City View Enrollment Packet

Student Enrollment Form

City View Charter Enrollment Packet

Instructions: The Enrollment Form is an official record. The information provided by parent/guardian should match legal documentation. Please complete ALL pages and sign where applicable. 

Family Educational Rights and Privacy Act (FERPA) information is located in the Standards of Student Conduct.

Please enter your email address to begin. You will need to fill out an online enrollment packet for each student that is enrolling in City View Charter. You can expect to spend approximately 15 minutes on this process for each student. The information you enter can be saved so you may return to the form to complete it at a later time, if needed.

Student Information

Type "NA" if no middle name
Grade*
Gender*
Birth Date*
Ethnicity*
Race*
Is this Mailing address?*
Primary Contact number Type*
Do you allow your student to access the internet for enhanced instruction?*
Can your student use digital resources for enhanced instruction?*
Please select the Emergency Closure Plan for your student.*
There may be times when the school needs to close during the school day because of ice, snow, power failure, or other emergencies.

Parent Information-1

Call order*
Does parent live with student?*
Parent Name*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Contact with Student allowed*
Ed Rights*
Has Custody*
Mailing Allowed*
Enrolling Parent*
Released to*
Add Another Parent?*

Parent Information-2

Call order*
Does parent live with student?*
Parent Name*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Contact with Student allowed*
Ed Rights*
Has Custody*
Mailing Allowed*
Enrolling Parent*
Released to*
Add Another Parent?*

Parent Information-3

Call order*
Does parent live with student?*
Parent Name*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Contact with Student allowed*
Ed Rights*
Has Custody*
Mailing Allowed*
Enrolling Parent*
Released to*
Add Another Parent?*

Parent Information-4

Call order*
Does parent live with student?*
Parent Name*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Add Another Contact Phone number?*
Contact number type*
Contact with Student allowed*
Ed Rights*
Has Custody*
Mailing Allowed*
Enrolling Parent*
Released to*
Add Another Parent?*

Emergency Contacts-1

Contact Order*
Name*
Phone number type*
Add Another Emergency Contact?*

Emergency Contacts -2

Contact Order*
Name*
Phone number type*
Add Another Emergency Contact?*

Emergency Contacts -3

Contact Order*
Name*
Phone number type*
Add Another Emergency Contact?*

Emergency Contacts -4

Contact Order*
Name*
Phone number type*

RESTRAINING/COURT ORDER INFORMATION

Is there a current restraining/court order pertaining to this student?*
*If there is a current restraining/court pertaining to this student, you must submit a copy of such order before the school can limit access to this student.

Medical Information

School staff needs to know when your child has a current ongoing health problem for which he or she may require help during the school day.

Remember to advise your school of any changes in information.

Physician’s Name
Dentist's Name

HEALTH CONDITION INFORMATION

Student Name*
Birth Date*
Grade*

MEDICATIONS

Daily or As needed

A Medication Authorization form is required to grant permission for designated school personnel to administer medication. If the student will be carrying the medication and self-administering, the Medication Self-Administration form must also be completed. Signed forms must be provided to the school.

IMMEDIATE MEDICATIONS

NUTRITION INFORMATION

Does your student need an allergy alert on their school meal account?*

Siblings (List siblings from Birth-Grade 12)

Add Sibling(s) start*
Sibling Name (1)*
Birth Date (1)*
Grade (1)*
Add another sibling?*
Sibling Name (2)*
Birth Date (2)*

Early Childhood Services

Has the student received Early Childhood services?*
Select any that apply

Student Services

(1) Add Another Medication*
Is the student currently on an IEP?*
(2) Daily or As needed *
Has the student been enrolled in a special program in the past year?*
If yes, indicate the program(s)
(2) Add Another Medication*
Programs*
Select any that apply
(3) Daily or As needed*

Enrolling Record

Name of person enrolling student*
Use your mouse or finger to draw your signature above
Date

LANGUAGE USE SURVEY

Language Use Survey

The purpose of the Language Use Survey is to help the school determine if your child qualifies for additional Title III supports in language instruction for English learners. Title III provides support for English learners as defined by USED.

