Please download, complete, and email these back to Christi Thompson

Income Eligibility Guidelines/Determination Form
Immunization Exempt Form (if needed)

Click Here to Pay Suggested Supply Fee

2019-2020 Registration Form-
MUST COMPLETE FOR EACH STUDENT

Order Number

Student's Legal Name: First-Middle-Last *

Birthdate: *

Gender: *

Grade Level for 2019-2020: *

Please see above to download the Income Eligibility Guidelines/Determination Form & return to Christi Thompson at the office or by email cthompson@syringamountainschool.org *

Please verify the ethnic group (either Hispanic/Latino or not Hispanic/Latino) and by one or more racial groups (American Indian/Alaska Native, Asian, Black/African-American, Native Hawaiian/Other Pacific Islander, White) for your child *

Hispanic/Latino

American Indian/Alaskan Native

Asian

African American

Hawaiian/ Other Pacific Islander

White

Every school district is required to report to the Department of Education each year student data by race and ethnicity categories that are set by the federal government. Ethnic Group: *

Are there any legal issues such as guardianship/custody/court orders that we should be aware of? *

Yes No

Does your child live in dual households? *

Yes No

Household A Physical Address: Street *

Household A Physical Address: City *

Household A Physical Address: State *

Household A Physical Address: Zip Code *

Household A: Primary Contact Name *

Household A: Relationship *

Household A: Cell Phone Number *

Household A: Email address *

Household A: Primary Contact 2 Name

Household A: Contact 2 Relationship

Household A: Contact 2 Cell Phone Number

Household A: Contact 2 Email address

Allow Publication of Media Release *

Yes No

Allow Publication of Yearbook/Directories *

Yes No

• Your Contact Information will be used for the following purposes – school, teacher and parent communications, parent council events, and other community events for Syringa Mountain School. Please initial below for consent

Please take time to read the Family Handbook - https://syringamountainschool.org/family-handbook/ *

STATEWIDE HOME LANGUAGE SURVEY: Do you speak another language in your home besides English? *

Yes No

Emergency Information- Physician Name & Phone Number *

Insurance Provider *

Please list two (2) Emergency Contacts & Numbers *

This is a federal requirement for the McKinney-Vento Act of 2000. Please select the appropriate response to the following question: Where does the student stay at night? *

Schools across the country are preparing to formally track military-connected students, monitoring their academic progress as they move from military base to military base and state to state, under the new provision in the federal education law of the Every Student Succeeds Act (ESSA).Military-connected student: A student who has a parent, step-parent or sibling serving in the active or reserve components of the Army, Navy, Air Force, Marine Corps, Coast Guard, or National Guard. Please choose an option:

Check this box if your family has moved at some time in the past 3 years to look for work in:

Agriculture

Orchards

A Nursery

None of the above

Student Injuries/Medical Costs -Even with the greatest precautions and the closest supervision, accidents can and do happen at school. They are a fact of life and a part of the growing-up process our children go through. Parents need to be aware and prepared for possible medical expenses that may arise should their child be injured at school. Syringa Mountain School does not provide medical insurance or pay for medical expenses when students are injured at school. This is the responsibility of the parents or legal guardians. The school does provide student medical insurance information available to families for their individual purchase. Ask Christi Thompson for more information for specific event insurance available to purchase through at third party. Verification of medical insurance is required for all students participating in certain programs such as the ski program and any other school related overnight field trip. When those situations arise, parents will be given notice and medical insurance documentation will be required. Parents, please be prepared for your child's possible medical expenses. I have read and understand this notice. Please initial below: *

Medical Consent - I hereby consent to the treatment of my minor child by a medical physician or medical personnel at any hospital or temporary treatment by a registered or licensed practical nurse or emergency medical technician until a medical physician can be obtained for any illness or injury to my minor child while on the school grounds of Syringa Mountain School or on a school sponsored field trip. This consent shall include, but not be limited to, any surgery deemed required or desirable for the immediate health and medical treatment of my child. This consent shall be effective only if none of the undersigned can be contacted or found by reasonable diligence at the time of the needed medical treatment. This consent shall terminate as soon as any of the undersigned are contacted, in which case further medical treatment can be done only with the consent of the person contacted. This consent shall be valid unless and until revoked in writing by one of the undersigned. Please sign by typing your initials below & date: *

FIELD TRIP RELEASE FORM: Throughout the year, teachers plan field trips off campus to hike, explore, and attend events. We will utilize Mountain Rides as a preference if vehicular travel is warranted and the destination is on a bus route; however, we will also use school vans and parent vehicles if needed. We will always ask for individual permission for students to be taken off campus for overnight trips or events outside of regular school hours but ask for your release and agreement signature for teachers to be able to explore daily, as needed, with the students. I/we give permission for my child to leave the Syringa Mountain School Campus under the supervision of the teacher, or an approved adult with a background check, to enhance their curricular experience and learn from the outside world with teacher guidance. I/we , in consideration of the educational programs to be provided to my child, , on behalf of myself/ourselves and my/our child, release, waive, hold harmless and forever discharge Syringa Mountain School (the “School”), its officers, directors, employees, volunteers, independent contractors, agents and/or representatives of any kind, from any and all liability for all actions, all bodily injury and property damage claims, demands, or damages accruing to me/us resulting from any known or unknown injury, loss, or damage to person or property, or death, together with any attorney's fees and costs of litigation including, but not limited to those on appeal or in bankruptcy court, sustained or incurred by me/us, my/our child or any third party on or about the School premises or on a school field trip, while my child is participating in any of the School programs. I/we agree to assume all risks of activities sponsored by the school and acknowledge that I/we are aware of the risks inherent in allowing my child/children to attend the School and its programs. I/we agree this waiver and release shall legally bind me/us and my/our child, and my/our heirs, trustees, personal representatives and assigns. I/We are aware that we are releasing certain legal rights by this Contract that we otherwise might have. Please type your child name & parent's initial for field trip release: *

