RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9

Accord, New York 12404

Mr. Rosario Agostaro Dr. Timothy Wade

Superintendent of Schools Deputy Superintendent

845-687-2400 Ext. 4802 845-687-2400 Ext. 4863

Mrs. Lisa Pacht Mrs. Debra Kosinski

Executive Director for Curriculum & Instruction School Business Administrator

845-687-2400 Ext. 4805 845-687-2400 Ext. 4812

SPRING 2015

Dear Parent/Guardian,

Attached you will find a lottery application for anticipated Universal Pre-Kindergarten seats for the 2015-

2016 academic year. Seats will be offered based on a public lottery to be held on May 19 at 6:00 p.m. at the

Middle School Lecture Hall.

You must be a resident of the Rondout School District

Your child must be 4 years old on/before December 1, 2015.

Complete the enclosed Lottery Application and UPK Registration Forms.

Return both forms to the Rondout Valley Central School District Office by 4:00 p.m. on May 18, 2015.

Please review the enclosed information carefully. All required documents (see page 2) must be received no

later than July 1, 2015 in order for your child to attend school in September.

(We must have a Physical form and Updated Immunizations before they can attend UPK)

You may bring your required documents to the District Office and we will copy them for you,

or they may be faxed to: Atten: UPK 845-687-0945

or mailed to: Rondout Valley CSD

DO-PPS-UPK

PO Box 9

Accord, NY 12404

All are welcome to attend the lottery on May 19 although your presence is not required.

Please Note: The New York State budget has not been adopted as of March 27, 2015. Providing Universal

Pre-Kindergarten for residents of the Rondout Valley School District is dependent upon the State grant.

Parents will be contacted in July with results of lottery.

Robin Doick

CSE/CPSE Chairperson

Pupil Personnel Services

845-687-2400 Ext. 4863

Please keep this page for your information

Due to NYS Immunization requirements we must ask for documentation. All Preschoolers must be up to date on immunizations and Well Child exam before attending school.

*PLEASE NOTE: DOCUMENTS REQUIRED BY JULY 1st 1)Proof of Residency- copy of bill/receipt with name and physical address 2)Copy of Birth Certificate 3)Copy of Shot Records 4)Copy of Physical Exam -physical must be done between 9/14-9/15 – (please take enclosed Health

Assessment Form to your Doctor)

NY State Immunization Requirements for School Entrance/Attendance

Vaccines Pre-kindergarten (Day Care, Nursery, Head Start, or Pre-K)

Kindergarten

Diphtheria and Tetanus Toxoid-Containing Vaccine and Pertussis Vaccine (DTaP, DTP)

4 doses

4-5 doses (See footnote 2b)

Polio (IVP or OPV) 3 doses 3- 5 doses (See footnote 4b-d)

Measles, Mumps and Rubella(MMR) 1 dose 1 dose

Hepatitis B 3 doses 3 doses

Haemophilus influenzae type b conjugated vaccine (Hib)

1-4 doses (See footnote 8a-g)

Not applicable

Pneumococcal Conjugate Vaccine (PCV) 1-4 doses (See footnote 9a-f)

Not applicable

Varicella(Chickenpox) 1 dose 2 dose

2b. If the fourth dose of DTaP was administered at age 4 years or older, the fifth (booster) dose of DTaP vaccine is not necessary.

4b. If 4 or more doses were administered before age 4 years, an additional dose should be received on or after age 4 years.

c. If both OPV and IPV were administered as part of a series, a total of 4 doses should be received, regardless of the child’s current age.

d. For children 4 years of age or older who have previously received less than 3 doses, a total of 3 doses are required if the third dose is administered at

age 4 years or older and at least 6 months after the previous dose.

8. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks)

a. Children who start the series on time should receive a Hib vaccine primary series and a booster dose to all infants. The primary series doses should be

received at 2, 4, and 6 months of age. One booster dose should be received at age 12 through 15 months.

b. If the first dose was administered at ages 7 through 11 months, a second dose should be received at least 4 weeks later and a final dose at 12 through 15

months of age.

c. If 2 doses of vaccine were administered at 11 months of age or younger, a third and final dose should be received at 12 through 15 months of age and at

least 8 weeks after the second dose.

d. If dose 1 was administered at ages 12 through 14 months, a final dose should be received at least 8 weeks after dose 1.

e. For children who received 1 dose of vaccine at 15 months of age or older, no further doses are necessary.

f. For unvaccinated children 15 months of age or older, 1 dose of vaccine is required.

g. Hib vaccine is not routinely required for children 5 years of age or older.

9. Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks)

a. Children starting the series on time should receive a series of PCV13 vaccine at ages 2, 4, 6 months with a booster at age 12 through 15 months.

b. Unvaccinated children 7 through 11 months of age should receive 2 doses, at least 4 weeks apart, followed by a 3rd dose at age 12 through 15 months.

c. Unvaccinated children 12 through 23 months of age should receive 2 doses of vaccine at least 8 weeks apart.

d. Previously unvaccinated children 24 through 59 months of age should receive only 1 dose.

e. PCV13 is the preferred vaccine for use in healthy unvaccinated/partially vaccinated children 2 through 59 months of age. A single supplemental dose of

PCV13 is recommended for children 14 through 59 months who have already completed the age appropriate series of PCV7. (Note: PCV13 has been

licensed and recommended for children in the U.S. since 2/2010. PCV13 replaced the previous version of Prevnar, known as PCV7, which included 7

pneumococcal serotypes.)

f. For further information, refer to the PCV chart available at http://www.health.ny.gov/prevention/

immunization/schools/.

Fax Physical & Immunizations to: Mail to: Rondout Valley CSD-PPS-UPK

845-687-0945 PO Box 9

Accord, NY 12404

RONDOUT VALLEY CENTRAL SCHOOL DISTRICT

HEALTH SERVICES

P.O. BOX 9, ACCORD, N.Y. 12404

NYSED requires an annual physical exam for UPK, new entrants, students in Grades K, 2, 4, 7 and 10, sports, working permits and triennially for the Committee

on Special Education (CSE)

HEALTH ASSESSMENT FORM

Name: _____________________________________________________ Date of Birth: _____________________________________

School: ____________________________________________________ Gender: M F Grade: ______________________

Immunization on record attached Sickle Cell Screen: Positive Negative Not Done Date: _____________ No immunizations given today PPD: Positive Negative Not Done Date: _____________ Immunizations given since last Health Appraisal: Elevated Lead: Yes No Not Done Date: _____________

Dental Referral Yes No Not Done Date: _____________

_____________________________________________________________________________________________________________________________

Significant Medical/Surgical History: see attached ___________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Specify current diseases: Asthma Diabetes: Type 1 Type 2 Hyperlipidemia Hypertension

Other: _______________________________________________________________________________________________

Allergies: LIFE THREATENING Food: _______________________________ Insect: _______________ Other: _________________________________

Seasonal Medication: ______________________________ _________________________________

Height: ________________ Weight: _______________ Blood Pressure: ________________ Date of Exam: _____________

EXAM ENTIRELY NORMAL Tanner: l. ll. IIl. lV. V. Scoliosis: Negative Positive: ____________________

Specify any abnormality (use reverse of form if needed): ____________________________________________________________________________________

__________________________________________________________________________________________________________________________________

Medications (list all): None Additional medications listed on physician letter head stationary

Name: _____________________________________________________ Dosage/ Time: ________________________________________________________

Name: ____________________________________________________ Dosage/Time: ________________________________________________________

If AM dose is missed at home: ________________________________________________________________________________________________________ I assess this student to be self directed Yes No Student may self carry and self administer medication Yes No Note: Nurse will also assess self-direction for the school setting. Please advise parent to send in additional medication in the event that emergency sheltering is necessary at school or if morning medication has not been given.

Free from contagions & physically qualified for all physical education, sports, playground, work & school activities OR only as checked:

___ Limited contact: cheerlead, gymnastics, ski, volleyball, cross-country, handball, fence, baseball, floor hockey, softball.

___ Non-contact: badminton, bowl, golf, swim, table tennis, archery, riflery, weight train, crew, dance, track, run, walk, rope jump.

