed to bring their food back on campus.

Student Cell Phone Use DHS telephones are the property of the District and use by students is a privilege. The District has the right to refuse this privilege to any student. High school students are allowed to possess telecommunication devices with certain restrictions. Telecommunication devices may be used throughout the instructional day primarily for educational purposes at the discretion of the teacher. Students should not use the devices to receive or place personal calls or send/read messages during engaged instructional time. Students will be allowed to use these devices before/after school and during their specified lunch period. Devices confiscated by the office will be assessed a $15 fee and must be picked up by a parent.

Student Dress Code The dress code was established to teach grooming and hygiene, to instill discipline, to prevent disruption, to avoid safety hazards, and to teach respect for authority. General Guidelines: Students will be dressed and groomed in a manner that is clean, neat, safe, modest, and educationally non-distracting. The District prohibits any clothing or grooming that in the principal (or designee’s) judgment may be considered in violation of these guidelines. The student and parent may determine the student's personal dress/grooming standards provided that they comply with the guidelines. Students violating the dress code will be issued sweats and a t-shirt. Clothing will be returned to the student upon return of the sweats and t-shirts. Multiple violations will result in more serious consequences. The full version of this policy can be found in the DHS Student Handbook (print/online) or upon request.

We understand that students who violate these policies are in violation of the DHS Student Handbook & DISD Student Code of Conduct and shall be subject to disciplinary action.

__________________________________________________ _______________________ ____________ Student Signature Date Grade __________________________________________________ _______________________ Parent Signature Date

Dalhart Independent School District – Consent to Biological Test I _____________________________ as parent or guardian of ______________________________, a student enrolled in Dalhart Jr./Sr. High School and participating in any extra/co-curricular activities hereby agree to the following:

I understand the school district’s policy regarding substance abuse. I understand that it is the practice of the district to conduct drug and alcohol tests for the purpose of carrying out this policy.

I understand that my child cannot be compelled to give a biological specimen. I understand that if he/she gives a biological specimen, it will be tested for drugs and/or alcohol. I understand that the giving of a biological specimen, when requested by the district, is a condition of my child’s continued participation in Jr./Sr. high school extra/co-curricular activities. I understand that if a test of my child’s specimen reveals an unexplained presence of a drug and/or alcohol, the district will implement the steps associated with the drug use testing policy.

I hereby authorize the superintendent of Dalhart ISD and the agents of Coon Memorial Hospital Occupational Health Clinic to communicate among themselves for official purposes, my child’s drug/alcohol test results both orally and in writing. I also authorize the above officials and agents continued access to my child’s biological specimens for the purpose of further analysis or study that may be necessary, and require the results to be communicated to me prior to any district administrative proceedings or suspension from participation.

At this time, I hereby agree to my child giving a biological specimen.

______________________________ __ _______________________________ ________________ Parent/Guardian Signature Printed Name Date

________________________________ _______________________________ ________________ Student Signature Printed Name Date

At this time, I do not agree to my child giving a biological specimen.

_________________________________ _______________________________ ________________ Parent/Guardian Signature Printed Name Date

I do not intend to participate in any extra/co-curricular activities.

_________________________________ _______________________________ ________________ Student Signature Printed Name Date

Dalhart Independent School District – Declaration of Intent to Participate

Name: ___________________________________ Student ID: __________________ Grade: ___________

This signifies my intent to participate in the following extra-curricular activities for the current school year. (Students must declare their intention at the time of their registrations for each school year.)

Baseball Basketball Cheerleading Cross Country/Track Football Golf Powerlifting Softball Tennis Volleyball

**Other Activities National Honor Society Destination Imagination FPC Field Trips Student Crimestoppers Spanish Club Science Club Parking Permit Driver’s Education Student Council Ag Coop/MOCT HSTE Band FFA Academic Decathlon

UIL Academics Accounting Calculator Applications Computer Applications Computer Science Current Events Literary Criticism Editorial Writing Headline Writing Mathematics Number Sense Ready Writing Science Social Studies Spelling Feature Writing News Writing LD Debate CX Debate Prose/Poetry Persuasive Speaking Informative Speaking

Please list other activities not listed:

If any activities are checked for participation in this school year, the student will be subject to the random drug testing program for the entire school year. Students will be provided a copy of the “Student Drug Use Testing Policy” and “Consent to Biological Test” form which shall be read, signed, and dated by the student and parent or custodial guardian before that student shall be eligible to practice or participate in any extra-curricular activities. See policy guidelines for more information. For the current school year, students who register on or before the first day of school will declare their intention and turn in the consent from within three (3) days.

