Kearny School District

172 Midland Avenue phone: 201-955-5021 Kearny, NJ 07032 Fax: 201-955-0544

(main entrance on Elm Street) www.kearnyschools.com

Integrated Preschool Program for 3 Years Olds

Dear Parent/Guardian:

Kearny Public Schools will hold registration for a Half-Day Integrated Preschool Program for 3-year-olds. A child who is THREE (3) years of age on or before OCTOBER 1st is eligible to enter the PreK-3 program. Enrollment is open to 18 typical preschool children who will be enrolled on a first come, first serve basis. If the entire registration process (medical and residency) is not complete, you will be placed on a waiting list. All children must be toilet trained to enter the program. Parents are responsible for paying tuition to the Board of Education at the rate of $200 per month for 10 months. Tuition will be due on the 1st of every month. The first tuition payment of $200 for the month of September will be due on August 1, 2018. The integrated preschool class will be located at Garfield School. Please pass along this information to anyone that you may know that has a child that is ready to enter PreK-3.

Registration will be held at the Board of Education Office on the dates listed below from 9:00 a.m. to 11:00 a.m. and 1:00 p.m. to 3:00 p.m.

PLEASE USE THE ELM STREET ENTRANCE WHEN YOU ARRIVE.

PreK-3 Registration Dates

Thursday March 28th 2019 Friday March 29th 2019

All necessary forms can be obtained from our website: www.kearnyschools.com. On the date of registration, you should bring all documents, including medical with you in order to secure your child’s placement. Board of Education staff will be available to assist with the registration process.

**Please note that we cannot guarantee that someone will be available for translation if needed.

PreK-3 Program: Letters will be sent home the week of July 1st notifying you of the session your child has been enrolled in for September. Whenever possible, consideration will be given to parental preference regarding enrolling your child in the AM or PM session.

Registration/Residency Document Requirements

The following are the residency requirements for the registration of students in Kearny Public

Schools. Parent or legal guardian must be present at time of registration. All required information must be supplied at time of registration.

Student’s original Birth Certificate –no photo copies (Office will make photo copy)

Completed Student Information Sheet

Home Language Survey

Parents must show Identification

Legal Guardianship from U.S. Court for persons other than the parents who have custody of the child

(Notarized letters are unacceptable)

Custody /Divorce papers if applicable

Homeowners: Must produce a deed or a tax bill or mortgage papers for your property

Renters: Must produce a current lease (with the landlord’s phone number) or Form “A” ( attached)

signed and notarized by the landlord

Homeowners and Renters –Must also produce three (3) pieces of mail

Immunization/ Medical Requirements :

Pre-K-3: 1. DPT – 4 doses

2. Oral Polio Vaccine or enhanced IPV – 3 doses

3. Measles – 1 dose (on or after 1st birthday)

4. Rubella – 1 dose (on or after 1st birthday)

5. Mumps – 1 dose (on or after 1st birthday)

6. H.I.B. – 1 dose (on or after 1st birthday)

7. Varicella (Chickenpox) – 1 dose (on or after 1st birthday. If your child had the Chickenpox, please submit

written documentation from your child’s doctor or evidence of a blood test confirming immunity.

8. Pneumococcal Conjugate Vaccine – 1 dose (on or after 1st birthday)

9. Influenza Vaccine – 1 dose annually

10. Documentation of a Physical Examination by a private M.D. within 365 days prior to entrance into school.

11. Parental Questionnaire ( included in attached medical packet)

L/W

Kearny Schools

District Residency Office 172 Midland Avenue

Kearny, NJ 07032

201-955-5128

Form “A”

Statement of Landlord

I, , am the landlord/lawful owner of the residential property

(Please print name)

Located at __________________________________________________________________

( Please print address)

The following are tenants of apartment # floor

_______________________________________ ____________________________________

The answers provided above are absolutely true. I understand the above information is

being relied upon by the Kearny Board of Education to determine a student’s residency in

Kearny. I fully understand that any false answers provided above are subject, if proven

false, to punitive action. ( N.J.S.A. 2C:28-2)

(Landlord/Homeowner) (Telephone #of Landlord/Homeowner)

Sworn and subscribed before me Dwelling/Designation

This day of 20__

Notary Public

Single Family

Two Family

Three Family

Multi-Family

Revised 5/2016

KEARNY PUBLIC SCHOOLS

Student Information Sheet

Placement Data Automated Calling System Global Connect # School: ______________________ 1. ________________________________________

Grade: 2. ________________________________________

Teacher: ______________________

Enrollment Record Date Enrolled: _____________

Student Data Date Entered: _____________ Please Print:

Name: ____________________________________________________________________ / F _____ / M ______ First Middle Last

Address: _____________________________________ Prior Address: ______________________________________________

Phone # _____________________________ Emergency Contact Name/Phone#(other than parents):____________________________

