The Champion School

A Traditional Theme Middle School

2014-2015 NEW STUDENT INFORMATION PACKET

STUDENT

NAME__________________________________________________________________________ FIRST MIDDLE LAST

STUDENT NUMBER_________________BIRTHDATE________________□ MALE □ FEMALE

ADDRESS_____________________________________________________________APT#__________

CITY___________________________________STATE______ZIPCODE____________________

PARENT/GUARDIAN:

MOTHER’S INFORMATION FATHER’S INFORMATION

NAME____________________________________ ______________________________________

ADDRESS IF DIFFERENT FROM ABOVE:

_________________________________________ _______________________________________

_________________________________________ _______________________________________

HOME PHONE:___________________________ _______________________________________

CELL PHONE:____________________________ _______________________________________

EMAIL ___________________________________ _______________________________________

ADDRESS:

ALLERGIES: □ NO □ YES

_____________________________________________________________

EMERGENCY:

CONTACT

PERSON:_______________________________________RELATIONSHIP_______________

PHONE NUMBER:___________________________MAY WE CALL 911? □ YES □ NO

PHYSICIAN’S

NAME________________________________________________________________________

ADDRESS___________________________________________________________________________ I hereby grant the school authorities present during any emergency or accident involving the student named herein

to obtain the services of a physician and/or to transport the student to a hospital. I also hereby grant permission to

the physician to treat the student in my absence and request otherwise or until I later request otherwise.

□ I AUTHORIZE THE ABOVE □ I DO NOT AUTHORIZE THE ABOVE

PARENT/GUARIDAN SIGNATURE DATE

Additional information REQUIRED on back ►

Page 2 – STUDENT INFORMATION SHEET

Grade: ________

THE FOLLOWING PEOPLE LISTED BELOW ARE AUTHORIZED TO PICK UP THE

STUDENT LISTED ON THE FRONT PAGE OF THIS INFORMATION SHEET. I

UNDERSTAND THAT MY CHILD WILL NOT BE RELEASED EXCEPT TO THE BELOW

NAMED PEOPLE, AND THAT A PHOTO ID IS REQUIRED.

NAME RELATIONSHIP PHONE

NUMBER

NAME RELATIONSHIP PHONE

NUMBER

NAME RELATIONSHIP PHONE

NUMBER

NAME RELATIONSHIP PHONE

NUMBER

Please check below all that applies:

_____ Gifted

_____ IEP(Special Education)

_____ Year Long Band

_____ Year Long Orchestra

PARENT/GUARDIAN SIGNATURE DATE

Principal Superintendent

Mr. Antoine L. Rhodes Mr. Michael Thurmond

Champion Theme Middle School

5265 Mimosa Drive Stone Mountain, GA 30083-1027

678-875-1502

REQUEST FOR RELEASE OF STUDENT RECORDS

CHAMPION COUNSELING CENTER

The below reference student is enrolling at Champion Theme Middle School. Please

provide the requested information as indicated to expedite the enrollment process.

FULL

NAME_____________________________________________________________

(First) (Middle) (Last)

DATE OF

BIRTH:__________________________GRADE:________________________

SCHOOL RELEASING INFORMATION TO CHAMPION:

NAME:____________________________________________________________

ADDRESS:_________________________________________________________

CITY:_________________________________STATE________ZIP___________

INFORMATION TO BE RELEASED:

Final Grades Discipline Profile/Records & History

Standardized Educational History Test Scores

Special Ed. Placement Plan if applicable Individual Education Plan if applicable

Psychological Report if applicable Eligibility Report________if applicable

Immunization Record GA #3132 Vision, Hearing, Dental GA #3300

Birth Certificate Social Security Number

I hereby authorize the above referenced school to release records to the requesting school

without hesitation or delay.

Parent/Guardian

Signature_______________________________________Date_____________

The Champion School

Academic Protocol Contract

STUDENT NAME_______________________________________GRADE_____

Student Continuation Guidelines

Satisfactory academic performance at The Champion School is necessary for continuation in the

program. The thrust of student achievement is parental involvement which is expected of all

parents with students enrolled at Champion Theme Middle.

Performance Criteria

Students must…

Maintain a 2.5 grade point average each semester in ALL subject areas which includes:

math, science, social studies, language arts, connections, PE, and ELT

Meet the promotion requirement each school year. If a student does not satisfy the

promotion requirement, the student will be withdrawn from the program. The student will

then be enrolled in his/her zoned school

Probation/Continuation Procedures

When a student has not attained the above requirements…

The student will be placed on academic probation for one semester

The parent(s) will be notified in writing

The progress of the student will be reviewed at mid-semester by the Student Support

Committee, and the parent(s) will be notified concerning the status of his/her child

The Student Support Team (SST) consists of the four core academic teachers, the grade

level counselor and the SST Coordinator.