Syringa Mountain School implements necessary procedures to ensure that students with disabilities attending our school receive special education and related services that meet the requirements of the Individuals with Disabilities Education Act (IDEA). In order to help us meet the needs of your child, please complete the following:

Has your child ever had an education plan? *

Yes No

Student Health Information To the best of your knowledge, does your child have any problems which may affect his/her learning in school, cause you any concern, and/or may be important for school staff to know. *

Yes No

Does your child have any allergies? *

Yes No

Suggested Annual Supplies Fee: Syringa Mountain School is a unique community guided by the Core Principles of Public Waldorf Education. We have additional activities and events that are outside of the core curriculum that enhance the student involvement and opportunity for learning. We ask families to provide $165.00 fee includes: annual Mountain Rides bus pass, grade level festivals, garden and handwork project supplies, and general classroom school supplies. *

2019-2020 PARENT SUPPORT AGREEMENT: Enrolling in Syringa Mountain School is a commitment to creating the best possible support for your child’s educational success and this is only possible with a strong partnership between home and school. You have not simply chosen a school for your child; you have decided to become a contributing member of a Public Waldorf Charter community committed to social renewal. The public charter school guided by the Core Principles of Public Waldorf education you have chosen for your child is only possible if we are all working together collaboratively toward shared goals.

1. The first area of engagement is direct support of your child’s educational process. There is no suggested number of hours that this will require – it is simply an ongoing commitment to be involved and attentive to your child’s day to day experience and to support the classroom and school community as you are able.

Assure your child arrives on time

Attend two parent/teacher conferences, and additional meetings as needed

Respond to requests for classroom support from your child’s teacher and/or the parent classroom representative. Examples of classroom needs include driving for field trips, making costumes for plays, assisting with in-school events such as plays and performances, helping with class events such as fundraising activities, making food for a class celebration, etc.

Limiting the students’ screen time is the expectation at home throughout these important years of your child's development.

Promote positive use of your child’s extracurricular time.

Create daily and weekly rhythms for your child at home; share meals together.

Send wholesome ingredients, fruits and vegetables, and as little processed sugar as possible. Pack only water to drink. No gum, candy, soda, juices, unhealthy foods. Send snacks and lunches in reusable containers with reusable utensils in lunch baskets or boxes void of media or commercial images.

2. It takes a village to raise a child, please volunteer.

We recommend 40 hours of volunteerism per family, per year.

Please check some ways you can help invest your parent contribution time?

Join Parent Council

Office help

Crafting

Cooking

Helping with promotional events

Cleaning/Organizing

Festival Support

Other

3. Financial Contributions – Annual Fund Drive.

The funds we receive from the State of Idaho are not sufficient to provide the full Waldorf program we offer. Unlike other Blaine County Public schools, we receive only funding from State and Federal entities. Other Blaine County Public schools for example, receive this, but also receive approximately $10,000 in additional local funding per student from our property taxes and local school levies. In order for us to thrive, grow and provide the enriched programs inherent in Waldorf methods, we rely on the resources, networking, and collaborations of our parent body. We seek 100% participation from our families at whatever financial level you are able to contribute. SMS needs to raise approximately $3,000 per student per year to augment operational costs and provide this unique education that requires Waldorf trained staff, additional teachers to teach farm, garden and sustainability, handwork, world languages, and integrated arts such as painting, drawing, drama, and music including voice, flute, violin, and cello

Optional Monthly Donation: As a school offering such unique and diverse instruction, we need to fundraise to meet our budget needs annually. Receiving no local funding, we apply for grants, participate in Idaho Gives, hold fundraising events throughout the year, and ask for your help with our annual fund drive. Setting up a monthly contribution or a one-time charge is one of the easiest ways to help ensure the quality program we provide thrives. We appreciate any amount donors are able to contribute to help fund the unique educational opportunities we offer your child at SMS! Would you like to make a donation?? *

Yes No

HOME SCHOOL COMPACT- Dear Parent/Guardian, Please discuss the following Home and School Contract with your child and sign below:

Student: It is important that I do my best. I know my parents and teachers want to help me, but I am the one who has to do the work. So, I will: believe that I can and will learn, be responsible for my behavior, give work and school papers to my parent/caregiver, pay attention and ask for help when needed, and complete class work on time and to the best of my ability. Please initial below: *

Parent/Caregiver: I want my child to succeed and I will encourage him/her by doing the following: encourage positive attitudes about school, support the school discipline policy and school policies, make sure my child attends school regularly, make sure that my child gets 8-10 hours of sleep and to eat nutritious meals, and establish with my child a place and time to study and a daily reading time. Please initial below: *

SMS Classroom Teachers: We understand the importance of the school experience to every student and my position as a teacher and a role model. We agree to: be aware of your child’s needs, communicate with you about your child’s progress frequently, teach basic concepts and skills to your child to meet state student achievement standards, motivate and encourage your child to practice academics at home, hold parent/teacher conferences annually, deliver high quality curriculum and instruction, and provide materials for home to enhance literacy and other academic subjects.

School Administration: We support and encourage student/parent/teacher compacts and partnerships. We will: provide an environment that permits positive communication between the student, parent and teacher, encourage teachers and parents to provide regular opportunities for practicing academics at school and at home, and provide equal and fair opportunities to access staff and the opportunity to volunteer.

Are you transferring from another school?

Yes No

Is this your child's first year at Syringa?

Yes No

2019-2020 Registration Form- MUST COMPLETE FOR EACH STUDENT

2019-2020 Registration Form-
MUST COMPLETE FOR EACH STUDENT