e1 e2 g2 g3 g4 sulphur middle school …...date of the oklahoma pre-k score on pre-k language...

E1 E2 G2 G3 G4 SULPHUR MIDDLE SCHOOL-SULPHUR, OK L1 L2 L3 L4

Enrollment Date Student Information Dropped Date:

Student’s Full Legal Name:

Grade: Date of Birth: _________ Gender: M______ F_________

Place of Birth:______________________________________________________ Graduation Date:

Race: Spanish:_____ Black:_____ Asian:_____ Caucasian:_____ Native American:_____ Tribe: Are you of Hispanic or Latino Origin? Yes ____ No ____

Language: Do you or your Parents speak a second language? Yes_____ No_____ If yes, Please list Language:

Is the language used in the home more often or less often than the English language? __________________________________

Doctor‘s Name and Phone #:

Transportation: Do you live more than 1.5 miles from Sulphur Schools? Yes_____ No_____ If yes Bus #:_____

Student’s Address: City: State: Zip:

Mailing Address: City: State: Zip: Student Student

Home Phone #: Cell #: E-Mail Address:

Last School Attended if not Sulphur Public Schools:

City & State: Phone #: FAX #:

Future Plans: College Southern OK Tech Center Work Male Parent with whom student resides: Female Parent with whom student resides:

Name: Name:

Father:_____ Step-Father:_____ Guardian:_____ Mother:_____ Step Mother:_____ Guardian:_____

Employer: Employer:

Work Phone #: Cell #: Work Phone #: Cell #:

E-Mail Address: E-Mail Address:If student’s parents are divorced or separated, Please indicate who has primary custody:

EMERGENCY INFORMATION:

Name:______________________________ Relation:_________________________ Phone:________________



ADDITIONAL CONTACTS: (May check-out or assist your child’s needs)



Name:______________________________ Relation:_________________________ Phone:____________

Dear Parent and/or Guardian:

Below is the school district’s policy regarding the Family Educational Rights and

Privacy Regulations (FERPA):

Directory Information

The Sulphur School District proposes to designate the following personally identifiable information

contained in a student’s education record, as “directory information’, and it will disclose that

information without prior written consent.

1. The student’s name

2. The names of the student’s parents

3. The student’s date of birth

4. The students class designation (i.e. first grade, tenth grade, etc.)

5. The students extra curricular participation

6. The student’s achievement awards or honors

7. The student’s weight and height of a member of an athletic team

8. The student’s photograph

9. The school or school district the student attended before he or she enrolled in the Sulphur

School District.

Within the first three weeks of each school year, the Sulphur School district will publish in the Sulphur

Times Democrat the above list, or a revised list, of the items of directory information it proposes to

designate as directory information. For students enrolling after the notice is published, the list will be

given to the student’s parent or the eligible student at the time and place of enrollment.

After the parents or eligible students have been notified, they will have two weeks to advise the

school district in writing (a letter to the school superintendent’s office) of any or all of the items they

refuse to permit the district to designate as directory information about that student. At the end of the

two-week period each student’s records will be appropriately marked by the records custodian

indicating the items the district will designate as directory information about that student. This

designation will remain in effect until it is modified by the written direction of the student’s parent or

the eligible student.

To serve as your “letter to the superintendent” expressing your decision regarding your

student’s information, please indicate on the provided form your decision regarding directory

information. You may return this letter to the principal’s office. If you have any questions,

please contact the school at 622-3174.

Student’s Name________________________________________

Grade________________

____ I have read the FERPA policy and DO NOT wish to release any of my

student’s information.

_____I have read the FERPA policy and GIVE MY CONSENT to release all of

my student’s information that is described in the above nine directory items.

_____I have read the FERPA policy and CONSENT ONLY TO THE RELEASE OF

THE FOLLOWING DIRECTORY ITEMS. (In the above list, circle the number of

items that you agreed to release.)

Parent’s/Guardian’s Signature____________________________

Sulphur Public Schools (form 5060 A)

Medical Release to Administer Medicine to Students

Because of the legal implications involving teachers and other staff who administer

medication to children, it is required that this form be completed by the parent and/or

physician regarding any medication that needs to be administered during school hours.

Please include Tylenol or Ibuprofen if taken for headaches. It is understood this

creates no responsibility or obligation on the part of the school faculty and staff but is

done only as a service to the parent or child.

Dear Principal Pyle,

I have read and understand the above paragraph and hereby authorize you or a

member of your staff to give the medication listed below to the student named on this

form. This will be done at my request and you or the staff member will not be held

accountable for any effects nor the outcome of administration of the medication, nor shall

you be held liable in any manner whatsoever for any act of negligence in giving such

medication or for any failure to give such medication.

Student’s Name__________________________________________________________

Name of Medication____________________________ Dosage___________________

Physician’s name or signature_________________________ Phone ______________

Time(s) for medication to be administered___________________________________

Reason for administering medication________________________________________

I authorize his/her medication to be administered by Sulphur Public Schools Staff.