The student will be withdrawn from the program and return to his/her zoned school if

he/she does not attain the required 2.5 grade point average after two consecutive

semesters. The end of the semester grades will be used to determine the student’s

academic status.

Administration allows students removed from a program the opportunity to reapply to be

selected through the lottery process, if eligible. NO placement is guaranteed.

When a student has attained the required 2.5 grade point average after being placed

on academic probation for one semester, then the student will return to a

satisfactory academic performance status.

Signatures acknowledge that parent(s) and the student are aware of the academic

guidelines.

____________________________ _______________________

Student Parent

Signature/Date Signature/Date

The Champion School

A Traditional Theme Middle School

School-wide Discipline Plan and Protocol

STUDENT NAME_________________________________________________GRADE_________

Discipline is a vital part of the curriculum at The Champion School. Standards are very difficult to achieve

when interruptions are present. We want to establish a working environment where parents and students

feel that distractions are minimized and academics are maximized.

Everyone is accountable for the success of a child’s education. The purpose of the behavior management

plan is to serve as a guideline for students to follow on a day-to-day basis. In the plan, we will address the

middle school student using different techniques. The plan will address classroom expectations,

consequences, and positive reinforcement. In addition, the plan will accommodate students while

participating in various learning activities.

Several techniques are beneficial in the classroom to help maintain effective management. These

techniques are concentrated solely to redirect a student’s off task behavior without disrupting the

instructional time.

Classroom Expectations

1. Listen carefully and follow instructions

2. Arrive on time to class

3. Keep hands, feet, and objects to yourself

4. Be respectful of others, NO Bullying

5. Bring all needed materials to class

6. Adhere to dress code

Consequences for Failure to Follow Expectations

1. WARNING 4. TEAM PARENT CONFERENCE

2. REASSIGNED SEAT/RELOCATE W/TEAM 5. ADMINISTRATIVE REFERRAL

3. TEACHER DETENTION OR SILENT LUNCH AND PARENTAL CONTACT

Positive Reinforcement Incentives

Verbal Reinforcement

Incentive Coupons

Edible Treats

Positive note from teacher/administrator

Student of the Month Recognition

Others as deemed by student and teacher or team

Students in middle school seek attention that may channel behavior in a negative way. Rewards and

consequences are essential in order for the middle school child to meet and maintain expectations. Waiting

for consequences may cause students to continue to act out. Students may seek negative ways of gaining

attention and recognition if consequences are not rewarded in a timely manner.

Severe Clause Violations

Fighting, Bullying, Bus Misbehaviors or Harassment

Use and/or Possession of Weapons

Use and/or Possession of Alcohol & Drugs

Skipping class or Failure to report to assigned location

Consequences for Misbehavior: Immediate referral to grade level administrator.

In addition, when deemed appropriate, student may be required to return alternative school setting,

if he/she has failed to meet the criteria of local school probation, severe level violations. The

Champion School adheres to the DeKalb County School District Student Rights and Responsibilities

and Character Development Handbook.

PARENT SIGNATURE________________________________________________DATE____________

The Champion School

School Required Uniform Contract

Student Name: ___________________ Homeroom Teacher: ____________ Grade:_____

The philosophy of The Champion School is to offer students a comprehensive, interdisciplinary educational

program in a highly structured setting. Emphasis is placed on high academic standards and a strict code of

conduct. Part of the strict code of conduct is a mandatory uniform policy. The mandatory uniform policy at

The Champion School is an important part of our overall educational program and parent contract. Spirit

days are usually the last Friday of the month from August to March, except testing months-December,

April, and May unless otherwise announced by local administration. Students will be required to wear

business attire every Monday beginning September 8, 2014 in addition to honors programs or

special events. When business attire is required for special events, prior notification will be made.