The State of Oregon honors the language and culture of its people and respects the over 166 languages in our schools, and recognizes that:

  • Language is a key component of each person’s cultural identity,
  • Heritage and primary languages are instrumental in student academic and cultural success, and
  • Students who are multilingual/multicultural may have an advantage over students with a single language and are valued in career placements.
Student's Name*
Grade*
Parent/Guardian Name*
Use your mouse or finger to draw your signature above
Date of Birth

Language Use Information

Communication Preferences This question helps the school provide an interpreter or translated documents, free of charge, should you want them. This section is for informational purposes only. It is not used to identify your child for English language proficiency placement testing.
Eligibility for Language Development Support This section helps the school identify if your child should be assessed to receive support in academic English instruction. This section is used to identify your child for English Language Proficiency placement testing. A response other than English to questions #2, #3, and/or #4 may qualify your child for English language proficiency placement testing.
Eligibility for Language Development Support This section helps the school identify if your child should be assessed to receive support in academic English instruction. This section is used to identify your child for English Language Proficiency placement testing. A response other than English to questions #2, #3, and/or #4 may qualify your child for English language proficiency placement testing.
Eligibility for Language Development Support This section helps the school identify if your child should be assessed to receive support in academic English instruction. This section is used to identify your child for English Language Proficiency placement testing. A response other than English to questions #2, #3, and/or #4 may qualify your child for English language proficiency placement testing.
2. Describe the language(s) your child understands.
6. Is there anything else you think the school should know about your child’s language use (e.g., what language(s) did your child speak/express from ages 0-4; did your child have speech classes; did your child attend a bilingual preschool, etc.)?

Below is the United States Department of Education definition of an English learner.

The term “English learner,” when used with respect to an individual, means an individual —

(A) who is aged 3 through 21;

(B) who is enrolled or preparing to enroll in an elementary school or secondary school;

(C) (i) who was not born in the United States or whose native language is a language other than English;

(ii) (I) who is a Native American or Alaska Native, or a native resident of the outlying areas; and

(II) who comes from an environment where a language other than English has had a significant impact on the

individual's level of English language proficiency; or

(iii) who is migratory, whose native language is a language other than English, and who comes from an environment where a

language other than English is dominant; and

(D) whose difficulties in speaking, reading, writing, or understanding the English language may be sufficient to deny the individual —

(i) the ability to meet the challenging State academic standards;

(ii) the ability to successfully achieve in classrooms where the language of instruction is

English; or

(iii) the opportunity to participate fully in society.

(ESEA Section 8101(20))

Federal Title Program Information


Was your child born in the United States?*
Has your child attended any school in the U.S. totaling less than three years during their lifetime?*
U.S. Dept. of Ed. requires Oregon school districts to collect this information: Title III-A, Section 3114(d) (1) of the Elementary and Secondary Education Act
Have you moved during the past 3 years to obtain seasonal or temporary employment in agriculture, fishing, forestry, dairy, or cannery work?*
Federal law supports programs to help reduce educational disruptions that result from repeated moves for migrant children under Oregon Title 1-C of the Elementary and Secondary Education Act of 1965.
Is your child, parent, or grandparent a member of a U.S. Federally recognized American Indian tribe?*
Enrollment in a Federal or State recognized tribe can establish eligibility to participate in the Title VI - A Indian Education Program, under the Indian Education Act of 1988, Section 7102 (a).

OREGON DEPARTMENT OF EDUCATION Dental Screening Certification Form

State law now requires a child who is 7 years of age or younger to have a dental screening before entering school for the first time. (HB 2972 (2015))

IF YOUR CHILD HAS ALREADY RECEIVED A DENTAL SCREENING

Parent/Guardian: 

  • If you know your child has already had a dental screening, please check the box below, fill out this section, and sign it. 
  • If you do not know if your child has had a dental screening, please have a dental provider fill out this section and sign it. 
  • Please return this form to the school office.
Child's name*
Date of last dental visit*
Use your mouse or finger to draw your signature above

TO OPT-OUT OF THE DENTAL SCREENING REQUIREMENT 

Parent/Guardian: You may choose to have your child opt-out of a dental screening due to a reason listed below. Please fill out this section and sign it. Then return this form to the school office.

