Registration Packet Gr 1 12 English 2012 2013 by fDQ7Zq

VIEWS: 9 PAGES: 14

									                            Home Zone                                           ID #
          Assigned School                          Homeroom                            Program

                      LONG BRANCH PUBLIC SCHOOLS REGISTRATION FORM (Gr. 1-12)
                                      Long Branch, New Jersey

Today’s Date:                             Home Phone #
Entering Grade:                           Cell Phone #
Entry Date:                               Mother’s Work Phone #
                                          Father’s Work Phone #
NAME OF CHILD
                            LAST                           FIRST                        MI

ADDRESS                                                                                 Apt #
             Long Branch, NJ 07740
CLOSEST CORNERS TO HOME
                                              STREET             AND               STREET

DATE OF BIRTH                                          GENDER:         MALE                  FEMALE
                   MONTH      DAY      YEAR

RACE: (CIRCLE ONE)            I Amer. Indian/Alaskan       A     Asian                  B    Black Not Hispanic
                             H Hispanic                    W     White                  M    Multi Racial
                             P Pacific Islander

BIRTH PLACE
                              CITY                       STATE             COUNTRY                    ENTRY DATE
LAST SCHOOL ATTENDED
                                     SCHOOL NAME                         CITY                      STATE

WHAT LANGUAGE IS SPOKEN AT HOME?
HAS CHILD PREVIOUSLY ATTENDED SCHOOL IN THE U.S.?                                      YES              NO
HAS CHILD PREVIOUSLY ATTENDED SCHOOL IN LONG BRANCH?                                   YES              NO


       PARENT                         LEGAL GUARDIAN                                    FOSTER PARENT

PARENTS :
            NAME
                       MOTHER AND/OR FATHER FIRST & LAST NAMES                                 HOME PHONE
            ADDRESS
                                                                                                CELL PHONE

LEGAL GUARDIAN OR FOSTER PARENT:
         NAME                                                               AFFIDAVIT OF SUPPORT

            ADDRESS
                                                                           HOME PHONE                   CELL PHONE
EMERGENCY NOTIFICATION (Parent/Guardian will be called first)
            NAME                                                       HOME PHONE

            ADDRESS                                                 WORK PHONE

OTHER CHILDREN IN FAMILY (Please list oldest first)
NAME                                   SEX         DATE OF BIRTH                   SCHOOL                     GRADE
                             RECORD OF TRANSFERS
CROSS                                                                     ENTRY   LAST
OUT ONE               CITY      STATE      SCHOOL ADDRESS      REASON      DATE   DATE
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
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From
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                                RECORDS ACCESS
      PRINT NAME/SIGNATURE              REASON          DATE   TIME/CIRCUMSTANCE/RECORDS
1.



2.



3.



4.



5.



6.



7.
                              LONG BRANCH PUBLIC SCHOOLS
                                LONG BRANCH, NEW JERSEY


Our school district is participating in a system where the federal government’s Medicaid will pay state and
local school districts for a portion of the costs of health-related special education services provided to
Medicaid eligible children. Your child will continue to receive services at no cost to you under this new
system. This initiative simply helps us maximize federal funds in support of local education. The information
you voluntarily provide by completing this consent form will only be used for the purposes identified.

Please fill in the information below, sign the form, and return it to the address indicated:



             CONSENT FOR RELEASE OF INFORMATION TO ACCESS MEDICAID
              REIMBURSEMENT FOR HEALTH RELATED SUPPORT SERVICES



                                       (Name of parent or person in parental relationship)


CHILD’S NAME
                           (First)                                   (Middle Initial)                (Last)


CHILD’S MEDICAID NUMBER

CHILD’S DATE OF BIRTH                                      /                   /


As parent/guardian of the child named above, I give permission to disclose information from my child’s
educational records to local,

state and federal agency representatives for the sole purpose of claiming Medicaid reimbursement for health
related support services

in my child’s Individualized Education Program (IEP).