Your child is in violation of the Champion Traditional Theme Middle School MANDATORY uniform policy by not wearing:

Uniform Attire Tuesday through Friday: TOPS Approved Colors: Yellow/Burgundy [ ] Golf Shirt – Long or Short Sleeved (burgundy or yellow) [ ] Turtleneck (burgundy or yellow) [ ] Cardigan (button down) & V-Neck (pull over)Sweater with/without crest-Burgundy BOTTOMS Approved Colors: Khaki/Charcoal Gray [ ] Slacks (No Jeans, Leggings, Capri, Cargo, Skinny Pants/Jeans or Corduroys) [ ] Dress gray pants [ ] Shorts worn at or below fingertip length [ ] Skirt (#43 plaid/charcoal gray flannel) (no skorts) Skirt must be worn at or below fingertip length

Spirit Wear Day Only: [ ] Blue/Black Jeans (comfortably/loosely fit) w/black belt [ ] School Spirit T-shirt [ ] Your choice of tennis shoe color

Footwear, Outerwear & Accessories: [ ] Socks/Tights (Gray/Khaki/Burgundy/Black/White) [ ] Shoes - Solid BLACK leather shoes/sneakers (No sandals or boots ever) [ ] Tie – Boys (Burgundy or #43 plaid) [ ] Tie – Girls Cross Bow Tie ONLY(Burgundy or #43 plaid) [ ] Belt (Belt BLACK with plain buckle) [ ] Jewelry (no oversize jewelry of any kind) (No earring for boys) [ ] #43 plaid Hair accessories or solid Burgundy

PE Uniform: Burgundy/Gray PE Uniform & solid black sneakers

Monday Business Attire: Girls: (Blazer with school crest Burgundy, #43 plaid or charcoal gray flannel skirt, Oxford Shirt White (button down only), cross bow tie (Burgundy or #43 plaid), Socks/Tights -Gray/Burgundy/Black/White, and all black dress shoes not sneakers.

Boys: (Blazer with school crest Burgundy, dress gray pants, Oxford Shirt White (button down only), Tie – Boys Burgundy or #43 plaid and all black dress shoes not sneakers.

Reminders: Sweaters and Jackets worn during the school day

must be Burgundy.

Tank tops, V-neck, crew neck, fitted t-shirts etc. are NOT part of the uniform.

Shirts can be plain or have The Champion Crest. (Shirts may not have other logos such as Abercrombie, Aeropostale, Lacoste, Polo, etc.)

Jeans, Leggings, Capri, Skinny Jeans, Cargo Pants and Corduroys are NOT part of the uniform.

Outer Coats (not to be worn in class)

No Head Gear (scarves, bandannas, big bows, etc.)

White button down shirt cannot be worn with any other uniform except BUSINESS ATTIRE

All shoes must be SOLID BLACK

The consequences for not following the uniform code are as follows:

Offenses Action of the School

First Verbal Reprimand and Contact Parent (Sign and return uniform violation notice.)

Second In-School Suspension (ISS) until end-of-day or correction of the violation.

Third 2 days In-School Suspension (ISS) and referral to the counselor.

Fourth 3 days In-School Suspension (ISS), Letter sent home, Required parent conference with the Assistant Principal, Local school probation contract and Referral to the social worker.

Fifth 3 Days In-School Suspension (ISS) and Required parent conference with the Principal

Sixth Violation of Probation which will result in the student returning to his/her home school. The local school administration reserves the right to make the final judgment regarding uniform, hair appropriateness and jewelry.

The administration reserves the right to modify the dress code for special occasions such as Olympic day or school spirit day.

Parent’s Signature: ___________________ Date: _________ Student’s Signature: _______________________ Date: ________

THE CHAMPION SCHOOL A TRADITIONAL THEME MIDDLE

INTERVIEW/PHOTOGRAPY RELEASE

During the year, we sometimes have requests from local newspapers, publications, and/or

television stations/programs for our students to be interviewed, videotaped and/or photographed

as they participate in school related activities. This positive media coverage helps create a better

informed, more supportive public; however, your child will be included ONLY IF YOU GIVE

PERMISSION. These interviews/photographs/videotapes will be used for no other purpose

than the one stated above.

______YES, I agree for my child to be interviewed/photographed/videotaped.

______NO, I do not agree for my child to be interviewed/photographed/videotaped.

Print Student’s Name________________________________________Grade________

Parent/Guardian’s Signature__________________________________Date_________

FIELD TRIP PERMISSION

During the school year, fieldtrips are planned as an extension and outgrowth of classroom

experiences. Unless notified in advance, field trips will be planned during the regular school day

and transportation to and from The Champion School campus will be provided on DeKalb

County School buses.

Your signature below grants permission for your child to participate in all field trips to

Fernbank Science Center.

