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_________________

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 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 ISD – Dalhart High School Foster Care/Military Connected Student Form

Dear Parent/Guardian:

In accordance with Senate Bill 833 – Foster Care, the following information is required of all students as part of the enrollment process for Dalhart ISD.

Please read carefully and check the appropriate response for your student.

___ Student is not currently in the conservatorship of the Department of Family & Protective Services ___ Student is currently in the conservatorship of the Departments of Family & Protective Services ___ Pre-K student was previously in the conservatorship of the Departments of Family & Protective Services following an adversary hearing held as provided by Section 262.201, Family Code.

In accordance with HB 525 – Military Connected Student, the following information is required of all students as part of the enrollment process for Dalhart ISD.

Please read carefully and check the appropriate response for your student.

___ Not a military connected student ___ Student is a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard on Active Duty ___ Student is a dependent of a member of the Texas National Guard (Army, Air Guard, or State Guard) ___ Student is a dependent of a member of a reserve force in the US militaru (Army, Navy, Air Force, Marine Corps, or Coast Guard) ___ Pre-K student is a dependent of an active duty uniformed member of the Army, Navy, Air Force, Marine Corps, or Coast Guard, or activated/mobilized uniformed member of the Texas National Guard (Army, Air Guard, or State Guard) who was injured or killed while serving on active duty.

Student Name: _____________________________ Grade: ___________ (Please Print)

__________________________________________ Date: ____________ (Parent Signature)

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