SUMMER 2019

NEW STUDENT REGISTRATION HOURS

MON., JULY 8, 2019- THURS., SEPTEMBER 5, 2019

NO STUDENT REGISTRATIONS ARE SCHEDULED BETWEEN JUNE 24 and JULY 5

Days/Hours BEGINNING JULY 8th

Monday, Tuesday, Wednesday, Thursday  8:15am -  10:15am

Monday, Wednesday                                    1:00pm -   2:30pm

Location

610 Fountain Avenue, Burlington

Hopkins Building behind the High School  (Door 16A)

 For Registration Forms and Required Documents

Please visit our website at www.burltwpsch.org under Student Registration - to download forms required for registration.

Bring completed forms and required documents with you when you register.  

Registration cannot be finalized without the required forms.

bs01001_

http://www.burltwpsch.org/pics/banner.gif


Burlington Township School District                                        Phone: 609- 387-3955

PO Box 428                                                                Fax:     609- 387-8968

       Burlington, NJ  08016                                                        www.burltwpsch.org

INFORMATION REQUIRED FOR REGISTRATION

Burlington Township School Registration is conducted centrally at the Board of Education offices in the Hopkins Building at 710 Jacksonville Road.  Enter the Burlington Township High School campus from the main entrance on Fountain Avenue, and follow signage and the green line painted on the asphalt to the Board of Education offices.  Please review registration hours included in this packet.

  1. Parent/Guardian must produce the following IN PARENT/GUARDIAN name as proof of residence:
  1. ___Mortgage Statement OR ___Copy of Deed OR ___Copy of Apartment Lease

AND ONE OR MORE OF THE FOLLOWING

  1. __Utility Bill (i.e. electric, gas, water/sewer) OR __Tax Bill OR ___Other Governmental Document or Business Record

If you have difficulty obtaining the forms necessary for enrollment, or are in transition with your residence please contact our District Homeless Liaison Walt Spiehs at wspiehs@burltwpsch.org  or (609) 387-3955 ext 1067.

If special circumstances apply, the following may be required in lieu or in addition to above:

  1. ___Guardianship- Submit Court approved Guardianship Papers for Superintendent approval
  2. ___Affidavit of Temporary Residency- Affidavit of Temporary Residency completed by parent/guardian and Affidavit of Property Owner completed by property owner submitted for Superintendent approval
  3. ___Court-issued Child Custody Papers

  1. The following STUDENT documents are required:
  1. ___Birth Certificate OR ___Passport
  2. ___Immunization Records
  3. ___ Proof of Physical on Burlington Township Physical Form (Submit to physician for completion, signature and return within 30 days of school start)
  4. ___Transfer Card from Previous Public School (All NJ public schools provide this)

  1. The following STUDENT documents are requested if available:
  1. Most recent ___Transcript OR ___Final Report Card
  2. ___Standardized Test Scores
  3. ___Copy of IEP if applicable

___ Registration for Falcon Flyer

___ Release of Records Signed (if attended previous school)

___ CST Release Signed (if applicable)

___ Medicare Form Signed (if applicable)


                                                        BURLINGTON TOWNSHIP SCHOOL DISTRICT

 Pupil Enrollment Form  

Date ________          Bus #________                                           Date to Begin School __________

                                                                                                

                                                                                                             

Please list all OTHER children in your home.

                  Child’s Name (First/Last)                       Birth Date                                  Grade (if school age)                                   

1. ______________________________________________________________________________

2. ______________________________________________________________________________

3. ______________________________________________________________________________            

4. ______________________________________________________________________________

5. ______________________________________________________________________________

I, ________________________ (Name of Parent/Guardian), do hereby request the release of all school records of

  ______________________   (Name of Student) to the _________________________________ (Name of School.)                                                                                                         

I attest that I have legal authority to request release of these records.

Today’s Date _______________                                             __________________________________________

                                           _____________________________________________________

                                                                                                                          Email Address – Parent / Guardian                    Revised 02/2018

http://www.burltwpsch.org/pics/banner.gif


Burlington Township School District                                                        Phone: 609- 387-3955

PO Box 428                                                                                Fax:     609- 387-8968

       Burlington, NJ  08016                                                                        www.burltwpsch.org

PARENTAL PERMISSION TO RELEASE INFORMATION

________________________        _________                ______                  ____________

Student’s Name                              Birth Date                  Grade                    New School

Previous School Attended (Name and Address) _________________________________

________________________________________________________________________

On __________ (date) the student listed above registered in our school district. Please provide the following student records and information to the address provided to help our district to provide for this child:

1. Standard Achievement Test Scores

2. Academic Cumulative File

3. Medical Records

4. Attendance Data

5. Behavioral/Discipline Records

6. Counseling or Psychological Records

7. Special Education Records (IEP, Annual Reviews, CST Evaluations)

8. Legal Records (Custody Agreements, Guardianship Affidavits)

9. New Jersey Student State ID Number

10. Other- Additional Information Which May Be Pertinent

Forward to:

School:         ____________________________________

Address         ____________________________________

____________________________________

____________________________________

Authorization Statement and Signature

I understand that under the Family Education Rights and Privacy Act (FERPA) all information (records and documents) received under this release are confidential but will be available for inspection and review by the student’s parents/guardians, an eligible student, or the authorized representative of the parent or eligible student.

Authorized representatives of the organization/agency to which the records are released will have access to these records. No other parties, however, will have access without my knowledge or consent unless authorized to have access under FERPA.

I also understand that under the Health Information Privacy Authorization Act (HIPAA), all medical health information will become part of the student’s education record and will transfer with the student.

____________________________                         _________________________

Signature of Parent/Guardian                                                   Date

http://www.burltwpsch.org/pics/banner.gif


Burlington Township School District                                                        Phone: 609- 387-3955

PO Box 428                                                                                Fax:     609- 387-8968

       Burlington, NJ  08016                                                                        www.burltwpsch.org

Health Screening/Background Information

Date        ____________ Child’s Name _____________________ Gender _____  Grade ________

Current Age ____________        Date of Birth _______________

Address ___________________________________________   Phone (       ) ____-_____

Family Information

Parent/Guardian Information:

Father_____________________________        Phone (       ) ____-_____        Phone (       ) ____-_____

Mother ___________________________        Phone (       ) ____-_____        Phone (       ) ____-_____

Other Guardian______________________   Phone (       ) ____-_____ Relation _________________

Other Guardian_______________________ Phone (       ) ____-_____ Relation _________________

         

List all members of household:

Name                                        Relationship                        Age of Children

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

_____________________________        ______________________________        _______________

Who generally cares for child after school?

___ Parent/Guardian        ___ Babysitter ___ Daycare____________         ____  Other _________________

CHILD’S HISTORY

Please list any complications mother experienced during pregnancy. (e.g. high blood pressure, medications, drugs, smoking)_________________________________________________

Please list any complications with labor and delivery. (e.g. breech, premature) __________________

Please list any concerns during infancy (e.g. jaundice, infection) _____________________________

Has child attended a previous school or daycare?  ___Yes ________________________    ___No

Child’s energy/activity level   ____High        ___Average         ___ Low   Comment:________________

                                                                                Rev. 03/2011