_________________________________________Date___________________________

Signature of Parent/Guardian

Address__________________________________Phone #________________________

Business Phone # ________________________

6/27/11

1021 W. 9th Street www.sms.sulphurk12.org Phone (580) 622-4010 Sulphur, Ok 73086 Fax (580) 622-3900

Sulphur Middle School “Committed to Student Success”

7TH GRADE: T-DAP BOOSTER IMMUNIZATION

Dear Parent/Guardian,

We must have the T-Dap booster immunization on file in the SMS office before your child can be enrolled. If you are exempt from immunizations due to religious or personal beliefs, please stop by the SMS office or the local health department for an exemption form, which also must be on file with our office and the Oklahoma Dept. of Human Services before your student can be enrolled.

Immunizations are given at the Murray County Health Dept.; Wednesday OR Friday 8:30-11:30 or 1 -4 pm or call them for more information or to request that your child’s vaccination record be faxed to our office 580-622-3900. You may also visit the Oklahoma State Department of Health Immunization Service website at http://imn.health.ok.gov..

Thank you for your immediate attention to the matter.

Steven Pyle (SMS Principal)

Steven Pyle, Principal Emile Heitland, Counselor J.J Tucker, Secretary

http://www.sms.sulphurk12.org/

Would you like to be contacted by an employee of the school to discuss additional educational services that may be available to your child?

(Print) Parent/Guardian or Adult Caring for the Student: _____________________________________________

Relationship to Student: ____________________________________ Signature: ___________________________

________________________________________________________________________________________________

Sulphur Public SchoolsStudent Enrollment Questionnaire

Student Name:

Date of Birth:

Your child may be eligible for additional educational services through Title X, Part C McKinney-Vento Assistance Act. Eligibility can be determined by completing this questionnaire.

Grade: School:

Today’s Date:

Where are you and your family currently living? Please check one of the boxes below.

If you checked a box in section B, in the space below please list all children currently living with you who attend “name” Public Schools.

SECTION A

SECTION B

Rent/own my own home or apartment

Temporarily with another family member or friend until we can locate affordable housing

In a hotel or motel

In a vehicle, park, campground, or on the streets

Alone or in different locations, without an adult serving as a caregiver

In an emergency or transitional shelter

With an adult that is not a parent or legal guardian

In a house, building, or trailer WITHOUT running water or electricity

Wherever I can find a place to stay at nightOther Please Explain:

STOP: If you checked the box that you rent/own your own home or apartment skip to the bottom of the page, sign the form, and then submit to school personnel. If you do not rent/own your own home or apartment, please continue to the next section.

FIRST & LAST NAME OF STUDENT MALE OR FEMALE DATE OF BIRTH GRADE SCHOOL NAME

Yes NoThe undersigned certifies that the information provided is correct and accurate.

Street Address City State Zip

Phone Number: _________________________ Email Address: _________________________________________

HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS

Name of Student: ____________________________________________________________________ Grade:____________ Last Name First Name Middle Name

Date of Birth: __________________ School: _____________ Student ID # ___________________ Gender: Male_______ Female________ MM/DD/YYYY

Is the student of Hispanic or Latino culture or origin? Yes________ No_________

Select one or more of the following races: ______ African American/Black ______ American Indian/Alaskan Native ______ Asian ______ Native Hawaiian/Pacific Islander ______ Caucasian/White

1. What is the dominant language most often spoken by the student?

2. What is the language routinely spoken in the home, regardless of the language spoken by the student?

3. What language was first learned by the student?

4. Does the parent/guardian need interpretation services? Yes _____ No _____ If so, what language? _______________________________

5. Does the parent/guardian need translated materials? Yes _____ No _____ If so, what language? _______________________________

6. What was the date the student first enrolled in a school in the United States? ________________________MM/YYYY

______________________________________________________________________________________________________________

☐ Other language than English indicated TWO OR MORE times on questions 1 – 3 above. The student is classified as “more often” and automatically qualifies as bilingual on

the accreditation report.

☐ Other language than English indicated ONLY ONCE on questions 1 – 3 above. The student is classified as “less often” and only qualifies as bilingual on the accreditation

report if he or she meets one of the following (any selection below REQUIRES appropriate documentation):

☐ 1. Designated English Learner on one of the Oklahoma English language proficiency assessments: ACCESS for ELLs 2.0, Alternate ACCESS for ELLs,

WIDA Screener, WIDA MODEL, K-WAPT, W-APT or Oklahoma Pre-K Language Screening Tool.

☐ 2. Scored unsatisfactory or limited knowledge in Reading on the Oklahoma State Testing Program (OSTP).

☐ 3. Scored at or below the 35th percentile (or equivalent) composite reading score from spring of the previous school year on a state approved norm-referenced test (NRT).

DOCUMENTATION OF A TEST RESULT FOR STUDENTS MARKED LESS OFTEN

Date(s) of Kindergarten ACCESS, ACCESS for ELLs 2.0, or Alternate ACCESS Test

Score(s) on Kindergarten ACCESS, ACCESS for ELLs 2.0,or

Alternate ACCESS

Date(s) of WIDA Screener or K-WAPT/WAPT or

WIDA MODEL

Score(s) on WIDA Screener or K-WAPT/WAPT or

WIDA MODEL Composite Score Literacy Score Composite Score Literacy Score

1. 2. 1. 2.

1. 2.