Signature:                                                                                   Date:
                 (Parent or person in parental relationship)                                           (month/day/year)




                                                               Please return this form to:
                  OFFICE OF THE SUPERINTENDENT
                  LONG BRANCH PUBLIC SCHOOLS
                  540 BROADWAY, LONG BRANCH, NEW JERSEY 07740



 Michael Salvatore                                    “Where Children Matter Most”
 Superintendent of Schools
 (732) 571-2868, Ext. 40010
 Fax: (732) 229-0797

                                                     Home Language Survey
New Jersey Department of Education regulations require that all schools determine the language(s) spoken in each student’s
home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful
instruction for all students. If a language other than English is spoken in the home, the District is required to do further
assessment of your child. Please help us meet this important requirement by answering the following questions. Thank you for
your assistance.

                                                        Student Information
 __________________________                 ____________________________            __________________________               F F   M
 First Name                                 Middle Name                             Last Name                                  Gender
 /        /                                            /        /                   ________________________________
 Country of Birth                           Date of Birth (mm/dd/yyyy)              Date first enrolled in ANY U.S. school (mm/dd/yyyy)


                                                         School Information
        /       / 20 ______ ______                    ____________________________________________                    ____________
 Start Date in New School (mm/dd/yyyy)                Name of Former School and Town                                  Current Grade


              Questions for Parents/Guardians
     What is the native language(s) of each parent/guardian? (circle             Which language(s) are spoken with your child?
                                 one)                                        (include relatives -grandparents, uncles, aunts,etc. - and
                                                                                                     caregivers)
            ___________________________________Mother
                                                                              _______________________sometimes / often / always
             __________________________________Father
                                                                              _______________________sometimes / often / always
         ____________________________________Guardian
       What language did your child first understand and speak?           Which language do you use most to communicate with your
                                                                                                  child?

      Which other languages does your child know? (circle all that       Which languages does your child use to communicate? (circle
                               apply)                                                              one)
                                                                               ___________________sometimes / often / always
        ________________________________speak / read / write

         ________________________________speak / read / write                   ___________________sometimes / often / always
     Will you require written information from school in your native      Will you require an interpreter/translator at Parent-Teacher
                 language?             Yes          No                                             meetings?
                                                                                               Yes             No

                      Parent/Guardian Signature:
                                                                                        _____/       /20_____________
 X                                                                                       Today’s Date:   (mm/dd/yyyy)

  *Please note copies of any Home Language survey that indicates another language other than English in the above
             questions must be submitted to the Bilingual Office at 540 Broadway, Long Branch 07740*
                                    LONG BRANCH PUBLIC SCHOOLS
                                      LONG BRANCH, NEW JERSEY

                       ELEMENTARY SCHOOL REGISTRATION CHECKLIST
         (Documentaciones necesarias para Matricularse en la Escuela Intermedia o Secundaria )

STUDENT NAME(NOMBRE/ ESTUDIANTE)                                              DATE(FECHA)_______

    1.   REGISTRATION (MATRÍCULA)
         (a) PROOF OF RESIDENCY (PRUEBA DE RESIDENCIA EN LONG BRANCH)
                       Copy of lease – if renting(Contrato de renta-si alquila)
                       Copy of closing – if purchasing home (Contrato de cierre-si adquirio casa)
                       Copy of utility bill(s) dated(Copia de factura –fechada)

                                   Telephone         Date
                                   Electric          Date
                                   Fuel              Date
                                   Water             Date
                                   Notarized         Date
                                   Affidavit

         (b) PROOF OF BIRTHDAY (Prueba de Nacimiento)
                       YES              NO
                       Birth Certificate (Certificado de Nacimiento)
                       Passport (Pasaporte)
                       Baptismal Certificate (Certificado de Bautismo)
                       Other (otros)                                          (specify) (explique)

    2.   NURSE (Enfermera)
         (a) IMMUNIZATION RECORDS (Record de Vacunas)
                YES         NO

       (b) HEALTH REGISTRATION FORM (Formulario de Historial de Salud)
            ______YES         NO
        (c) HEALTH INSURANCE INFORMATION (Información de Seguro medico)
        ________ YES ________ NO
    3. FOOD SERVICE APPLICATION? (Aplicación de Almuerzo)
                  YES         NO

    4.   LANGUAGE SURVEY – If the child speaks another language besides English,
         please have parent fill out the Language Survey. (Pida a los padres completar el cuestionario si
         hablan otro idioma además de Inglés.)