Dalhart Independent School District – Confidential Health Card

Dear Parent/Guardian:

The information that is requested is needed to maintain a school health record for your child. Please understand that this information may be shared with school or emergency personnel who have the need to know.

______________________________ _________________ ________________________________ (Child’s First Name) (Middle) (Legal Last Name) ☐ Male ☐ Female Date of Birth ___________________ Grade __________ Mother’s Name ______________________________ Father’s Name ____________________________________ Mother’s Home Phone _____________________Work Phone ___________________Cell Phone ____________________ Father’s Home Phone ______________________Work Phone ___________________Cell Phone ____________________ ☐ My child has no known life threatening allergies at this time. Please check any life threatening allergies to anything listed below. Medication: ____________________________ What happens? ___________________________________________________ Food: __________________________________ What happens? ___________________________________________________ Other: _________________________________ What happens? ___________________________________________________ During the past year, has your child been hospitalized? ☐ No ☐ Yes, please explain _____________________________________ ___________________________________________________________________________________________________________

Please indicate if your child has any of the following health problems: ☐ NO KNOWN HEALTH PROBLEMS

YES Health Problem Age Treatment/Medication/History Doctor/Dentist Phone Numbers

ADD/ADHD Asthma/Breathing Seizure/Neurological Arthritis Bone/Joint Problems Bladder Problems Bleeding Disorders Diabetes Heart Problems/ BP Hearing Problems Hearing Aids: Yes No Mental Disorders Scoliosis-spine curvature Sleep Problems/Nightmares Skin Disorders Sinus/Seasonal Allergies Vision Problems Glasses: Yes No Contacts: Yes No

Medications to be taken at school: No Yes *If yes, see nurse for medication form.

Please note: The school nurse or any other school personnel may not give any medication without written permission from a parent or legal guardian. Any daily medication, which needs to be given for longer than one month, must have written permission from a physician. All medication must be in the original container with a proper label. Prescription medication must contain the physician’s name; child’s name; current date; correct dosage, and directions for use. In addition, the child’s medication must be such that the medication cannot be sufficiently administered outside of school hours.

We grant permission for school officials to act in lieu of us, should an injury occur to my child, in securing emergency medical services if they appear to be needed. I also agree, unless otherwise noted in writing, that this health information may be shared with others related to the care and safety of my child. I give my permission for DISD school nurses to receive healthcare information from my child’s physician or other healthcare provider(s).

Parent/Guardian Signature __________________________________________ Date_________________

Documenting History of Varicella (Chickenpox) Illness

Amendment to §97.67

*All histories of varicella illness must be supported by a written statement from a physician or achild’s/student’s parent or guardian containing wording such as: “This is to verify that (name of student) had varicella disease (chickenpox) on or about (date) and does not need varicella vaccine.” or by serologic confirmation of varicella immunity. School nurses may also write this statement to document cases of chickenpox that they observe. This school shall accurately record the existence of any statements attesting to previous varicella illness or the results of any serologic test supplied as proof of immunity. The original should be returned to the child/student or the child’s/student’s parent or guardian. If a child or student is unable to submit a statement or serologic evidence, varicella vaccine is required.

Varicella requirement takes effect August 1, 2000.

For Further Information:

Contact the Texas Department of Health at (800) 252-9152, or visit the Texas Department of Health - Immunization Division’s Web site: http://www.dshs.state.tx.us/immunize/school/default.shtm

Instructions for Documenting Prior Illness

1. A written statement from a physician, school nurse or the child’s/student’s parent or guardiancontaining wording such as:

“This is to verify that _____________________ had varicella disease (chickenpox) on or about (child’s name)

__________________ and does not need varicella vaccine.” (month/date/year)

__________________________________ ___________________________ ________________ Signature Relationship to Student Date

2. OR by serologic confirmation of varicella immunity.

Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC).

