HOW TO ACCESS 2016/2017 COURSE CATALOG

In our continuing efforts to be better stewards of our environment and to cut administrative costs we are ask-

ing parents to access our 2016/17 Course Catalog online at our websites:

Galt High School- 209-745-3083 http://ghs.ghsd.k12.ca.us/ Liberty Ranch High School- 209-744-4250

For those families that do not have internet access we have made copies and they will be made available for

your use. Please contact your home school.

District School Boundaries

With the exception of New Hope District Students, if you live in San Joaquin County, your student will

be

attending Galt High School. New Hope and Arcohe school students will attend Liberty Ranch High

School. To confirm your school of attendance you may go to our district website at http://www.ghsd.k12.ca.us/ -Select the Parent Tab

-Click on District School boundaries

-Select the first letter of your street name from the list to find your home address and determine your school of attendance.

If you have further questions regarding which your high school of attendance, you may contact transportation at 209-745-1059.

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9th Grade- Enrollment Check List

Student Name: _____________________________________ DOB: _____________ Grade: _________ ID#: __________

STUDENT MUST BE REGISTERED UNDER HIS/HER LEGAL NAME

(Title 5, CCR, Sec. 432) The student’s permanent record will reflect the child’s legal name. In case of multiple last names, the child will usually be en-

rolled by the father’s last name. In case of foreign documents, this policy will be adhered to unless other documents, such as immigration cards, pass-

ports, visas, etc. reflect a different condition. As a rule of thumb, the last name reflected on the father’s driver’s license is the legal name.

C = complete N/A = not applicable

If you did not finish 8th grade at McCaffrey, Oakview, Arcohe or New Hope Middle school, you must also provide the following:

School Official: ______________________________________________________ Date: _________________________

C N/A Residency Verification *(required)

Electric bill Rental/Lease Agreement Escrow papers Phone bill (no cell phone bills) City of Galt Mortgage Verification Gas bill Affidavit of residency – Notarized see page 9

Completed Registration Form *(required)

Custody Agreements (if applicable)

Physical/Legal Custody (natural parents have full access to child and/or records unless court documentation is provided) Restraining orders– Copy must be provided

Authorization for Adult to Act as a Custodial Parent (if applicable)- See Page 7

Must be Notarized

Appointment of Education Representative (for Foster or Ward) Please notify us if the court has removed the education rights for this child (Foster or Ward)

Inter-district Transfer Agreement (if applicable) You must enroll at your home school . If you would like to submit an Intra District Transfer, forms must be sub-

mitted to district office for approval.

Immunization Record *(required) Must include TDAP

Birth Certificate *(required) Verified by: ____________________________(office staff only)

Transcript /Clearance Slip *(required) This form must be provided from last school of attendance prior to enrollment

Diploma or Promotion Slip *(required) If coming from 8th grade

IEP/Psych Report (if applicable)

If student is in Special Ed, this is required prior to enrolling

504 Accommodation Plan (if applicable)

Galt Joint Union High School District- Registration Form

12945 Marengo Rd. Galt, CA 95632-1733 ph#(209) 745-3061 fax:(209) 745-0881 www.ghsd.k12.ca.us

Estrellita_________

Galt High_________

Liberty Ranch______

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Student Information

Student’s Legal Name (Last) __________________________________________ (Fisrt)_______________________________ (middle)____________________

Gender :____ M ____ F DOB:___ ____________________ Other Names used: __________________________________________________________

Birth Plcae (city) _____________________________________ (state) ____________________________ (Country) _________________________________

Residence Address: ___________________________________________________________ (city)________________________ (zip) ______________

Mailing Address (If diferrent) ___________________________________________________ (city)_________________________ (zip) ______________

*Primary Contact Ph# (____)________________________________ Celular Residence Work Email: __________________________________

Name of Contact : _________________________________________________________ Relationship:__________________________________________

*This phone number will be used for all automatic notifications and as first emergency contact.