    5.   SCHOOL RECORDS & TRANSFER SCHOOL CARD(Libreta de calificaciones y tarjeta de
         transferencia de Escuela)
                               ALL REGISTRATION REQUIREMENTS MUST BE MET
                                    BEFORE CHILD CAN ATTEND SCHOOL

Mr. Francisco Rodriguez            Mrs. Marissa Fornicola            Mr. Christopher Volpe
Anastasia School                   Audrey W. Clark School            West End School
732-571-3396                       732-571-4677                      732-222-3215

Mr. Matthew Johnson                Mrs. Bridgette Burtt              Mrs. Bonita Potter-Brown
Morris Avenue School               Gregory School                    Lenna W. Conrow School
732-571-3139                       732-222-7048                      732-222-4539

Mrs. Loretta Johnson                                                 Mrs. Donna Critelli
Joseph M. Ferraina Early Childhood Learning Center                   Transportation Manager
732-571-4150                                                         732-571-2868, Ext. 40080
                          ELEMENTARY SCHOOL REGISTRATION CHECKLIST
                       Formulario de Matrícula para Escolas Secundárias e Intermediárias

STUDENT NAME (Nome do aluno(a):                                               DATE (data)

    1.   REGISTRATION- MATRĺCULA
         (a) PROOF OF RESIDENCY- COMPROVANTE DE RESIDÊNCIA
                       Copy of lease – if renting – Copia de Contrato de Arrendamento
                       Copy of closing – if purchasing home Comprovação de Casa Própria
                       Copy of utility bill(s) dated (Copia de Conta de utilidade pública datada)

                                    Telephone - Telefone Date
                                    Electric - Eletricidade Date
                                    Fuel -Gás               Date
                                    Water -Água             Date
                                    Notarized               Date
                                    Affidavit (Carta comprovando endereço notarizada)

         (b) PROOF OF BIRTHDAY- COMPROVANTE DE NASCIMENTO
                       YES/SIM                 NO/NÃO
                       Birth Certificate – CERTIDÃO DE NASCIMENTO
                       Passport          - PASSAPORTE
                       Baptismal Certificate –CERTIDÃO DE BATISMO
                       Other-OUTRO                              (especificar)

    2.   NURSE- ENFERMEIRA
         (a) IMMUNIZATIONS UP-TO- DATE
             (Vacinas pôr em dia)
                  YES/SIM          NO/NÃO

         (b) HEALTH REGISTRATION FORM/HEALTH INSURANCE INFORMATION
              ______YES/SIM       NO/NÃO

    3.   FOOD SERVICE APPLICATION? (SOLICITAÇÃO PARA ALIMENTAÇÃO? )
                YES/SIM        NO.NÃO

    4.   LANGUAGE SURVEY – If the child speaks another language besides English,
         please have parent fill out the Language Survey.
         (Se o aluno falar outro idioma além do Inglês, os pais devem preencher o questionário de idioma)

    5.   SCHOOL RECORDS & TRANSFER SCHOOL CARD- -
         FICHA INDIVIDUAL DO ALUNO & CARTA DE TRANSFERÊNCIA ESCOLAR

                       ALL REGISTRATION REQUIREMENTS MUST BE MET
                             BEFORE CHILD CAN ATTEND SCHOOL


Mr. Francisco Rodriguez            Mrs. Marissa Fornicola            Mr. Christopher Volpe
Anastasia School                   Audrey W. Clark School            West End School
732-571-3396                       732-571-4677                      732-222-3215

Mr. Matthew Johnson                Mrs. Bridgette Burtt              Mrs. Bonita Potter-Brown
Morris Avenue School               Gregory School                    Lenna W. Conrow School
732-571-3139                       732-222-7048                      732-222-4539