Specify medical accommodations needed for school: __________________________________________________________________ None

Known or suspected disability: ____________________________________________________________________________________ Please monitor

Restrictions: ___________________________________________________________________________________________________ Please monitor

Protective equipment required: Athletic Cup Support goggles/impact resistant eyewear Other: _________________________________

Provider’s Signature: __________________________________________________________________ Phone: _____________________________

Provider’s Name/ address: ______________________________________________________________ Fax: _______________________________

Parent Signature: _____________________________________________________________________ Date: ______________________________

This exam complies with NYSED requirements above and is valid for twelve months, with the exception of any illness or injury lasting more that five days that will

require review by private healthcare and the school medical director. DH #6new 1/08

IMMUNIZATIONS/ HEALTH HISTORY

PHYSICAL EXAMS

Body Mass Index: ______ ______ - ______

Weight Status Category (BMI Percentile):

Less than 5th 5th through 49th 50th through 84th

85th through 94th 95th through 98th 99th and higher

Vision - without glasses/contact lenses R L

Vision – with glasses/ contact lenses R L

Vision – Near Point R L

Hearing ___ Pass 20 db sc both ears or: R L

MEDICATIONS

PHYSICAL EDUCATION / SPORTS / PLAYGROUND / WORK QUALIFICATION / CSE CONSIDERATION

Pre Kindergarten Lottery Application

2015-2016 Rondout Valley Central School District

Office of Pupil Personnel

P.O. Box 9

Accord, New York 12404

Name of Student: _________________________________________Male/Female (Please Circle one )

Date of Birth: Must be 4 years old on December 1, 2015

Father/Legal Guardian:________________________________________Phone#___________________________

Mother/Legal Guardian:_______________________________________Phone#___________________________

Mailing Address:______________________________________________________________________________

We have 4 schools participating is our Universal Prekindergarten program:

The Brookside School in Cottekill on Lucas Ave.

RMCC Preschool at the Rondout Methodist Church on Schoonmaker Lane

Ulster County Community College ChildCare

Lederman Children’s Center on Rt 213

Please indicate below your preference in rank order with:

1- being your first choice 2- second choice 3- third choice 4-Fourth Choice

Morning Afternoon

Brookside School _______ Afternoon sessions are available

Wrap around available*

RMC Cooperative PreSchool _______ No afternoon session/Wrap around available**

UCC Childcare Center _______ No afternoon session/Wrap around available*

Lederman Children’s Center _______ No afternoon session/Wrap around available*

*Wrap around-Parent pays for afternoon session

**Available Tuesday, Wednesday, Thursday til 3:00- Parent pays for afternoon session

This Lottery Application and the following UPK Registration Form must be delivered to the Office of

Pupil Personnel at the Rondout Valley Central School District Office by 4:00 p.m., May 18, 2015.

Pre-Kindergarten Lottery will take place on May 19, 2015 at 6:00 p.m. in the Middle School Lecture Hall

RONDOUT VALLEY CENTRAL SCHOOL DISTRICT – UPK REGISTRATION FORM

Student First Name Middle Name

Student Last Name

Physical Address

(Street Address) (City) (State) (Zip)

Mailing Address

(if different)

(PO Box/address) (City) (State) (Zip)

Town/Village of Residence Email Address:

Mother Father (Please circle one)

Father/Legal Guardian’s Name: Mother/Legal Guardian’s Name:

Student’s Sex M F

Student’s Date of Birth: Special Programs/IEP:

Student’s Place of Birth

(City) (State) (Zip)

Date of Entry (if not born in US)

Country of Origin

Number of years in US Schools: What languages does the student understand?

Home Language

What language does student:

Read

Write

Race (circle one) Hispanic Non-Hispanic International Adoption?

YES NO

Date of Adoption ____________

Ethnicity (circle one):

I – American Indian or Native America

A – Asian

B- Black or African American

H – Hispanic or Latino

P – Native American or other Pacific Islander

W - White

Citizenship Status (check one)

Dual Nation:

Non-resident alien:

US Citizen:

Other:

Date of 1st Polio

Immunization:

RESIDENCY INFORMATION –( please circle one)

Student lives with: Both Parents Father Mother Legal Guardian Stepparent

Relative Relationship:

Foster Home PLEASE NOTE PLACEMENT AGENCY & ADDRESS:

STUDENT LIVING ARRANGEMENTS

Is the student homeless? …………………………………………………………………………………………..