CUSTODIAL INFORMATION

PARENT/LEGAL GUARDIAN: ( LIVING WITH STUDENT)

Legal Name: (Last) ________________________________________________ (First) _______________________________ (Middle) ________________

Relationship to Student: __________________________________________ Lives with Student: Yes NO

Do you have Educational Rights? Yes NO Receive Mailings Yes NO

Phone Number (___) ______________________________ Cell Work Message Email__________________________________

Employer: __________________________________________________________ Work Ph# ____________________________________________

PARENT/LEGAL GUARDIAN: ( LIVING WITH STUDENT)

Legal Name: (Last) ________________________________________________ (First) _______________________________ (Middle) ________________

Relationship to Student: __________________________________________ Lives with Student: Yes NO

Do you have Educational Rights? Yes NO Receive Mailings Yes NO

Phone Number (___) ______________________________ Cell Work Message Email____________________________________

Employer: __________________________________________________________ Work Ph# ____________________________________________

NON_CUSTODIAL INFORMATION

PARENT/LEGAL GUARDIAN: (NOT LIVING WITH STUDENT)

Legal Name: (Last) ________________________________________________ (First) _______________________________ (Middle) _____________

Relationship to Student: _________________________________ Deceased Do you have Educational Rights? Yes NO

Receive Mailings Yes NO Home/Mailing Address _____________________________________________________________________

Phone Number (___) ______________________________ Cell Work Message Email__________________________________

PARENT/LEGAL GUARDIAN: (NOT LIVING WITH STUDENT)

Legal Name: (Last) ________________________________________________ (First) _______________________________ (Middle) ________________

Relationship to Student: __________________________________ Deceased Do you have Educational Rights? Yes NO

Receive Mailings Yes NO Home/Mailing Address _____________________________________________________________________

Phone Number (___) ______________________________ Cell Work Message Email__________________________________

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Student Name : _____________________________

Last Name First Name Birthday

Mo/day/yr.

Gender (M/F)

School

Grade Level

Lives w /Student Y/N

Sibling Information

Previous Enrollment Information

Last School Attended_______________________________________________ Comprehensive Continuation Community Day Other

Telephone FAX Address _________________________

City State _______ Date Entered____________ Date Left _______Grade __________

Has student ever been accelerated (advanced a grade earlier than expected)? Yes No If yes, What Grade Level(s) ___________

Has student ever been retained? Yes No If Yes, What Grade Level(s) Reason:_________

Has student been suspended from school in the last three years for any reason (EC 49079)? Yes No Reason _______________

___________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Has student been expelled from any previous school district? Yes No Is expulsion pending? Yes No

If yes, reason ___________ ____________________________________________________________________________

If yes, from which school? Is student currently on Juvenile Probation? Yes No

Probation Officer Name:_________________________________________ Phone#: ________________________________________________________

Has this student ever been enrolled in GJUHSD schools before? No Yes If yes, last year and/or grade enrolled: ______________

If Yes, What was the student number at time of attendance in GJUHSD#________________________

I authorize the release of all records including special education. Parent/Guardian Signature:______________________________________________

Is this a single Parent Household? YES NO

If yes, Are there any court orders? YES NO A copy of the court order must be provided to the School.

(Please check what applies) Legal Custody Physical Custody Restraining Order

Is student living with parents YES NO If the student only (without their parents) is"living with"another family within the

school district's boundaries, you must fill out and notarize the Authorization for Adult to Act as Custodial Parent Affidavit before enrollment

can be completed. (see Page 7)

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Race and Ethnicity

The federal government now requires school districts to collect data on students' race and ethnicity. In ad-dition, California law requires that data on Asian and Pacific Islander subgroups be collected.

Please answer both questions.

1. Is this child Hispanic/Latino?

Yes No

2. You must indicate at least one Race-below

Race Primary (Mark only 1)

Other (Mark all that apply

American Indian or Alaska Native

Asian

Chinese Japanese

Korean Filipino

Cambodian

Laotian

Vietnamese

Asian Indian

Hmong

Other Asian Native Hawaiian or Other Pacific Is-lander

Hawaiian

Samoan

Tahitian

Guamanian

Other Pacific Islander

Black/African American

White

Is the pupil currently in a Special Program? Yes No

If Yes, please indicate which program:

Communicatively (speech, language) Learning Handicapped, RSP, ED. (must submit

copy of child's current IEP)

504 (Please submit copy of child's current 504)

Confidential Student Residence Information

(Required for Federal Reports)

Is the Primary Residence a permanent residence (200)?