Mrs. Loretta Johnson                                                 Mrs. Donna Critelli
Joseph M. Ferraina Early Childhood Learning Center                   Transportation Manager
732-571-4150                                                         732-571-2868, Ext. 40080
                                    LONG BRANCH PUBLIC SCHOOLS
                                      LONG BRANCH, NEW JERSEY

                 HIGH SCHOOL & MIDDLE SCHOOL REGISTRATION CHECKLIST
         (Documentaciones necesarias para Matricularse en la Escuela Intermedia o Secundaria )

STUDENT NAME(NOMBRE/ ESTUDIANTE)                                              DATE(FECHA)_______

    1.   REGISTRATION (MATRÍCULA)
         (a) PROOF OF RESIDENCY (PRUEBA DE RESIDENCIA EN LONG BRANCH)
                       Copy of lease – if renting(Contrato de renta-si alquila)
                       Copy of closing – if purchasing home (Contrato de cierre-si adquirio casa)
                       Copy of utility bill(s) dated(Copia de factura –fechada)

                                   Telephone (Telefono)     Date
                                   Electric (Electricidad) Date
                                   Fuel (Gas)               Date
                                   Water (Agua)             Date
                                   Notarized                Date
                                   Affidavit (Carta de prueba de dirección notarizada)
         (b) PROOF OF BIRTHDAY (Prueba de Nacimiento)
                       YES              NO
                       Birth Certificate (Certificado de Nacimiento)
                       Passport (Pasaporte)
                       Baptismal Certificate (Certificado de Bautismo)
                       Other (otros)                                           (specify) (explique)

    2.    NURSE (Enfermera)
          (a) IMMUNIZATION RECORDS (Record de Vacunas)
                   YES       NO
         (b) HEALTH REGISTRATION FORMATION (Formulario de Historial de Salud)
             ______YES       NO
         (c) HEALTH INSURANCE INFORMTION (Información de Seguro Medico)

    3.   FOOD SERVICE APPLICATION? (Aplicación de Almuerzo)
                YES         NO

    4.   LANGUAGE SURVEY – If the child speaks another language besides English,
         please have parent fill out the Language Survey. (Pida a los padres completar el cuestionario si
         hablan otro idioma además de Inglés.)

    5.   SCHOOL RECORDS & TRANSFER SCHOOL CARD(Libreta de calificaciones y tarjeta de
         transferencia de Escuela)

ALL REGISTRATION REQUIREMENTS MUST BE MET BEFORE CHILD CAN ATTEND SCHOOL
Todos Los Requisitos De Registración Deben Ser Cumplidos Antes De Que El Niño/a Pueda Atender A La Escuela

Mr. V. J. Muscillo                Mrs. Kristin Ferrara               Mr. James Brown
Principal                         High School                        High School
High School                       Visual & Performing Arts           School of Science, Technology,
732-229-7300 x41004               732-229-7300 x41020                Engineering & Mathematics (STEM)
                                                                     732-229-7300 x41030

Mr. Frank Riley                   Mrs. Carmen Vega                   Mrs. April Morgan
High School                       Alternative Program                Middle School
Leadership                        H.S. & M.S.                        Leadership
732-229-7300 x41010               732-728-9090                       732-229-5533 x42030

Mr. Michael Viturello             Mrs. Evelyn Cruz
Middle School                     Middle School
Visual & Performing Arts          Science & Computer Technology
732-229-5533 x42010               732-229-5533 x42020
                                    LONG BRANCH PUBLIC SCHOOLS
                                      LONG BRANCH, NEW JERSEY

                 HIGH SCHOOL & MIDDLE SCHOOL REGISTRATION CHECKLIST
                   Formulario de Matrícula para Escolas Secundárias e Intermediárias

STUDENT NAME (Nome do aluno(a):                                                DATE (data)

   1.   REGISTRATION- MATRĺCULA
        (a) PROOF OF RESIDENCY- COMPROVANTE DE RESIDÊNCIA
                      Copy of lease – if renting – Copia de Contrato de Arrendamento
                      Copy of closing – if purchasing home Comprovação de Casa Própria
                      Copy of utility bill(s) dated (Copia de Conta de utilidade pública datada)