Date(s) of Reading OSTP Score(s) on Reading OSTP

Unsatisfactory Limited Knowledge Satisfactory Advanced



Date(s) Norm Reference Test (NRT) Name of the NRT Reading Total Composite Score(s) %

Date of the Oklahoma Pre-K Language Screening Tool

Score on Pre-K Language Screening Tool

%

2020-2021

SCHOOL USE ONLY Please have test score documentation available for the Regional Accreditation Officer to review.

STUDENT INFORMATION

Revised: January, 2017 5

Date (MM/DD/YYYY) Parent / Guardian Signature

From Above: Question 1: Reference WAVE code 1036 Question 2: Reference WAVE code 1037 Question 3: Reference WAVE code 1038

OMB Number: 1810-0021 Expiration Date: 02/29/2020

U.S. Department of Education Office of Indian Education

Washington, DC 20202 TITLE VI ED 506 INDIAN STUDENT ELIGIBILITY CERTIFICATION FORM

Parent/Guardian: This form serves as the official record of the eligibility determination for each individual child included in the student count. You are not required to complete or submit this form. However, if you choose not to submit a form, your child cannot be counted for funding under the program. This form should be kept on file and will not need to be completed every year. Where applicable, the information contained in this form may be released with your prior written consent or the prior written consent of an eligible student (aged 18 or over), or if otherwise authorized by law, if doing so would be permissible under the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g, and any applicable state or local confidentiality requirements.

STUDENT INFORMATION

Name of the Child __________________________________________________ Date of Birth ______________ Grade ______ (As shown on school enrollment records)

Name of School ____________________________________________________________________________________________ TRIBAL ENROLLMENT

Name of the individual with tribal enrollment: ___________________________________________________________________

(Individual named must be a descendent in the first or second generation)

The individual with tribal membership is the: _____ Child _____ Child's Parent _____ Child's Grandparent

Name of tribe or band for which individual above claims membership: _______________________________________________ The Tribe or Band is (select only one):

_____ Federally Recognized _____ State Recognized _____ Terminated Tribe (Documentation required. Must attach to form) _____ Member of an organized Indian group that received a grant under the Indian Education Act of 1988 as it was in effect October 19, 1994. (Documentation required. Must attach to form)

Proof of enrollment in tribe or band listed above, as defined by tribe or band is:

A. Membership or enrollment number (if readily available) _____________________________________________________ OR B. Other Evidence of Membership in the tribe listed above (describe and attach) _______________________________________ Name and address of tribe or band maintaining enrollment data for the individual listed above:

Name ____________________________________________ Address ________________________________________________ City _______________________________State ______Zip Code ____________ ATTESTATION STATEMENT I verify that the information provided above is accurate.

Name Parent/Guardian ______________________________________ Signature _______________________________________

Address ______________________________________ City ____________________________State ______Zip Code __________ Email Address ________________________________________ Date _______________

2020-2021

Media Permission Slip

We the staff of Sulphur High School are proud of our students,

teachers, staff and programs. Many times during the school year we

promote our programs by using a variety of media, including but

not limited to newspapers, magazines, video, and the school website.

This permission slip gives us your release to include your child in

media promotions for our school.

Child's Name_______________________________________

Parent's Signature_______________________________________

Date __________________

Revised: May 2012

- 1 -

SULPHUR PUBLIC SCHOOLS

Internet Safety Policy & Technology Protection Measure

Sulphur Public School is pleased to offer students access to a computer network for the

Internet and believe the Internet offers vast, diverse and unique resources to both students

and teachers. Our goal in providing this service to students and teachers is to promote

educational excellence by facilitating resource sharing, innovation and com-munication.

To gain access to the Internet, all students must obtain parental permission as verified by

the signatures on the attached form. Should a parent prefer that a student not have

Internet access, use of the computers is still possible for more traditional purposes such

as: word processing, remediation and program specific software.

Technology Protection Measure

In compliance with the Children’s Internet Protection Act (CIPA), Sulphur Public

School enforces a policy of Internet safety that includes the use of filtering or blocking

technology. iBOSS Filter by Phantom Technology hardware is used to provide a

continually updated server-based filtering solution to protect Internet users against access

by adults and minors to visual depictions that are obscene, child pornography, or harmful

to minors.

Cyber Bullying

The use of electronic threatening behavior or cyber bulling is prohibited. The user will

not become a victim, or a perpetrator of cyber bullying. The user will report any threats

made against them to a teacher or administrator. Users found to be perpetrating cyber

bullying will be disciplined appropriately. Sulphur School will educate minors about

appropriate cyber bullying awareness and response. To ascertain each student

understands appropriate online & electronic behavior: every teacher will implement

activities and/or dialogue which will address appropriate online behavior which is age-

appropriate. The library-media specialist will address this topic during the annual library

orientation classroom visit. Principals will address this topic in an opening group

assembly. New students arriving throughout the year will be given the “Welcome

Brochure” which explains all of the above, when they are enrolled in the LAN (Local

area network).

Revised: May 2012

- 2 -

Possibilities

Access to the Internet will enable students to explore thousands of libraries, databases,

museums, and other repositories of information and to exchange personal communication

with other Internet users around the world. Families should be aware that some material

accessible via the Internet might contain items that are illegal, defamatory, inaccurate,

obscene, or potentially offensive. While the purposes of the school district are to use

Internet resources for constructive educational goals, students may find ways to access

other materials. We believe that the benefits to students from access to the Internet (in

the form of information, resources, and opportunities for collaboration) exceed the

disadvantages. But ultimately, parents and guardians of minors are responsible for setting

and conveying the standards that their children should follow when using media and

information sources. Therefore, we support and respect each family right to decide

whether or not to apply for access.