School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting.

Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866)

Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)

Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic/Latino

Part 2. Race: What is the person’s race? (Choose one or more)

American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

________________________________ Student/Staff Name (please print)

________________________________ (Parent/Guardian)/(Staff) Signature

________________________________

Student/Staff Identification Number

________________________________ Date

Texas Education Agency – March 2010

Agencia de Educación de Texas Cuestionario de Información de Datos Raciales y de Etnicidad de

Estudiantes/Miembros de Personal de las Escuelas Públicas de Texas

El Departamento de Educación de Estados Unidos (USDE) requiere que todas las instituciones estatales y locales de educación, recopilen datos sobre etnicidad y raza de los estudiantes y de miembros de personal. Esta información es utilizada para los reportes estatales y federales así como para reportar a la Oficina de Derechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo (EEOC).

Al personal del distrito escolar y los padres o representante legal de estudiantes que deseen matricularse en la escuela, se le requiere proporcionar esta información. Si usted rehúsa proporcionarla, es importante que sepa que el USDE requiere que los distritos escolares usen la observación para identificación como último recurso para obtener estos datos utilizados para reportes federales.

Favor de contestar ambas partes de las siguientes preguntas sobre la etnicidad y raza del estudiante así como del miembro de personal. Registro Federal de Estados Unidos (71 FR 44866).

Parte 1. Etnicidad: ¿Es la persona Hispana/Latina? (Escoja solo una respuesta) Hispano/Latino – Una persona de origen cubano, mexicano, puertorriqueño, centro o sudamericano o de otra cultura u origen español, sin importar la raza.

No Hispano/Latino

Parte 2. Raza. ¿Cuál es la raza de la persona? (Escoja uno o más de uno) Indio Americano o Nativo de Alaska – Una persona con orígenes o de personas originarias de Norte y Sudamérica (incluyendo America Central), y que mantiene lazos o apego comunitario con una afiliación de alguna tribu.

Asiático – Una persona con orígenes o de personas originarias del Lejano Este, Sureste de Asia o el subcontinente indio, incluyendo, por ejemplo a Cambodia, China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia y Vietnam. Negro o Áfrico-Americano – Una persona con orígenes de cualquier grupo racial negro de África. Nativo de Hawai u otras islas del pacífico – Una persona con orígenes o de personas originarias de Hawái, Guam, Samoa u otras Islas del Pacífico.

Blanco – Una persona con orígenes de personas originarias de Europa, el Medio Este o el Norte de África.

________________________________ Nombre del Estudiante/Miembro de Personal (por favor use letra de imprenta)

________________________________ Firma (Padre/Representante legal)/(Miembro de personal)

________________________________ Número de Identificación del Estudiante/Miembro del personal

________________________________ Fecha

Agencia de Educación de Texas – Marzo 2009

Dalhart Independent School District – FAMILY SURVEY

Dear Parents,

In order to better serve your children, Dalhart Independent School District would like to identify students who may qualify to receive additional educational services. The information provided below will be kept confidential. Please answer the following questions and return this survey form to your child’s school. Or, if you prefer, for more information, call: (806) 244-7374

1. Have you moved within the last 3 years? Yes No 2. If yes, have you done agricultural or fishing related work since your move? (e.g., field work, canneries,

lumbering, dairy work, meat processing) Yes NoIf you answered “yes” to both of the questions above, an educational representative may contact you to find out whether your child is eligible for additional educational services. Please complete the following: Name of Child _____________________________________ Age______________ Grade____________ Parent/Guardian Name: __________________________________________________ Telephone Number: _________________________ Best Time to Contact You: __________________________

Dalhart Independent School District – ENCUESTA DE FAMILIA

Estimados padres,

Para mejorar los servicios educativos de sus hijos, el distrito escolar de Dalhart quisiera identificar estudiantes que puedan calificar para recibir servicios educativos adicionales. Toda la información proporcionada sera mantenida confidencial. Favor de responder a las siguientes preguntas y devolver esta forma a la escuela de su niño/a. O, si prefiere, para más información, llame a: (806) 244-7374

1. ¿Ha cambiado de residencia usted o alguien en su familia dentro los últimos tres años? Si No