Date of Birth: _________________________________ Ethnic Group Circle: Hispanic-White-Black- American Indian

Alaskan- Asian- Hawaiian-Pacific Islander

Birthplace: ___________________________________ Native Language/Dialect: ____________________________________

Entered U.S.A.: _______________________________ Language Spoken at Home: __________________________________

First U.S. School Entrance date: _________________

Parent/Guardian Data Mother Father Guardian

Child Living with Both Parents _______ Mother only _______ Father Only ___________Other _____________________________ (specify)

Siblings Attending Kearny Schools: _______________________ ______________________ ____________________ ___________________

School Data

School Last Attended: ______________________________________________________________ Grade: ___________ Name Address

Has Child Ever Attended School in Kearny? _____________________________________________________________________ Name of School Grade/Year

NOTE: I hereby grant permission to the respective school officials to either send or to receive pertinent information about my son/daughter.

______________________________________________________________________

(Signature of Parent or Guardian) Date Revised 01/2019

AM____PM____

Name: _______________________

First Last

Address: ____________________________

(If different from Childs)

____________________________________

Place of employment

________________________________________________

Work Phone Number

________________________________________________

Cell Phone Number

________________________________________________

Email Address

Name: _______________________

First Last

Address: ____________________________

(If different from Childs)

____________________________________

Place of employment

________________________________________________

Work Phone Number

________________________________________________

Cell Phone Number

________________________________________________

Email Address

Name: _______________________

First Last

Address: ____________________________

(if different from Childs)

____________________________________

Place of employment

________________________________________________

Work Phone Number

________________________________________________

Cell Phone Number

________________________________________________

Email Address

All Shaded Areas Must be

filled in

ESL/BILINGUAL________

_

Kearny School District

172 Midland Avenue phone: 201-955-5017

Kearny, NJ 07032 Fax: 201-955-0544

www.kearnyschools.com

Home Language Survey

Parent/Guardian Language Questionnaire

Name: Date of Birth:

[first] [middle] [last]

Address: Home Phone:

Date of School Entrance: _

Person completing the survey: [ ] Mother [ ] Father [ ] Grandparent

[ ] Guardian [ ] Other

Directions: Check or write in the correct response for each of the following questions about your child.

1. What language did the child learn when he/she first began to talk?

English Other [specify]

2. What language does the family speak at home most of the time?

English Other [specify]

3. What language does the parent [guardian] speak to the child most of the time?

English Other [specify]

4. What language does the child speak to his/her parent [guardian] most of the time?

English Other [specify]

5. What language does the child speak to her/her brothers and sisters most of the time?

English Other [specify]

6. What language does the child speak to his/her friends most of the time?

English Other [specify]

7. In which language do you wish to receive school communication?

English Other [specify]

Signature: Date:

[person completing the survey]

KEARNY SCHOOLS MEDICAL DEPARTMENT

MEDICAL REGISTRATION PACKET INSTRUCTIONS

Dear Parent/Guardian,

The following forms must be completed and provided at the time of registration at your child’s assigned

school:

1. Parental Screening Questionnaire: To be completed by Parent/Guardian

2. Immunization Record: To be completed by Physician

3. Physical Examination Form: To be completed by Physician

Please be sure to have one completed medical packet for each child you are registering.

If you have any questions regarding the medical packet, please contact the nurse at your assigned school.

Thank you.

Estimado Padre/Representante,

Los siguientes formularios deben ser completados y entregados en el momento de la registración de su hijo(a)

en la escuela asignada:

1. Parental Screening Questionnaire- Cuestionario de información de los padres: Esto debe ser

completado por el padre/representante del niño(a)

2. Immunization Record- registro de vacunas: Esto debe ser completado por un doctor/médico.

3. Physical Examination Form- Formulario de Examen Físico: Esto debe ser completado por un

doctor/médico.

Por favor, asegúrese de completar un paquete médico por cada niño que está registrando.

Si tiene alguna pregunta relacionada al paquete médico, por favor comuníquese con la enfermera de la

escuela que le fue asignada.

Gracias.

Estimados Pais/Encarregados de Educaçāo,

Os seguintes formulários devem ser preenchidos e entregues no dia da matrícula do seu filho na escola que

lhe foi atribuida:

1. Parental Screening Questionnaire- Questionário de Informaçāo dos Pais: Este deve ser preenchido

pelos pais/encarregados de educaçāo do aluno.

2. Immunization Record- Registro das Vacinas: Este deve ser preenchido por um médico.

3. Physical Examination Form- Formulário do Exame Físico: Este deve ser preenchido por um médico.

Por favor, certifique-se que tem o pacote completo para cada aluno que está a matricular. Se tiver algumas

perguntas sobre o pacote médico, por favor entre em contato com a enfermeira da escola que lhe foi

atribuida.