Is the student living in a shelter:……………………………………………………………………………………

Is the student living with relatives due to lack of housing?................................................................. .....................

Is the student living in an abandoned apartment/building?.......................................................................................

Is the student living in a motel/hotel?...................................................................................... ..................................

Is the student living in a campground, car, train/bus station or other similar situation due to lack of alternative,

adequate housing?.................................................................................................... ..................................................

Is the student temporarily housed in a shelter awaiting OCF’S permanent foster care placement?.........................

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

TELEPHONE NUMBERS

(Fill out employer information only for parent(s), Legal Guardian or Relative that student lives with)

HOME# WORK# CELL#

Father

Father’s Employer

Mother

Mother’s Employer

Guardian

Guardian’s Employer

Relative

Relative’s Employer

****EMERGENCY NUMBERS****

Name

Relationship

Address Permission to pick up student: YES NO

Phone # Cell #

OTHER CHILDREN

Sex Date of Birth Attending Rondout?

Brother’s Names Yes No

Sister’s Names

RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9

Accord, New York 12404

Mr. Rosario Agostaro Dr. Timothy Wade

Superintendent of Schools Deputy Superintendent

845-687-2400 Ext. 4802 845-687-2400 Ext. 4863

Mrs. Lisa Pacht Mrs. Debra Kosinski

Executive Director for Curriculum & Instruction School Business Administrator

845-687-2400 Ext. 4805 845-687-2400 Ext. 4812

PARENTAL PERMISSION FOR USE OF

STUDENT NAMES, PHOTOGRAPHS & VIDEO Dear Parent/Guardian,

The Rondout Valley Central School District is changing its practice of publishing student names,

photographs and videos. From here forward, the district will publish names, photographs and videos

of students unless parents/guardians have completed and returned the following form expressing

that they do not give consent to publish his or her child’s name, photograph or video. Student

names, photographs and videos will be used only for educational and/or public relations purposes,

in newsletters, on the district website, etc. and student names will not be used together with their

photo or video.

OPT OUT FORM

I, _________________________________________, the parent/legal guardian of student

(Please print parent/guardian’s name)

_________________________________, DO NOT give my permission to the Rondout Valley

(Please print student’s name)

Central School District to use my child’s name, photograph or video.

_____________________________________ ______________________

Full Parent/Guardian Signature Date

/rc

RONDOUT VALLEY CENTRAL SCHOOL DISTRICT P.O. Box 9

Accord, New York 12404 Mr. Rosario Agostaro Dr. Timothy Wade Superintendent of Schools Deputy Superintendent 845-687-2400 Ext. 4802 845-687-2400 Ext. 4863 Mrs. Lisa I. Pacht Mrs. Debra Kosinski Executive Director of Curriculum & Instruction School Business Administrator 845-687-2400 Ext. 4805 845-687-2400 Ext. 4812

Dear Parent/Guardian, We have the capability of sending phone calls, e-mails, and/or text messages to inform you of school delays, emergency closings, and upcoming events in the district. This is accomplished through an automated system which we use to contact parents, students, and staff. If you would like the district to register you for this service, please fill in this form and either return it to your child’s school or mail it to RVCSD, Attn: Louann Miszko, P.O. Box 9, Accord, NY 12404. Thank you, Superintendent Rosario Agostaro

Parent/Guardian Name________________________________________________________ Student Name _______________________________________________________________ I would like the Rondout Valley Central School District to send me notifications about:

Emergency Closings/Delays ____ Upcoming Community Events ____

Please list information below regarding how you would like to receive the reminders. I prefer to receive notifications through a(n):

Phone call   @__________________________  @____________________________ 

E‐mail        @__________________________  @____________________________ 

Text message  @__________________________  @____________________________ 

Should you have any questions, please contact Ms. Randi Chase in the Technology Office at the following phone number: 845-687-2400 extension 4851.