2. Si usted contesto “si” en la pregunta anterior, ¿ha trabajado usted en la agricultura o en la pesca? (porejemplo, la labor, fábrica de conservas, explotación de bosques, trabajo en la lecheria, el proceso decarne)

Si No Si usted contestó “Si” en las dos preguntas anteriores, un representante del distrito escolar quizás se vaya a comunicar con usted para averiguar si su niño/a califica para servicios educativos adicionales. Favor de completar la siguiente información: Nombre de su Niño/a: _____________________________________ Edad ___________Grado ____________ Nombre del Padre/Guardián: ____________________________________________________ Número de teléfono: ___________________________ La mejor hora para localizarlo: ____________________

Dalhart Independent School District – Home Language Survey

19 TAC Chapter 89, Subchapter BB §89.1215

TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF IN GRADES 9-12): The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public schools. This survey shall be kept in each student’s permanent record folder.

NAME OF STUDENT _____________________________________ STUDENT ID# _____________________

DATE OF BIRTH ____________________ PLACE OF BIRTH _________________________________________

Has your child ever attended a school in Texas? __________ If so, where? _______________________

1. What language is spoken in your home most of the time? ______________________________2. What language does your child (do you) speak most of the time? ________________________

________________________________________ ______________________________________ Signature of Parent/Guardian Date

________________________________________ ______________________________________ Signature of Student if Grades 9-12 Date

Cuestionario del idioma que se habla en el hogar

DEBE DE COMPLETARSE POR EL PADRE/MADRE/O REPRESENTANTE LEGAL (O POR EL ESTUDIANTE SI ESTA EN LOS GRADOS 9-12): El estado de Texas requiere que la siguiente información se complete para cada estudiante que se matricula por primera vez en una escuela publica de Texas. Este cuestionario se archivará en el expediente del estudiante.

NOMBRE DEL ESTUDIUANTE ________________________________________ #ID _________________

FECHA DE NACIMIENTO ____________________ LUGAR DE NACIMIENTO _______________________________

¿Su niño ha asistido a la escuela en el estado de Texas? __________ ¿Si es si, donde?______________________________

1. ¿Que idioma se habla en su hogar la mayoria del tiempo? _____________________________2. ¿Que idioma habla su hijo/a (usted) la mayoria del tiempo? _________________________

____________________________________________ _______________________________________ Firma del Padre/Madre/o Representante Legal Fecha

_____________________________________________ ________________________________________ Firma del estudiante si esta en los grados 9-12 Fecha

Dalhart ISD – Student Residency Questionnaire

Name of School _______________________________________________________________________

Name of Student: ____________________________________________________ Sex: Male Last First Middle Female

Birth Date _____/____/_____ Age: _________ Social Security #: ____________________________ Month / Day / Year (or student identification number)

This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this residency information help determine the services the student may be eligible to receive.

1. Is your current address a temporary living arrangement? ____ Yes ____ No2. Is this temporary living arrangement due to loss of housing or economic hardship? ____Yes ____ No

If you answered YES to the above questions, please complete the remainder of this form. If you answered NO, you may stop here.

Where is the student presently living? (Check one box)

In a motel

In a shelter

With more than one family in a house or apartment

Moving from place to place

In a place not designed for ordinary sleeping accommodations such as a car, park, or

campsite

Name of Parent (s)/Legal Guardian (s) ________________________________________________________

Address _________________________________________ Zip _________ Phone ____________________

Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC sec. 25.002(3)(d).

Signature of Parent/Legal Guardian _________________________________ Date _________________

Please return original to your student’s campus principal.

For School Use Only

I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Veno Act.

_________________ ______________________________________ Date McKinney-Veto Liaison Signature

Dalhart ISD - Cuestionario de Residencia para Estudiantes

Nombre de la Escuela ___________________________________________________________________

Nombre del Estudiante ____________________________________________________ Sexo: Masculino

Apellido Nombre Segundo Nombre Femenino

Fecha de Nacimiento _____/____/_____ Edad: ______ #de Seguro Social:_______________________

Mes / Dia / Año (o número de indenitficación escolar)

El propósito de este cuestionario es presentar los objetivos del Acta McKinney-Vento (42 U.S.C.

