LEFLORE ENROLLMENT

Enrollment Date

MonthDayYear
Date
Grade
Birth Date

MonthDayYear
Date
Sex:
Name of Student
Address
Child lives with
Students SSN
Place of Birth
I give consent for LeFlore School to have my child tested for Gifted and Talented.
Where is the currently living?

In a shelter.With another family or other person because of a loss of housing.In a hotel/motel.In a car, park, bus, train, or campsite.Other temporary housing.In permanent housing.
Race - Checky all that apply.

African AmericanAmerican IndianHispanicAsianPacific IslanderWhite
Bilingual
Last School Attended
City
State
FatherGuardian
Place of Employment
WK Phone
Cell
Authorized to pick up

YesNo
MotherGuardian
Place of Employment
Wk Phone
Cell
Authorized to pickup

YesNo
Emergency Contact Person other than parents Name
Phone
Other persons authorized to pick up your child:
Name
Phone
Name
Phone
Name
Phone
Leflore County School Districts will be monitoring student attendance very closely. The parents of students found to be in violation of State Statute and school district policy will be subject to prosecution in District Court in accordance with Oklahoma Statute 21 Chapter 31A, Sec 858.1 School Administrators, the Department of Human Services, the District Attorney and the District Courts are takin this matter very seriously, as should all school patrons.

Oklahoma Statute 70-10-105 defines truancy as "four (4) absences without valid excuse, in 30 days, seven (7) absences, without valid excuse in a semester. The local school board is charged with defining what is acceptable as a "valid excuse". As a parent it is extremely important that you know and follow the policy stated in your school's Student Handbook. Patrons and parents who fail to adhere to district policy put themselves at certain risk of prosecution before the District Judge of LeFlore County. Patrons or parents appearing before the Judge will be charged under Oklahoma Statute 21 Chapter 31A "causing a child to be deprived or in need of supervision" or "contribution to the delinquency of a minor", punishable by fines of not more than $1,000 or imprisonment in the County Jail for one year or both.

I, the undersigned, have read and understand that a Truancy enforcement program is in effect as described above and also,I understand the LeFlore Public Schools are participating in this program.
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
ParentGuardian Printed Name
Students Name
Students Name
Grade
Is this child in the custody of DHS? If no, complete the following section on corporal punishment.
No, I do not want my child to received corporal punishment. I request that my child receive suspension instead. I will come to the school and pick up my child within 45 minutes of notification.Yes, I give permission to administer corporal punishment.I want to be notified prior to corporal punishment being administered.I want to be notified after coporal punishment has been administered.
Parents Signature

Clear
Date

MonthDayYear
Date
HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS
STUDENT INFORMATION
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
School
1 What is the primary language used in the home regardless of the language spoken by the student
2 What is the language most often spoken by the student
3 What language did the student learn first
4. Does the parent/guardian need interpretation services?
If so what language
5. Does the parent/guardian need translated materials?
If so what language
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
Economically Disadvantaged Form

This application should be completed even if your student attends a Community Eligibility Provision or Provision School.
School
Grade
Student Name
Please select the income range that represents the total annual gross income.

Less than $28,953Between $28,983 - 39,125Between $39,125 - $49,303Between $49,303 - $59,478Between $59,478 - $69,653Between $69,653 - $79,828Between $79,828 - $90,003Between $90,003 - $100,178Between $100,178 - 110,353Between $110,353 - $120,528Between $120,528 - $130,703Between $130,703 - $140878
Please select the total number of people in your household.

123456789101112
Sign Here

Clear
Date

MonthDayYear
Date
Print Name
Student Name

First NameLast Name
Permission to publish picture.
Technology Responsible Use Policy
Field Trip Permission
Parent/Guardian Name

First NameLast Name
Signature

Clear
Parent Email
example@example.com
Should be Empty:

HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS

STUDENT INFORMATION