YES No

Is Student Currently:

Foster Youth? Yes No

If Foster Youth, Where is your child/family currently living?

(Please check only one of the following)

Foster Family Home or Kinship placement (210)

Licensed Children’s Institution (Group Home) (220)

Homeless? Yes No

If Homeless, where is your child/family currently living?

(Please check only one of the following)

Temporary Shelter (100)

Hotels/Motel (110)

Temporarily Doubled up (120)

Temporarily Unsheltered (130)

Indicate the highest level of education in the household– Check One

Not a high school graduate (includes GED) High School Graduate Some College (includes AA and Vocational School)

College Graduate Graduate School (MA, PhD, etc.) Other________________________

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HOME LANGUAGE SURVEY (all students must complete)

Name of Student: __________________________________ _______________________ ___________________

Surname / Last Name First Name Middle Name

School: _______________________________ Age: ______ Grade Level: _________ DOB: _______________________

Directions to Parents and Guardians: The California Education Code contains legal requirements which direct schools to determine the language(s) spoken in the home of each student. This information is essential in order for the school to provide adequate instructional

programs and services.

As parents or guardians, your cooperation is requested in complying with this legal requirement. Please respond to each of the four questions listed below as accurately as possible. For each question, write the name(s) of the language(s) that apply in the space provided. Please do not leave any question unanswered.

Which language did your child learn when he/she first began to talk? ______________________________________

Which language does your child most frequently speak at home? ______________________________________

Which language do you (the parents or guardians)

most frequently use when speaking with your child? ___________________________________

Which language is most often spoken by adults in the home?

(parents, guardians, grandparents, or any other adults) ____________________________________

What month, day and year did your child first enroll in the US school system not including Preschool? ____/ _______ / _______

What month, day and year did your child enter (or enroll) in a California Public School? _____/ ______ /________

Please sign and date this form in the spaces provided below, then return this form to your child’s teacher. Thank you for your cooperation.

__________________________________________________________ _____________________________

Signature of Parent or Guardian Date

Form HLS, Revised 12/30/15

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Galt High School Authorization for Adult to Act as a Custodial Parent

145 N. Lincoln Way Galt, CA 95632-1733 PH# (209) 744-4545 / Fax# (209)744-4553

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

State of California , County of ___________________________ On ___________ before me,

_______________________,Notary public, personally appeared _________________________________ who proved to me on

the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowl-

edged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on

the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under

PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature _______________________________ (Seal)

Notary Public

This form must be notarized and completed for stepparents , relatives, and other responsible

authorized adults to act in the parent’s behalf.—One form per child

I verify that I am the natural parent/legal guardian of the child named below and have legal custody of this child. I give au-

thorization for the adult designee below to act on my behalf in school matters such as, but not limited to, signing absence

verifications, approving field trips, acknowledging notifications, and signing other authorizations.

My name (adult giving authorization):_______________________________________________________________ Relationship to Child: _________________________________________ Driver's License Number: __________ My home address: ____________________________________________________________________________ City: _________________________________ County: _____________________________ State:__________ Name of Adult Designee: _______________________________________________________________________ Adult Designee's home address: _________________________________________________________________ City: ___________________________________ County: ________________________ State: _____________ Name of child: __________________________________ Child's age: ______ Date of birth: _________________

Signature of Parent/Guardian ______________________________________________ Date________________ Print Name Clearly_________________________________________ Phone No. ________________________ Signature of Parent/Guardian _______________________________________________ Date _______________ Print Name Clearly_________________________________________ Phone No. ________________________ Signature of Adult Designee ______________________________________________ Date _________________

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RESIDENT VERIFICATION FORM l

Student Name (please print):________________________________________________________________

Date of Birth (month, day, year):_______________________School:_________________________________

Parent/Guardian Address:__________________________________________________________________

City, Zip:________________________________________________________________________________

State law requires the district to enroll students whose parent(s) and/or legal guardian(s) reside in our district.

Parent(s) and /or legal guardian(s) must provide verification of residency within the district and school boundaries.

This form has been prepared to verify your residency.