11435). La respuestas a estas preguntas ayudarán determinar los servicios que el estudiante debe

recibir.

1. ¿Es su domicilio actual un arreglo de vivinda temporal (de poca duración) ? ______ Si ______ No

2. ¿Es este arreglo de vivinda temporal debido a la pérdida de su casa, vivienda o habitación, o debido a

algún problema económico (ejemplo: desempleo)? ______ Si ______ No

Si usted contestó SI a estas preguntas, por favor complete el resto de este formulario.

Si usted contestó NO a estas preguntas, no siga.

¿Dónde se encuentra viviendo el estudiante actualmente? (Marque una opción.)

En un motel

En un albergue o lugar de refugio

Con más de una familia en una casa o apartamento

Moviéndose de lugar en lugar

En un lugar generalmente no designado para dormir (ejemplo: carro, parque, o

campamento)

Nombre del Padre/Madre/Guardián ________________________________________________________

Dirección________________________________ Zona Postal _______Teléfono____________________

Presentar información falsa o la falsificación de documentos para uso escolar son ofensas bajo la Sección 37.10 del

Código Penal, y la inscripción del estudiante usando documentos falsos traerá como consecuencia que los

responsables estarán sujetos a pagar los gastos de instrucción u ostros cargos. TEC Sec. 25.002(3)(d).

Firma del Padre/Madre/Guardián _________________________________ Fecha_________________

Por favor envíe una copia de este documento a el principal de la escuela.

Para el uso de la escuela solamente

Yo certidico que el estudiante nombrado en este formulario califica para los programas de nutrición

escolares bajo las provisiones del Acta McKinney-Vento.

_______________ ______________________________

Fecha Firma del official autorizado

DALHART HIGH SCHOOL Student Handbook, DISD Student Code of Conduct, & District AUP

Acknowledgment Form We understand and consent to the responsibilities and consequences outlined in the 2013-2014 DHS Student Handbook, 2013-2014 DISD Student Code of Conduct, and the District Acceptable Use Policy for Computers, Internet*, and Other Electronic Resources (AUP). *Parents have the right to submit a statement requesting that their child opt-out of Internet access, however, students are still subject to AUP guidelines. We understand that any student who violates the accepted standards of conduct is subject to disciplinary action up to and including referral for criminal prosecution for violations of law.

Regarding student records, I/We understand that certain information about my child is considered directory information. Directory information includes: student name, address, primary telephone number, date and place of birth participation in officially recognized activities and sports, photographs, weight and height or members of athletic teams, dates of attendance, awards received in school and most recent previous school attended. Directory information will be released by the District to anyone who follows the procedures for requesting information unless I/we object in writing to the release of any or all of this information within ten (10) school days of enrollment. I/we have marked through the items of directory information listed above that I/we wish the District to withhold about my children without my written consent.

Additionally, Federal law requires districts receiving assistance under the Elementary and Secondary Education Act of 1965 to provide upon request made by military recruiters or an institution of higher education, access to secondary school students’ names, address, and phone listings. Parents may choose not to have this information released. If you do not want information concerning your child released to military recruiters and institutions of higher education you must submit a statement in writing to the Dalhart High School Administration Office.

Minute of Silence/Pledges Dalhart High School students are required to participate daily in the Pledge of Allegiance & Minute of Silence. Parents may submit a written statement to the DHS Administration Office releasing their child from participation. Non-participating students must remain silent while other students are observing this time.

Acknowledgement of Medical Release

If, in the judgment of any representative of the school, my child needs immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given to said student by any physician, trainer, nurse, hospital, or school representative; and I do hereby agree to indemnify and save harmless the school and any school representative from any claim by any person whomsoever on account of such care and treatment of said student.

(Please check one)

I agree to the medical release. I do not agree to the medical release.

By signing this form we acknowledge that we have reviewed the current DHS Student Handbook/DISD Code of Conduct/District AUP or understand that access to the DHS Student Handbook/DISD Student Code of Conduct & District AUP can be found on the DISD Website at www.dalhart.k12.tx.us.

Student Name Printed Students Signature GRADE

Parent/Guardian Signature Date This form must be signed and on file at Dalhart High School