Expectancies

Students are responsible for appropriate behavior on the school’s computer network

just as they are in a classroom for on a school playground. Communications on the

network are often public in nature. General school rules for behavior and

communications apply. It is expected that users will comply with district standards and

the specific rules set forth. Internet activities result from specific tasks and assignments

that support learning and teaching and promote the district’s mission and goals. Students

will use the system for educational activities.

Privileges

The use of the network is a privilege, not a right, and may be revoked if abused. The

user is personally responsible for his/her actions in accessing and utilizing the school’s

computer resources. The students are advised never to access, keep or send anything that

they would not want their parents or teachers to see. The system administrators and

teachers will deem what is inappropriate use and their decision is final. The

District may deny, revoke, or suspend specific user access.

Revised: May 2012

- 3 -


TERMS AND CONDITIONS FOR INTERNET AND COMPUTER USERS

Privacy—Network storage areas may be treated like school lockers. Network administrators may

review communications to maintain system integrity and insure that students are using the system

responsibly.

Illegal copying—Students should never download or install any commercial software, shareware,

or freeware onto network drives or disks, unless they have permission from the Network

Administrator. Nor should students copy other people’s work or intrude into other people’s files.

Inappropriate materials or language—No profane, abusive or impolite language should be

used to communicate nor should material be accessed which are not in the line with the rules of

school behavior. A good rule to follow is never view, send or access materials that you would not

want your teachers and parents to see. Should students encounter such material by accident, they

should report it to their teacher immediately.

Unauthorized use and access—Users may not use the Sulphur Public Schools Wide Area

Network and the Internet for commercial purposes or political lobbying. However, users may use

the system to communicate with elected representatives and to express their opinions on political

issues. Users will not attempt to log into the network through another person’s account or access

another person’s files. These actions are illegal, even if only for the purpose of “browsing”.

Vandalism—Vandalism may result in cancellation of privileges. Vandalism is defined as any

attempt to harm or destroy computer hardware or data of another user, the Sulphur Public Schools

network, or any other network connected to the Sulphur Public Schools. This includes, but is not

limited to, the uploading of creation of computer viruses.

Advice

These are guidelines to follow to prevent the loss of network privileges at Sulphur Public

Schools:

1. Do not use a computer to harm other people or their work.

2. Do not damage the computer or network in any way.

3. Do not interfere with the operation of the network by installing illegal software,

shareware, or freeware.

4. Do not violate copyright laws.

5. Do not view, send or display, obscene, profane, lewd, vulgar, rude, inflammatory,

threatening or disrespectful messages or pictures.

6. Do not reveal your personal address, phone number, and/or other personal information or

the addresses, phone numbers and/or other personal information of fellow students.

7. Do not waste limited resources such as disk space or printing capacity.

8. Do not trespass in another’s folders, work, or files.

9. Do notify an adult immediately, if, by accident, you encounter materials that violate the

rules of appropriate use.

10. BE PREPARED TO BE HELD RESPONSIBLE for your actions and for the loss of

privileges if the Rules of Acceptable uses are violated.

11. Disciplinary actions will be consistent with the Sulphur Public Schools Board of

Education policy and existing practice regarding inappropriate language or behavior

including suspension from school and/or legal action.

Revised: May 2012

- 4 -


PARENT PERMISSION FORM

I understand and will abide by the above Terms and Conditions for Internet access. I further

understand that any violation of the regulations above is unethical and may constitute a criminal

offense. Should I commit any violation, my access privileges may be revoked and school

disciplinary and/or appropriate legal action may be taken. I also understand that computers and

technology are an integral part of Sulphur Public School’s academic process. If I violate this

policy, my grades may suffer.

User’s Name (please print) ________________________________________________________

User’s Signature: ____________________________________________Date_____/_____/_____

PARENT OR GUARDIAN (If the student is under the age of 18, a parent or guardian must also

read and sign this agreement.)

As the parent or guardian of this student, I have read the Terms and Conditions for Internet

access. I understand that this access is designed for educational purposes and that Sulphur Public

Schools and the Oklahoma State Department of Education has taken available precautions to

eliminate controversial material. However, I also recognize it is impossible for Sulphur Public

Schools and the Oklahoma State Department of Education to restrict access to all controversial

materials, and I will not hold the Sulphur Public Schools or the Oklahoma State Department of

Education responsible for materials viewed, read, or acquired on the network. Further, I accept

full responsibility for supervision if and when my child’s use is not in a school setting. I hereby

give my permission for Sulphur Public Schools to grant access for my child and certify that the

information contained o this form is correct.