                                   Telephone - Telefone Date
                                   Electric - Eletricidade Date
                                   Fuel - Gás              Date
                                   Water - Água            Date
                                   Notarized               Date
                                   Affidavit (Carta comprovando endereço notarizada)

        (b) PROOF OF BIRTHDAY- COMPROVANTE DE NASCIMENTO
                      YES/SIM                  NO/NÃO
                      Birth Certificate - CERTIDÃO DE NASCIMENTO
                      Passport          - PASSAPORTE
                      Baptismal Certificate - CERTIDÃO DE BATISMO
                      Other-OUTRO                               (especificar)

   2.   NURSE- ENFERMEIRA
        (a) IMMUNIZATION RECORDS- COMPROVANTE DE VACINAS
               YES/SIM          NO/NÃO

        (b) HEALTH REGISTRATION FORM/HEALTH INSURANCE INFORMATION
         ______YES/SIM           NO/NÃO

   3.   FOOD SERVICE APPLICATION? (SOLICITAÇÃO PARA ALIMENTAÇÃO? )
               YES/SIM        NO.NÃO

   4.   LANGUAGE SURVEY – If the child speaks another language besides English,
        please have parent fill out the Language Survey.
        (Se o aluno falar outro idioma além do Inglês, os pais devem preencher o questionário de idioma)

   5.   SCHOOL RECORDS & TRANSFER SCHOOL CARD- -
        FICHA INDIVIDUAL DO ALUNO & CARTA DE TRANSFERÊNCIA ESCOLAR

                        ALL REGISTRATION REQUIREMENTS MUST BE MET
                              BEFORE CHILD CAN ATTEND SCHOOL
         Todos os requerimentos para matrícula devem estar completosAntes que o aluno possa freqüentar a escola

Mr. V. J. Muscillo       Mrs. Kristin Ferrara                Mr. James Brown
HS Principal             High School                         High School
High School              Visual & Performing Arts            School of Science, Technology, Engineering &
732-229-7300 x41004      732-229-7300 x41020                 Mathematics (STEM)
                                                             732-229-7300 x41030

Mr. Frank Riley          Mrs. Carmen Vega                    Mrs. April Morgan
High School              Alternative Program                 Middle School
Leadership               H.S. & M.S.                         Leadership
732-229-7300 x41010      732-728-9090                        732-229-5533 x42030

Mr. Michael Viturello             Mrs. Evelyn Cruz
Middle School                     Middle School
Visual & Performing Arts          Science & Computer Technology
732-229-5533 x42010               732-229-5533 x42020
                             LONG BRANCH PUBLIC SCHOOLS
                                Long Branch, New Jersey

                                  NURSING SERVICES
                             CONFIDENTIAL HEALTH HISTORY

___________________________________                           ___________________
Child’s Name (Last, First)                                      Date of Birth

Adopted or Foster Child (circle one):    Yes       No
Age of child at adoption or foster placement: _______    Birth mother living? ___________
Does child have relationship with birth mother/father?

                             DEVELOPMENTAL INFORMATION

*Pre-natal History

Length of pregnancy: __________ Maternal age at birth: _______ Weight gain: _______
Total pregnancies (including child):____________ Living children:_______________
Significant stressful events during pregnancy:
_____________________________________________________________________________
Maternal acute illness during pregnancy:
_____________________________________________________________________________
Maternal chronic illness during pregnancy:
_____________________________________________________________________________
Medications (Rx & OTC), street drugs, alcohol, smoking during pregnancy:
_____________________________________________________________________________
Any other significant events:

*Post-natal History
Delivery: _____Vaginal ____Forceps ____C-section
Anesthetic:________________________
Length of labor: __________(hrs.)
Complications:_______________________________________
Length of hospital stay: ____________(mother) ____________(infant)
Birth weight: _____________lbs. _________oz.
Feeding: _____Breast (# months __________)     Bottle:_________
Difficulties?__________________
Any other significant events:________________________________________________