My child was not screened due to the following: (please check all that apply):
The dental screening is a burden for the student or the parent or guardian of the student when: (A) The cost of obtaining the dental screening is too high; (B) The student does not have access to a screener or; (C) The student was unable to obtain an appointment with an screener
Use your mouse or finger to draw your signature above

Vision and Dental Screening Certification Form

Oregon Law now requires a child who is 7 years of age or younger to have dental and vision screenings before entering school for the first time. 

For information about vision requirements see 2013 Oregon HB3000 Section 1: (2)(a) through (3)(b) 

For information about dental requirements see 2015 Oregon HB2972 Section 1: (2)(a) through (3)(c)

Student Name*
Date of Birth*
Grade*

VISION SCREENING CERTIFICATION

Complete the section below if your student is 7 years of age or younger 

OR you would like to opt out of screening at grades K, 1, 3 & 5

Was a follow-up recommended?*
Use your mouse or finger to draw your signature above

DENTAL SCREENING CERTIFICATION

Complete the section below if your student is 7 years of age or younger

Was a follow-up recommended?*
The dental screening is a burden because:
Use your mouse or finger to draw your signature above

Acknowledgement of Risk @ CVCS

I, agree to allow my child, to participate in recess and in all Expeditionary Learning Activities including outdoor fieldwork and overnight fieldwork. I am aware that hazards and risks are inherent in this kind of activity and agree to hold City View Charter School, and the parent volunteers, teachers, and staff organizers harmless from any liability resulting from any injury sustained to my child while participating in these activities. I will have the opportunity to opt-out of individual activities using the Permission to Participate Form issued for each activity. I understand that alternative arrangements will not be made for students who choose not to participate in any activity or do not have a signed permission slip. This permission will stay in effect as long as my students are enrolled at City View Charter School.

Parent/Guardian Name*
Student Name*
Grade*
Add another student*
Name
Grade
Use your mouse or finger to draw your signature above

City View Computer and Internet Acceptance

Dear City View Families,


Computers and the Internet are powerful educational tools and we believe that the benefits for students far exceed potential disadvantages. Everyone using computers and the Internet at City View Charter School is expected to act in a responsible, appropriate, and ethical manner. We realize that there are concerns about children being exposed to materials that are illegal, defamatory, or potentially offensive. City View has set up filters that block our school’s computers from accessing the vast majority of these undesirable sites. In addition, the following precautions are taken:


  • Students are supervised while using the Internet in school.
  • Students not following the Guidelines outlined in the Computer Use Policy will not be permitted to use our school’s computers for a given amount of time, depending on the offense.


The Computer Use Policy can be found here:


View City View's Internet Policy


At anytime a parent may either revoke this privilege or request a password change in writing to the school office. This form will be consent for computer usage by the student while they remain enrolled at City View Charter School.

Please Choose one option:

As the parent or legal guardian, I have read the Acceptable Use Policy (AUP) and grant permission for my child to use City View’s networked computers and access to the Internet.

Fieldwork Fees

Each crew member enrolling in City View will be asked to pay a “Fieldwork Fee.” This fee will be used in the classrooms in a variety of ways from day trips and overnight adventures, bringing in experts to talk to the crews and extra classroom supplies the crew leader needs for the classrooms. These fees need to be paid directly to the school and are non-refundable. Our budget is contingent on these fieldwork fees so it is important that these fees be paid in a timely manner.

Fieldwork fees are $215.00 per student and are non-refundable. The fees will be used for activities that the law allows (ORS 339.141 (2); ORS 339.155 (4) (5)).

Fieldwork fees due dates:

  • If enrolling your student prior to the beginning of the 2023-2024 school year and before Aug 10, 2023 a minimum of $35 is due by Aug 12th to retain your students placement.  A billing will be sent to the families prior to the Aug 12th deadline.  Please do not pay before August 1st as this will cause challenges for our accounting systems.
  • If enrolling after August 10th the minimum $35 payment will be due within 15 days of your acceptance of your students placement.
  • Prorated amounts will be considered for any student starting after Jan 1, 2024
  • All fees must be paid in full by Feb 15, 2024 to avoid a 20% late fee.  If this date will not work for your family please contact the school as soon as possible to make arrangements.  Arrangements made after the Feb 15th due date will still incur the 20% late fee.



Student Name*
Grade*
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