Parent or Guardian (please print): ___________________________________________________

Signature_________________________________________________Date_____/_____/______

OMB Number: 1810-0021 Expiration Date: 02/29/2020

INSTRUCTIONS FOR THE ED 506 FORM

FOR APPLICANTS:

PURPOSE: To comply with the requirements in 20 USC 7427(a), which provides that: “The Secretary shall require that, as part of an application for a grant under this subpart, each applicant shall maintain a file, with respect to each Indian child for whom the local educational agency provides a free public education, that contains a form that sets forth information establishing the status of the child as an Indian child eligible for assistance under this subpart, and that otherwise meets the requirements of subsection (b)”. MAINTENANCE: A separate ED 506 form is required for each Indian child that was enrolled during the count period. A new ED 506 form does NOT have to be completed each year. All documentation must be maintained in a manner that allows the LEA to be able to discern, for any given year, which students were enrolled in the LEA’s school(s) and counted during the count period indicated in the application.

FOR PARENTS/GUARDIANS:

DEFINITION: Indian means an individual who is (1) A member of an Indian tribe or band, as membership is defined by the Indian tribe or band, including any tribe or band terminated since 1940, and any tribe or band recognized by the State in which the tribe or band resides; (2) A descendant of a parent or grandparent who meets the requirements described in paragraph (1) of this definition; (3) Considered by the Secretary of the Interior to be an Indian for any purpose; (4) An Eskimo, Aleut, or other Alaska Native; or (5) A member of an organized Indian group that received a grant under the Indian Education Act of 1988 as it was in effect on October 19, 1994. STUDENT INFORMATION: Write the name of the child, date of birth and school name and grade level. TRIBAL ENROLLMENT INFORMATION: Write the name of the individual with the tribal membership. Only one name is needed for this section, even though multiple persons may have tribal membership. Select only one name: either the child, child’s parent or grandparent, for whom you can provide membership information. Write the name of the tribe or band of Indians to which the child claims membership. The name does not need to be the official name as it appears exactly on the Department of Interior’s list of federally-recognized tribes, but the name must be recognizable and be of sufficient detail to permit verification of the eligibility of the tribe. Check only one box indicated whether it is a Federally Recognized, State Recognized, Terminated Tribe or Organized Indian Group. If Terminated Tribe or Organized Indian Group is elected, additional documentation is required and must be attached to this form.

• Federally Recognized- an American Indian or Alaska Native tribal entity limited to those indigenous to the U.S. The Department of Interior maintains a list of federally-recognized tribes, which OIE can provide you upon request.

• State Recognized- an American Indian or Alaska Native tribal entity that has recognized status by a State. The U.S. Department of Education does not maintain a master list. It is recommended that you use official state websites only.

• Terminated Tribe-a tribal entity that once had a federally recognized status from the United States Department of Interior and had that designation terminated.

• Organized Indian Group- Member of an organized Indian group that received a grant under the Indian Education Act of 1988 as it was in effect October 19, 1994.

Write the enrollment number establishing the membership of the child, if readily available, or other evidence of membership. If the child is not a member of the tribe and the child’s eligibility is through a parent or grandparent, either write the enrollment number of the parent or grandparent, or provide other proof of membership. Some examples of other proof of membership may include: affidavit from tribe, CDIB card or birth certificate. Write the name and address of the organization that maintains updated and accurate membership data for such tribe or band of Indians. ATTESTATION STATEMENT: Provide the name, address and email of the parent or guardian of the child. The signature of the parent or guardian of the child verifies the accuracy of the information supplied.

The Department of Education will safeguard personal privacy in its collection, maintenance, use and dissemination of information about individuals and make such information available to the individual in accordance with the requirements of the Privacy Act.

PAPERWORK BURDEN STATEMENT According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of

information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-0021.

The time required to complete this portion of the information collection per type of respondent is estimated to average: 15 minutes per Indian

student certification (ED 506) form; including the time to review instructions, search existing data resources, gather the data needed, and complete

and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this

form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your

individual submission of this form, write directly to: Office of Indian Education, U.S. Department of Education, 400 Maryland Avenue, S.W.,

LBJ/Room 3W203, Washington, D.C. 20202-6335. OMB Number: 1810-0021 Expiration Date: 02/29/2020.


TRANSPORTATION AGREEMENT (RURAL TRANSPORTATION ONLY)

(Complete the form below and return to the school or the bus driver)

This agreement is between the Sulphur Public School and the parents/guardians of students transported

to and from school.

The school bus driver has a great responsibility. Each day he/she carries a “precious cargo” your child

and his/her only concert should be to ensure that all of his/her passengers are transported to and from

school safely. Unfortunately, there are times when children (young and old) do things that causes the

driver to be distracted from his/her job. This is dangerous and cannot be allowed. It is necessary

therefore, that Student Conduct Rules and Regulations be in force and that they be followed. Each

parent/guardian must ensure that their child understands the importance of good behavior while riding a

bus.

Riding a school bus is not a right but a privilege granted to those who are eligible and are able to abide by

the rules and regulations. It is not right that a student be allowed to ride a school bus when he/she

continues to jeopardize the safety of others. The Board of Education realizes that a hardship may result in

your having to transport your child to and from school, but it is sometimes necessary.

Therefore, the School System asks the parents/guardians to sign an agreement that their child will abide

by the rules and regulations. If the rules are broken, there will be punishment administered on an

increasing scale. The rules and regulations are attached and can also be found in the Student Handbook.

We the parents/guardians have read and discussed with our child the school bus policy and rules. We

agree with the School District that these rules should be in force and that if any student who cannot abide

by them should and shall be disciplined with accordance to the school policy. As parents/guardians, we

ask the school district to contact us each time our children are involved in incidents so we may further

counsel our children on proper bus conduct.