Please check ONE of the following:

1. I ____own _____rent ___lease my residence. You must Present two (2) of the items listed below in the

name of the parent(s) and/or legal guardian(s) for resident verification, with your child(ren)’s completed enroll-

ment packet. Original current billings with your name, your residence and service address within the school’s

boundaries within the last three (3) months from: Cable Bill, PG&E, SMUD, Telephone bill (land line), *Escrow

papers or rent/lease agreement (*must be followed up with utility bills within 30 days of enrollment)

If you are unable to provide proof of residency fill out the portion below and page 9 must be notarized

2. I ________________________________am the Parent/Legal Guardian of the student seeking

enrollment. I declare that we are "living with" another family and I am unable to provide proof of

address within the school district's boundaries. I have attached the required notarized Affidavit of Resi-

dency, signed by myself and the homeowner/legal Tenant (see page 9). (Proof of the "host family's"

residency verification must also be submitted (noted in Section 1)

I certify under penalty of perjury that I am a resident of said high school, and the information I submitted in

support of my child’s enrollment is complete and accurate. I understand that my child may be withdrawn

from his or her assigned school if incomplete, inaccurate or false information is provided.

I also understand that I must notify the school office within 30 days if my residence changes.

__________________________________________________ ___________________________

Signature of Parent (s)/Legal Guardian Date

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AFFIDAVIT OF RESIDENCY

As parent and/or legal guardian of ______________________________________ , _________, __________,

Student’s Name Grade Date of Birth

I, _____________________________, hereby declare under penalty of perjury that I reside with my son/daughter at the

following address:

_________________________________________________________________________________________

This is the residence of __________________________________________ and their telephone number

is ______________________________.

Parent/Legal Guardian Signature________________________________________ Date __________________________

FALSIFYING THIS ADDRESS WILL RESULT IN IMMEDIATE DISENROLLMENT

(TO BE SIGNED BY HOMEWONER)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Dated: __________________ Signed:_________________________________________

STATE OF CALIFORNIA )

COUNTY OF __________ ) ss.

On ________________before me, _____________________Notary Public, personally appeared

______________________________________________________________________________

[ ] personally know to me –OR- [ ] proved to me on the basis of satisfactory evidence to be

the person(s) whose name(s) is/are subscribed to the within instrument and acknowledge-ment to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

________________________________________________

NOTARY PUBLIC

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As legal custodian of , a minor, I hereby authorize the principal or his/her designee, into whose care the aforementioned minor pupil has been entrusted, to consent to any X-ray, examination, anesthetic, med-ical or surgical diagnosis, treatment, and/or hospital care to be rendered to said minor upon the advice of any licensed physician and/or dentist.

I understand that this authorization is given in advance of any required diagnosis, treatment, or hospital care and provides authority and power to the aforementioned agent(s) to give specific consent to any such diagnosis, treatment, or hospital care which a licensed physician or dentist may deem necessary.

This authorization shall remain effective for the full school year unless revoked in writing and delivered to said agent(s). I understand that the Galt Joint Union High School District, its employees, and its Board assume no liability of any nature in relation to the transporta-tion or treatment of said minor.

I further understand that all costs of paramedic transportation, hospitalization, and any examination, X-ray, or treatment provided in relation to this authorization shall be my responsibility.

Preferred Doctor Phone No. ( ) Preferred Hospital _______________ _

Health Insurance Carrier Group No. Policy No. ___

In the event of an accident or emergency, I give permission for school staff or emergency contact to obtain necessary emergency

medical care for my child.

I do not consent to medical care for my child I release the school/district from liability. Please initial. _______

Registration Signature

I affirm to the best of my knowledge, that the above information is correct and that I will notify the school each time there is a change in any of this information.

Parent/Guardian Signature Print Name __________________________ Date _____________

OFFICE USE ONLY

Clearance_______ Residency ______ Transcript ____ Immunizations_____ Guardianship ______ Birth Certificate_______

Residence School ________________________ Date of Entry ________ Grade Level ____ Records Requested___________

School Assigned _________________________ Reason: Residence ___ Overflow___ IDT_____ SPED/SCOE_______

Student Enrolled by: Parent/Guardian ___ Foster ____ Care Giver (copy of Affidait must be notarized) _______________

Intra District ___ Inter District____ (signed approved copy must be attached) Registered by _________________________