*Developmental Milestones
Age child crawled: ________         Sat alone: __________         Stood alone: ____________
Age child walked: ________ Spoke words:___________
Spoke short sentences:______________
Fed self:_____________       Eat nonfoods?_____________           Dress self:_______________
Bladder control:________________________            Bowel control:______________________
Has child attended preschool/day care?________________________________________
Does child suck his/her thumb?______________________ Is child clumsy?_________
Does child have temper tantrums or act aggressively?________ How often?_____________
Does your child have difficulty speaking or listening?_______________________________
Do you have any concerns about your child and his/her adjustment to school?
______________________________________________________________________________
                                 LONG BRANCH PUBLIC SCHOOLS
                                     Long Branch, New Jersey

                                   HEALTH REGISTRATION FORM

Transferred from:___________________________________________
Date:__________________

Has student ever attended school in Long Branch? ____ Yes _____ No                               Year ________


Student’s Name (Last, First)                          Address                                      Phone

Father’s Name                                         Mother’s Name                                Guardian’s


Date of Birth                       Male/Female                         Physician                  Dentist

Yes___we do have Health Insurance:                       Provider name______________

No ___ we do not have Insurance but would like further information.


DISEASE AND ILLNESS HISTORY: (note year)
Medications_______________________________ Heart Condition_____________________
Diet Restrictions___________________________                   Rheumatic Fever____________________
Serious Illness(es)__________________________ Seizures____________________________
Chronic Illness(es)_________________________ Lead Poisoning______________________
Chicken Pox______________________________ Frequent Colds_____________________
Asthma___________________________________ Ear Infections_______________________
German Measles___________________________ Visual Difficulty_____________________
Allergy___________________________________ Hearing Difficulty___________________
Measles___________________________________ Accidents/ER Visits__________________
Diabetes__________________________________ Concussion__________________________
     : Blood Sugars/medication________________ Neurological _______________________
Hospitalization______________________                          GI illnesses _________________________
Anemia___________________________________ Operations__________________________
Whooping Cough__________________________ Tuberculosis Exposure________________
Kidney Disease____________________________ Sickle Cell___________________________
Other________________________________________________________________________
---------------------------------------------------------------------------------------------------------------------
Were immunization records submitted?                           Yes _____         No _____
Are immunization records up to date?                           Yes _____         No _____
Was physical exam form given to family
 and explained?                                                Yes _____         No _____
Are there religious considerations regarding
Medical treatment/immunizations                                Yes _____         No _____
Revised March 09
             OFFICE OF THE SUPERINTENDENT
             LONG BRANCH PUBLIC SCHOOLS
             540 BROADWAY, LONG BRANCH, NEW JERSEY 07740



Michael Salvatore                          “Where Children Matter Most”
Superintendent of Schools
(732) 571-2868, Ext. 40010
Fax: (732) 229-0797




It has been brought to my attention that your son/daughter _______________________needs the following
vaccinations:

         __________________________        __________________________

         __________________________        __________________________

If these shots are not administered your child will be suspended from attending school. You can call the
Monmouth Care Center at 732-923-7100 for an appointment or you can call the Head Nurse, Kathleen Celli
at 732-229-7300 Ext 41651 for more information.




c: Principal
   Nurse




Revised Jan. 12
                                    LONG BRANCH PUBLIC SCHOOLS
                                        Long Branch, New Jersey

                                  ELEMENTARY MAGNET PROGRAMS
                                      PARENT CHOICE FORM
Dear Parent/Guardian:

Please indicate your choice by placing 1, 2, or 3 in front of the magnet choice. We will attempt to give you your
first or second choice, however, we must consider the balancing of classes with regard to race, sex, and
class size. Please keep in mind: (1) the Core Curriculum is the same in all schools; (2) the magnet programs
provide a theme of activities that compliment the core subjects; and (3) all classrooms have computers, a teacher
work station, and all schools have a computer lab.
                                                MAGNET PROGRAMS

        Metropolis, A Unique Community Magnet             Gregory School: K-5
                                                                 K-5 8:50 a.m. – 3:30 p.m.

        Science Computer Technology Magnet                Morris Avenue School: PreK-2
        Bilingual Program                                         PreK 7:50 a.m. – 1:50 p.m.
                                                                  K-2    7:50 a.m. – 2:30 p.m.