Parent’s/guardian’s signature_____________________________Date_________Phone_____________

Physical Address____________________________________City_________________State__________

Please write the names and grades of each child in your family that will ride the school bus. This statement will be in

effect for the current school year 2020-2021.

Name____________________________________________Grade____________Bus number________





Sulphur Public School

Bus Rider Rules

Riding a school bus is a privilege and the privilege may be removed for not abiding by the bus

rider rules.

Previous to loading, students should:

1. Be on time at the designated school bus stops to keep the bus on schedule.

2. Stay off the road at all times while waiting for the bus.

3. Not move toward the bus at the school loading zone until the bus has been brought to a

complete stop.

4. Respect people and their property while waiting on the bus.

5. Receive proper school official authorization to be discharged at places other than the regular

bus stop.

While on the bus, students should:

1. Keep all parts of the body inside the bus.

2. Refrain from eating and drinking on the bus.

3. Refrain from the use of any form of tobacco, alcohol or drugs.

4. Assist in keeping the bus safe and clean at all times.

5. Remember that loud talking and laughing or unnecessary confusion diverts the driver’s

attention and may result in a serious accident. (The life you save may be your own).

6. Treat bus equipment as you would valuable furniture in your own home. Damage to seats,

etc., must be paid for by the offender.

7. Never tamper with the bus or any of its equipment.

8. Maintain possession of books, lunches, or other articles and keep the aisle clear.

9. Help look after the safety and comfort of small children.

10. Do not throw objects in or out of the bus.

11. Remain in their seats while the bus is in motion.

12. Refrain from horseplay and fighting.

13. Be courteous to fellow pupils and the bus driver.

14. Remain quiet when approaching a railroad crossing.

15. Remain in the bus during road emergencies except when it may be hazardous to your

safety.

After leaving the bus, students should:

1. Go at least ten (10) feet in front of the bus, stop, check traffic, wait for bus driver’s signal,

then cross the road.

2. Go home immediately, staying clear of traffic.

3. Help look after the safety and comfort of small children.

Sulphur Public Schools Student Drug Testing Policy

In an effort to protect the health and safety of its students from illegal and/or performance-enhancing drug use and abuse, the Sulphur Board of Education has adopted the following policy for drug testing of students. Activity students will be tested.

Statement of Purpose and Intent This policy governs performance-enhancing and illegal drug use by students participating in

certain extra-curricular activities. The sanctions imposed for violations of this policy will be limitations solely upon the opportunity of any student determined to be in violation of this policy to a student’s privilege to participate in extra-curricular activities. Participation in school-sponsored interscholastic extra-curricular activities at the Sulphur Public School District is a privilege. Students who participate in these activities should be respected by the student body as well as the school district and community they represent. Accordingly, students in extra-curricular activities carry a responsibility to themselves, their fellow students, their parents and their school to set the highest possible examples of conduct, sportsmanship, and training, which includes avoiding the use or possession of illegal drugs. Illegal and performance-enhancing drug use of any kind is incompatible with the physical, mental and emotional demands placed upon participants in extra-curricular activities and upon the positive image these students project to other student sand to the community on behalf of the Sulphur Public School District. For the safety, health and well being of students in extra-curricular activities the Sulphur Public School District has adopted this policy for use by all participants in interscholastic extra-curricular activities in grades seven (7) – twelfth (12).

Testing Procedure Each student shall be provided with a copy of the “Student Testing Consent Form” which shall

be read, signed, and dated by the student, parent or custodial guardian, and coach/sponsor before such student shall be able to be eligible to participate in any extra-curricular activities. This consent requires the student to provide a urine sample for the present school year and thereafter either a urine or hair sample. (a) as part of the activity student‘s annual physical or the eligibility for participation; (b) when the student is selected by the random selection basis to provide a urine sample and or hair sample Each participating student shall receive a copy of the Student Drug Testing Policy. The sponsor or administration will be responsible for explaining the policy to all prospective students.

All Activity Students will be required to provide a sample before the student can participate in an extra-curricular activity covered under this policy. A student who moves into the district after the school year begins will have to undergo a drug test before they will be eligible for participation in any extra-curricular activity. Drug use testing for students will also be chosen on a random selection basis from a list of all students participating in extra-curricular activities. The Sulphur Public School District will determine names to be drawn at random to provide a urine sample for drug use testing for illegal or performance-enhancing drugs throughout the year. Any use drug test will be administered by or at the direction of a professional laboratory chosen by the Sulphur Public School District. The professional laboratory shall be required to use scientifically validated toxicological testing methods, have detailed written specifications to assure chain of custody of the specimens, and proper laboratory control and scientific testing. All aspects of the drug use testing program, including the taking of specimens, will be conducted so as to safeguard the personal and privacy rights of the student. The test specimen shall be obtained in a manner designed to minimize intrusiveness of the procedure. The principal/athletic director shall designate a coach, sponsor, or school employee of the same sex as the student to accompany the student to a restroom or other private facility behind a closed stall. The monitor shall not observe the student while the specimen is being produced but the monitor shall be present outside the stall. If at anytime during the testing procedure the monitor has reason to believe or

suspect that a student is tampering with the specimen, the monitor may stop the procedure and inform the principal/athletic director, who will then determine if a new sample should be obtained. The monitor shall give each student a form on which the student may list any medications legally prescribed for the student he or she has taken in the preceding 30days. The parent or legal guardian shall be able to confirm the medication list submitted by their child during the 24 hours following any drug test. The medication list shall be submitted to the lab in a sealed and confidential envelope and shall not be viewed by district employees.