Print Student’s Name_______________________________________Grade___________

Print Parent/Guardian Name_________________________________________________

Parent/Guardian Signature_______________________________________DATE______

THE CHAMPION SCHOOL, A TRADITIONAL THEME MIDDLE SCHOOL

PARENTAL INVOLVEMENT CONTRACT

STUDENT NAME GRADE

FAILURE TO COMPLY WILL RESULT IN STUDENT RETURNING TO HOME SCHOOL

“Charging Beyond Imagination”

We, the parents of The Champion School- A Traditional Theme Middle School, commit to serve as collaborators with the faculty,

administration and students to achieve excellence in the educational goals for our children through academic, social, moral, and

vocational participation.

As parent/guardian for the above mentioned student(s), I pledge to do the following:

1. Sign the parent volunteer contract committing 8 hours per semester per family; for a total of 16 hours per year to be

completed by the published annual date. Please be advised that hours must be completed for the end of the

academic year published date. There are no summer opportunities. If hours are not completed, student (s) will

be withdrawn effective June 30. The student (s) will have to attend their zoned school. No Exceptions!

2. Join the PTSA on Registration/Open House Day. Actively support the PTSA by attending at least two meetings.

PTSA membership is required (1 parent-volunteer hour given per parent).

3. Strictly enforce the established uniform dress code as outlined in the parent/student handbook and uniform contract.

4. Ensure that students arrive on time daily at 8:45 a.m. to receive instruction and are to be picked up by 4:20 p.m. or a

late fee will apply through the after school program.

5. Check in at the security desk during each visit to school as required by law to ensure the safety of all children and staff.

6. Strictly enforce the school’s conduct codes and policies. (See School-wide Discipline Plan and DCSD Student Code of

Conduct Booklet)

7. Encourage a minimum of 30 minutes of daily reading, mathematics, and science at home.

8. Support the daily class work, homework, and project requirements (during school, summer, winter, and spring breaks),

ensuring completeness to the best of your ability. Student must maintain C+ (2.5 GPA) – See Academic Protocol.

9. Facilitate the home/school communication effort by monitoring and enforcing the use of the agenda planner and Parent

Portal by the student, parent, and teacher.

10. Support the mandatory tutorial program when recommended by the teacher

11. Ensure that student(s) participating in extracurricular activities are picked up on time, as indicated by the permission

slip. After three (3) late pickups, student will be removed from the activity – NO REFUND.

12. Attend a minimum of one in-school parent/teacher conference per semester to discuss student’s progress.

13. Support instructional counseling for student development.

14. Submit updated student information to the registrar office within seven calendar days.

15. All parents must follow the guidelines outlined in our School-wide Title 1 Program.

The child must be in attendance on the first day of school to maintain his/her seat.

NO EXCEPTIONS TO DEADLINES WILL BE GRANTED BY LOCAL ADMINISTRATION.

_________________________________________________________ _____________ Parent/Guardian’s Signature Date Revised December 19, 2012

THE CHAMPION SCHOOL

A TRADITIONAL THEME MIDDLE SCHOOL 5265 Mimosa Drive

Stone Mountain, Georgia 30083 678-875-1502 (Main) 678-875-1510 (Fax)

VOLUNTEER AGREEMENT AND PROCEDURES

STUDENT NAME___________________________________________ GRADE_______

Each family is expected to fulfill their volunteer commitment on a yearly basis. There are guidelines for volunteering in order to safeguard parents and our children. It is important that the following be adhered to when volunteering:

1. Volunteers are not place their hand(s) on or have any physical contact with a child in any manner.

2. All corrective behavior should be directed to a local school administrator. 3. Any verbal information that you would like communicated to a child in relation to

the discussion of child’s conduct should come from a local school administrator. 4. Any ordering, threatening, arguing, student name calling, yelling, harassing

behavior, pulling of hair, arts, etc…are forbidden at any time during the day. 5. You must sign at the Parent Center and wear your visitors badge at all times. 6. Volunteers are to refrain from any cell phone usage while volunteering during the

school day. Please sign below to acknowledge that you have read, understand and agree with the above out-lined volunteer agreement and procedures. For any parent who fails to follow the above procedures, volunteer options will be prohibited for the remainder of the school year. Parents need to dress for working in the various areas i.e., cafeteria, custodial department. Comfortable footwear for walking throughout the building during your volunteer time is recommended. _______________________________ Parent Name – Print _______________________________ Parent-Signature ______________________________ Date

(Revised July 2013)

THE CHAMPION SCHOOL

A Traditional Theme Middle School PARENT AND STUDENT INFORMATION

Website Address: www.dekalb.k12.ga.us/championms/ Check website for updates

weekly and listen to the weekly calling posts for information. Champion is a Go Green

School.