Obrigada.

KEARNY PUBLIC SCHOOLS MEDICAL DEPARTMENT

Parental Screening Questionnaire

Student Name: Date of Birth:

PREGNANCY ALLERGIES

FULL TERM PEANUTS

PREMATURE *Anaphylaxis

DELIVERY METHOD SEASONAL

BIRTH WEIGHT MEDICATION

COMPLICATIONS FOOD

NEWBORN ASTHMA

COMPLICATIONS MEDICATION PRESCRIBED

RETAINED IN HOSPITAL MOST RECENT ATTACK

SURGERY

DEVELOPMENTAL HEARING/EAR ISSUES

MILESTONES MET APPROPRIATELY SPECIFY: SPECIFY:

ANY CONCERNS

VISION/EYE ISSUES

SPECIFY:

GASTROINTESTINAL ISSUES

MEDICAL HISTORY SPECIFY:

CURRENT MEDICATION URINARY ISSUES

SPECIFY:

DERMATOLOGY/SKIN ISSUES

HOSPITALIZATIONS SPECIFY:

DATES:

REASON

REVISED 03/25/14

Dear Parent/Guardian,

KEARNY PUBLIC SCHOOLS MEDICAL DEPARTMENT

Immunization Record

Please make sure your child’s required immunizations are up to date. If your child’s records are in a language

other than English, please have your doctor translate those records utilizing this form.

Child’s Name

DPT/DT: Pre K-12 4 doses (4th dose on or after 4th birthday)

Birth Date

1st 2nd 3rd 4th 5th

Tdap: entering grade 6 born on or after 1/1/97

IVP: Pre K-12 3 doses (3rd dose on or after 4th birthday)

1st 2nd 3rd 4th

MMR: K-12 Measles: 2 doses (1st dose on or after 1st birthday)

Mumps/Rubella (1 dose)

1st 2nd

Measles only

Hepatitis B: K-12 3 doses (*4 if needed) / 2 adult doses (*last dose must be 6 months after 1st dose)

1st 2nd 3rd *4th (if needed)

Varicella: Born on or after 1/1/98 1 dose

HIB: Pre K only 1 dose On or After 1st Birthday

Pneumococcal Conj.: Pre K only 1 dose On or After 1st Birthday

Meningococcal: entering grade 6 born on or after 1/1/97

PPD: Result:

Date MD Signature Stamp

Revised 01/10/16

KEARNY PUBLIC SCHOOLS

ENTRANCE PHYSICAL EXAMINATION FORM

Student’s Name Age

Height Weight Blood Pressure

Vision: Right Left Glasses (Yes/No) To be worn for

Hearing: Right ___________ Left___________

Scoliosis Exam Nervous System (reflexes)

Heart Lungs Abdomen

Ears Throat Nasal Passages

Skin Allergies: (Yes/NO) Type Asthma

Medication

Genitals Hernia Skeletal System

History of Positive TB Reaction INH CXR

Mantoux: Date planted Results (May be read in school)

Is there any condition or history that we should be aware of?

_

Any limitations for Physical Education?

Date of Exam Signature and Stamp of Physician

Revised 02/10/2017

Kearny School District

INTEGRATED PRESCHOOL 3

FINANCIAL AGREEMENT

2019-20 School Year

Student Information:

Last Name: First Name:

School: Birthdate: Male Female

Parent/Guardian Responsible for Payment:

Last Name: First Name:

Address: Apt #:

City: State: Zip:

Home Ph: Cell Ph:

Work Ph: Email:

I hereby acknowledge that I understand and agree to comply with the policies listed above. I further acknowledge and

understand that I am responsible for the full amount of the monthly payment once my child is enrolled in the program.

Printed Name of Party Responsible for Payment: Date:

Signature of Party Responsible for Payment:

Payment Option: Check or Cash (Invoices are NOT mailed each month)

Tuition is $2,000.00 for the school year – payable in ten installments August through May.

August $200 December $200 April $200 September $200 January $200 May $200 October $200 February $200 November $200 March $200

Payments are due to the Kearny Board of Education Business Office on or before the 1st

day of each

month. If payment is not received by the 10th

of the month, steps for withdrawing your child from the

program will be taken.

If your child enrolls in the program after the start of the school year, the first payment is due prior to the first day

in the program.

Enrollment date of 1st – 15

th of the month equals full month tuition obligation.

Enrollment date of 16th – end of the month equals half month tuition

obligation.

Payments are to be made, according to the payment schedule, regardless of the actual number of school days

scheduled or attended in any given month. There are no individual reimbursements/credits or proration of

payments due to your child’s absence from the program (i.e., illness or vacation)

To withdraw from the program, written notification must be received in the school office 14 days prior to your

child’s last day. Less than 14 notice days will result in a full month tuition being charged.