Confidentiality The laboratory will notify the principal of any positive Test. To keep the positive test results confidential, the principal will only notify the student, the head coach/sponsor, and the parent or custodial guardian of the student of the results. The principal will schedule a conference with the student and parent or guardian and explain the student’s opportunity to submit additional information to the principal/athletic director or to the lab. The Sulphur Public School District will rely on the opinion of the laboratory which performed the test in determining whether the positive test result was produced by something other than consumption of an illegal or performance-enhancing drug. Test results will be kept in files separate from the student’s other educational records, shall be disclosed only to those school personnel who have a need to know, and will not be turned over to any law enforcement authorities. These records will be destroyed upon graduation or permanent withdrawal from Sulphur Public Schools.

Appeal An Activity Student, who has been determined by the principal to be in violation of this policy, shall have the right to appeal the decision to the superintendent or his/her designee(s). Such request for a review must be submitted to the superintendent in writing within five calendar days of notice of the positive test. The superintendent or his/her designee(s) shall then determine whether the original finding was justified. Any necessary interpretation or application of this policy shall be in the sole and exclusive judgment and discretion of the superintendent which shall be final and non-appealable

Test Results and Restrictions Any Activity Student who tests positive in a drug test under this policy shall be subject to the following restrictions: The parent/guardian will be contacted and a private conference will be scheduled to present the test results to the parent/guardian. A meeting will then be set up with the student, parent/guardian, and principal concerning the positive drug test. A positive drug test will result in seven (7) weeks of probation. The student will be retested at the conclusion of the probationary period. If the student sample is negative, the student will remain eligible to participate. If the sample is positive, the student will not be allowed to participate for the remainder of the school year.

Refusal to Submit to Drug Use Test A participating student who refuses to submit to a drug test authorized under this policy shall not be eligible to participate in any activities covered under this policy, including all meetings, practices, performance and competitions for the remainder of the school year.

Sulphur Public Schools 2020-2021

Extra-Curricular Activities Student Drug Testing Consent

Statement of Purpose and Intent Participation in school sponsored extra-curricular activities at the Sulphur Public Schools district is a privilege. Extra-curricular activity students carry a responsibility to themselves, their fellow students, their parents, and their school to set the highest possible examples of conduct, which includes avoiding the use or possession of illegal drugs.

Drug use of any kind is incompatible with participation in extra-curricular activities on behalf of the Sulphur Public School District. For the safety, health, and well-being of the extra-curricular activity students of the Sulphur Public Schools District, the Sulphur Board of Education has adopted the attached Student Drug Testing Program Policy for extra-curricular activities and this student drug testing consent form for use by all participating activity students at the Junior High and High School levels.

Participation in Extra-Curricular Activities Each extra-curricular activity student shall be provided with a copy of the policy and this student drug testing program consent form that must be read, signed, and dated by the student, parent or custodial guardian, and coach/sponsor before participation in any extra-curricular activity. The consent shall be to provide a urine sample (a) as part of the annual physical or on a scheduled testing day and (b) as chosen by the random selection basis. Non-athletic activities students may omit the annual physical. No students shall be allowed to practice or participate in any extra-curricular activity unless the student has returned the properly signed consent form

Student’s Last Name First Name Middle Initial

I understand, after having read the policy on student drug testing program for extra-curricular activities and this extra-curricular activities student drug testing consent form, that, out of care for my safety and health, the Sulphur Public Schools enforces the rules applying to the consumption or possession of illegal, and performance enhancing drugs. As a member of a Sulphur extra-curricular activity, I realize that the personal decisions that I make daily in regard to the consumption or possession of illegal or performance enhancing drugs my affect my health and will being as well as the possible endangerment of those around me and reflect upon any organization with which I am associated. If I choose to violate school policy regarding the use or possession of illegal or performance enhancing drugs any time while I am involved in in=season or off-season activities, I understand, upon determination of that violation, I will be subject to the restriction of my participation as outlined in the policy.

Signature of Student Grade Date

Sulphur Public School 2020-2021

Student Extra-Curricular Activities Contract

We have read and understand the Sulphur Public School District policy on the student drug testing program for extra-curricular activities and this extra-curricular activities student drug testing consent form. We desire that the student named above participate in the interscholastic extra-curricular activity programs of the Sulphur Public School District and we hereby voluntarily agree to subject to its terms. We accept the methods of obtaining urine samples, testing and analysis of specimens, and all other aspects of the program. We further agree and consent to the disclosure of the sampling, testing, and results as provided in this program.