                                                          Audrey W. Clark School: PreK & 3-5
                                                                 PreK 9:00 a.m. – 3:00 p.m.
                                                          Audrey W. Clark School: 3-5
                                                                 3-5      7:50 a.m. – 2:30 p.m.

        Marine Environmental Science Magnet               A. A. Anastasia: K-5
        Talented Program                                          K-5 8:35 a.m. – 3:15 p.m.

        Future Leaders Magnet                             West End School: K-5
                                                                 K – 5 8:50 a.m. – 3:30 p.m.

                     Long Branch Public Schools provide a free breakfast program to every student.
                     The program begins 20 minutes before the start of the school day (listed above).
□    Indicate if you request Assessment for our Bilingual program.

Parent/Guardian Signature                                                 Date


Child’s Name                                                             Phone Number


Address

I have made my choices in order to have my children on the same school schedule.           Yes          No
(If the answer is “Yes”, fill out the following information on the other child(ren).)

Sibling’s Name(s)                                Grade(s)                 School




Revised: 5/22/07 MS Revised: 7/24/09
Revised: 9/6/11 – Revised 9/12/12
                                    LONG BRANCH PUBLIC SCHOOLS
                                          Long Branch, New Jersey

                                    HIGH SCHOOL ACADEMY PROGRAMS
                                          PARENT CHOICE FORM

Dear Parent/Guardian:

Please indicate your choice by placing 1, 2, or 3 in front of the magnet choice. We will attempt to give you your first
or second choice, however, we must consider the balancing of classes with regard to race, sex, and class size.
Please keep in mind: (1) the Core Curriculum is the same in all academies; (2) the magnet programs provide a theme
of activities that compliment the core subjects; and (3) all classrooms have computers, a teacher work station, and all
academies have a computer lab.
                                              SCHOOL PROGRAMS


                School of Leadership                                        Gr. 9 - 12
                                                                            7:55 a.m. – 2:50 p.m.

______          School of Science, Technology,                              Gr. 9 - 12
                Engineering, & Mathematics                                  7:55 a.m. – 2:50 p.m.


______          Academy of Visual & Performing Arts                         Gr. 9 - 12
                                                                            7:55 a.m. – 2:50 p.m.


                       Long Branch Public Schools provide a free breakfast program to every student.
                       The program begins 20 minutes before the start of the school day (listed above).


□    Indicate if you request Assessment for our Bilingual program.

Parent/Guardian Signature                                                   Date


Child’s Name                                                              Phone Number


Address


Sibling’s Name(s)                                Grade(s)                   School




Revised 5/22/07 MS
Revised: 7/24/09
                              LONG BRANCH PUBLIC SCHOOLS
                                  Long Branch, New Jersey

                        MIDDLE SCHOOL ACADEMY PROGRAMS
                               PARENT CHOICE FORM
Dear Parent/Guardian:

Please indicate your choice by placing 1, 2, or 3 in front of the magnet choice. We will attempt to give you
your first or second choice; however, we must consider the balancing of classes with regard to race,
sex, and class size. Please keep in mind: (1) the Core Curriculum is the same in all academies; (2) the
magnet programs provide a theme of activities that compliment the core subjects; and (3) all classrooms have
computers, a teacher work station, and all academies have a computer lab.

                                          ACADEMY PROGRAMS

                Academy of Science &                                           Gr. 6-8
                Computer Technology                                            8:30 a.m. – 3:18 p.m.

                Academy of Visual &                                            Gr. 6 -8
                Performing Arts                                                8:30 a.m. – 3:18 p.m.

     __         Academy of Leadership                                          Gr. 6 -8
                                                                               8:30 a.m. – 3:18 p.m.



                     Long Branch Public Schools provide a free breakfast program to every student.
                     The program begins 20 minutes before the start of the school day (listed above).


□    Indicate if you request Assessment for our Bilingual program.

Parent/Guardian Signature                                                      Date


Child’s Name                                                                  Phone Number

Address


Sibling’s Name(s)                                    Grade(s)                  School




Revised 5/22/07 MS
Revised: 7/24/09

								
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