Transportation is provided through the school system’s shuttle service. Please check the

DeKalb County School System’s website.

Please review the online parent/student handbook as a family prior to the first day of

school.

Mandatory Summer Project will be available on the school’s web page. It is due the first

day of school, August 11.

Students must be present the first day of school in order to maintain enrollment.

NO CELLPHONE USE DURING THE SCHOOL DAY; ALL PHONES MUST BE

IN STUDENT’S LOCKER. PLEASE CALL THE MAIN OFFICE FOR

EMERGENCIES. CELLPHONE PICKUP IS ON TUESDAY ONLY FROM

8:30AM – 3:30PM

Middle School hours are 8:50AM – 3:50PM. No student checkouts after 3:15PM.

Students may arrive at 7:30 PM. Students must be picked up by 4:30 PM.

Uniforms are required at a theme school, including a black belt. Champion uses

Buckhead School Uniforms…2100 Riverside Pkwy, Std. 132, Lawrenceville, GA 30043,

678.442.0817. (www.buckheaduniforms.com).

Eight (8) Volunteer hours are required per family per semester for a total of 16 hours

per year. Hours can be split if you have another student in an elementary theme school.

Failure to meet this requirement means that your child will be withdrawn at the end of

May. Hours are communicated through the Parent Center Coordinator Only. PTSA

Membership is required, and it counts towards one (1) volunteer hour.

*Agendas are required for the purpose of organization and communication. The

approximate cost of agenda planners is $13.00.

*Students must purchase a Champion School Lock for their PTSA school lockers

($8.00). This is effective for the 2014-2015 year. This is a school safety and security

policy. Students can use their lock for the three years they are enrolled at

Champion.

*School Gym Uniforms are $25.00 a set and yearbooks are $35.00 for early bird

purchase.

Connection Offerings: Extended Learning Time, PE/Health, Year-long Band,

Orchestra, or Nine-week Exploratory Rotation of Art, Business Education, Spanish, and

General Music. Please note that these classes are very important and students do receive

an academic grade.

If students become ill during the school day, a phone is provided in the counseling center

for students to contact a parent/guardian. MIDDLE SCHOOLS DO NOT HAVE A

NURSE OR CLINIC ON SITE FOR STUDENTS. The counseling center can provide

peroxide, band aids and ice. Parents of female students must make sure your student is

always prepared. Students taking any medication during the school day MUST have

a “Physician’s Request for Administration of Medication” form on file. It is

strongly encouraged that at least one inhaler is housed in the counseling center.

The physician’s form can be obtained from the counseling center.

A hard copy of the monthly newsletter may be sent home. However, in an effort to Go

Green all copies are on the school’s website. Champion is a Go Green School.

*Extended Day Program offered 4:00 PM until 6:30 PM daily – Registration is $25.00

per child, $50.00 per week per child. Please contact Coach Sylvester Jones for more

information.

Parents must be registered for Parent Assistant. Parents may view students grades,

attendance, change contact information. If change of address is done on Parent Assistant,

parent is to provide a copy of their proof of residence at that address.

*Prices are subject to change

NEW STUDENT REGISTRATION 2014/2015 Registration Guidelines for Parents and Students

Print and Complete Registration Forms from the Champion Website.

Bring completed forms to Champion between March 24-April 4, 2014 during the

hours of 10:00am to 2:30pm Mon-Thurs. Please bring with you the following

documents:

Copy of Theme School Acceptance Letter

Parent’s Picture ID (Driver’s License)

Current proof of DeKalb County residency- Mortgage Statement or Lease, or a

Utility Bill (Electric/Gas Only)

Student’s updated Immunization Form 3231

NOTE; ALL STUDENTS ENTERING 6TH GRADE MUST HAVE CURRENT

IMMUNIZATION (FORM 3231) WHICH INCLUDES A SECOND VARICELLA

SHOT. ALL STUDENTS ENTERING 7TH GRADE MUST HAVE CURRENT

IMMUNIZATION (FORM 3231) WHICH INCLUDES TDAP AND

MENINGOCOCCAL VACCINES.

Please contact your physician if you have questions.

NEW STUDENTS TO DEKALB MUST ALSO BRING A COPY OF:

BIRTH CERTIFICATE, HEARING, VISION AND DENTAL FORM (FORM 3300),

SOCIAL SECURITY CARD, REPORT CARDS AND TEST SCORES.

Registration MUST be completed by 2:30p.m on Friday, April 4, 2014. Failure to do so

will result in your slot being vacated.

If you have any questions, please contact the Champion School’s Counseling

Department at 678.875.1528.