Signature of Parent or Custodial Guardian Date

Signature of Coach/Sponsor Date

Medication List

I, , am currently taking or have taken the following drugs, substances, or medications in the last ninety-six (96) hours (four (4) days):

Additional information:

Updated April 2017

OSSAA PHYSICAL EXAMINATION AND PARENTAL CONSENT FORM

PLEASE PRINT DATE OF EXAM____________________________ Name ________________________________________________________________ Sex _________ Age ________________ Date of Birth ___________________________________ Grade _______________ School ___________________________________________________________________________ Sport(s) _______________________________________ Address _______________________________________________________________________________________________________ Phone _________________________________ Personal physician ______________________________________________________________________________________________ Phone _________________________________ In case of emergency, contact: Name ______________________________________________________________________________________________________________________ Relationship _____________________________________________________________Phone (H) ________________________________ (W) ________________________________ Explain “Yes” answers below. Circle questions you don’t know the answers to. YES NO YES NO

1. Have you had a medical illness or injury since your last check up or sports physical?

2. Do you have an ongoing or chronic illness?

3. Have you ever been hospitalized overnight?

4. Have you ever had surgery?

5. Are you currently taking any prescription or nonprescription (over-the-counter) medications or pills or using an inhaler?

6. Have you ever taken any supplements or vitamins to help you gain or lose weight or improve your performance?

7. Do you have any allergies (for example, to pollen, medicine, food, or stinging insects)?

8. Have you ever had a rash or hives develop during or after exercise?

9. Have you ever passed out during or after exercise?

10. Have you ever been dizzy during or after exercise?

11. Have you ever had chest pain during or after exercise?

12. Do you get tired more quickly than your friends do during exercise?

13. Have you ever had racing of your heart or skipped heartbeats?

14. Have you had high blood pressure or high cholesterol?

15. Have you ever been told you have a heart murmur?

16. Has any family member or relative died of heart problems or of sudden death before age 50?

17. Have you had a severe viral infection (for example, myocarditis or mononucleosis) within the last month?

18. Has a physician ever denied or restricted your participation in sports for any heart problems?

19. Do you have any current skin problems (for example, itching, rashes, acne, warts, fungus, or blisters)?

20. Have you ever had a head injury or concussion?

21. Have you ever been knocked out, become unconscious, or lost your memory?

22. Have you ever had a seizure?

23. Do you have frequent or severe headaches?

24. Have you ever had numbness or tingling in your arms, hands, legs, or feet?

25. Have you ever become ill from exercising in the heat?

26. Do you cough, wheeze, or have trouble breathing during or after activity?

27. Do you have asthma?

28. Do you have seasonal allergies that require medical treatment?

29. Do you or does someone in your family have sickle cell trait or disease?

30. Do you use any special protective or corrective equipment or devices that aren’t usually used for your sport or position (for example, knee brace, special neck roll, foot orthotics, retainer on your teeth, hearing aid)?

31. Have you had any problems with your eyes or vision?

32. Do you wear glasses, contacts, or protective eyewear?

33. Have you ever had a sprain, strain, or swelling after injury?

34. Have you broken or fractured any bones or dislocated any joints?

35. Have you had any other problems with pain or swelling in muscles, tendons, bones, or joints?

36. If yes, check appropriate box and explain below. Head Elbow Hip Neck Forearm Thigh Back Wrist Knee Chest Hand Shin/calf Shoulder Finger Ankle Upper arm Foot

37. Do you want to weigh more or less than you do now?

38. Do you lose weight regularly to meet weight requirements for your sport?

39. Do you feel stressed out?

40. Record the dates of your most recent immunizations (shots) for: Tetanus _________________ Measles __________________________ Hepatitis ________________ Chickenpox _______________________ Explain “Yes” answers on a separate sheet.

The above information is correct to the best of my knowledge. I hereby give my informed consent for the above-mentioned student to participate in activities. I understand the risk of injury in athletic participation. If my son/daughter becomes ill or is injured, necessary medical care can be instituted by physicians, coaches, athletic trainers or other personnel properly trained. I further acknowledge and consent that, as a condition for participating in activities, identifying information about the above-mentioned student may be disclosed to OSSAA in connection with any investigation or inquiry concerning the student’s eligibility to participate an/or any possible violation of OSSAA rules. OSSAA will undertake reasonable measure to maintain the confidentiality of such identifying information, provided that such information has not otherwise been publicly disclosed in some manner. Signature of parent/guardian_____________________________________Signature of Athlete_________________________________________Date__________________

Updated April 2017

PREPARTICIPATION PHYSICAL EVALUATION

PLEASE PRINT DATE OF EXAM _____________________________

Name ___________________________________________________________Date of Birth _______________________________________ Height _______ Weight _______ Body fat (optional) _____% Pulse_______ BP _______/_______ Color Blind Yes No (circle one) .

Vision: R 20/_______ L 20/________ Corrected Y / N Pupils: Equal ______ Unequal ______ MEDICAL Normal Abnormal Findings Appearance Eyes/Ears/Throat Lymph Nodes Heart Pulses Lungs Abdomen Genitalia (male only) Skin MUSCULOSKELETAL Neck Back Shoulder/Arm Elbow/Forearm Wrist/Hand Hip/Thigh Knee Leg/Ankle Foot CLEARANCE ( ) Cleared ( ) Cleared after completing evaluation/rehabilitation for: _________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ( ) Not cleared for: __________________ Reason: __________________________________________________________ ____________________________________________________________________________________________________ Recommendations: ___________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Name & Title of Examiner (Print/Type) ______________________________________ Date _________________________ Address ____________________________________________________________ Phone __________________________ Signature of Examiner ______________________________________________________

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