1. education
2. school

Spring Registration
Packet
2015 -2016
Tammy Mason, Superintendent
March 26, 2015
Arlington Elementary &Donelson Elementary
Arlington High School – Grades 9th and 10th only
4:30 p.m. – 7:00 p.m.
March 31, 2015
Arlington Middle School
Arlington High School – Grades 11th and 12th only
4:30 p.m. – 7:00 p.m.
Required Documents Are Enclosed:
Registration Information
Items Accepted for Proof of Residency
Student Enrollment Form
Primary Home Language Survey
Arlington Community Schools offers educational and employment opportunities without regard to race, color, creed, national origin,
religion, sex, age, or disability and adheres to the provisions of the Family Educational Rights and Privacy Act (FERPA).
SPRING REGISTRATION
Arlington Community Schools
March 26, 2015
March 31, 2015
Arlington Elementary
Donelson Elementary
Arlington High School – Grades 9 and 10
4:30 – 7:00 p.m.
Arlington Middle School
Arlington High – Grades 11 and 12
4:30 – 7:00 p.m.
Items Needed for Enrollment
PROOF OF RESIDENCE: Parents/guardians must provide two (2) of the following items showing the
parent/guardian’s name and address to prove residency:
1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student
will reside during the current school year;
2. Mortgage statement or deed of the owner of the home in which the student will reside during the current
school year;
3. Lease of the lessee of the home in which the student will reside during the current school year;
4. Rental Agreement of the renter of the home in which the student will reside during the current school year;
5. Real Estate tax receipt;
6. Public assistance/government benefits check, card, or papers;
7. In the event that two (2) of the items listed above cannot be provided, residency may be established by
submitting other documentation deemed to be appropriate proof of residence by the department responsible
for verifying residency.
Immunization Records
IMMUNIZATION REQUIREMENTS: K-12 students must have a TN School Immunization Certificate
showing:
Two (2) doses of Varicella
or proof of Chickenpox
Two (2) doses of
Tdap Booster
Hepatitis A (Grade K)
(7th Grade Entry Only)
For more on state-required immunizations, please refer
website: https://health.state.tn.us/ceds/required.htm.
Two (2) doses of MMR
Four (4) doses of Polio
Four (4) or Five (5) doses
of DTaP (all students)
Three (3) doses of Hepatitis
B (Grade K & 7)
to the Immunization Requirements at the following state
New Student Enrollment
Students who have previously enrolled in another school system in Tennessee may enroll pending receipt of their
academic and health records. Students transferring into the system from an out of state school or from a nonpublic school must provide a Tennessee Department of Health Immunization Certificate that includes a physical
exam. The following documents are required:
1. Proof of Residence: Same as above. Proof of residence is required of all students at registration and
may be required of any student during the school year.
2. Social Security Number: Bring student’s Social Security Card. (T.C.A. 49-6-5102)
!
3. Tennessee Department of Health Immunization Certificate: Contact the school for additional
information.
4. Kindergarten Students must be 5 years old on or before August 15, 2015, and the following
items must be provided:
A. Certified copy of Birth Certificate
B. Proof of recent medical examination
C. Tennessee Department of Health Immunization Certificate with proof of a physical
exam within 12 months prior to enrollment.
D. Social Security Card
E. If applicable, custody papers and parenting plan
Arlington Community Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex,
age, or disability and adheres to the provisions of the Family Education Rights and Privacy Act (FERPA).
Student Enrollment Form
For School Use Only:
Proof of Residence: ______ Mortgage ______Lease ______Rental Agreement ______Real Estate Tax ______MLGW ______Government benefits check
Proof of residence if living with someone else: ______ Notarized Proof of Residence Form Completed ______ Administrative Approval
Date of enrollment:
Teacher:
Last Name:
Bus RT#: ______ Daycare: ______Car: ______
First Name:
Middle Name:
Grade:
Nickname:
SS#:
Mother’s Maiden Name:
DOB:
Birth State/Nation:
Male:
Birth City:
Birth County:
Ethnic Codes
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Female:
Resides With Codes
(1) Black / African American
(2) American Indian
(3) Asian
(4) Hispanic
(5) Pacific Islander or Native Hawaiian
(6) White (not Hispanic)
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(B) Both Parents
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(R) Grandparents
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(O) Other
Is a language other than English spoken in the home?______ Yes
Language
(F) Father & Stepmother
(M) Mother & Stepfather
(A) Father [single parent]
(T) Mother [single parent]
(G) Guardian/Foster
______ No
County of Origin
ACS is implementing a Blackboard Notification System to help keep parents informed of school activities and
emergencies. It is very important that parents contact information be up to date in case of emergency.
Home Address
Street #:
Street Name:
Home Phone #:
City/State/Zip:
Parent 1 / Guardian Student Lives With
Name:
Work #:
Cell #:
Email:
Relationship to Child:
Employed By:
Parent 2 / Guardian Student Lives With
Name:
Work #:
Employed By:
Cell #:
Email:
Relationship to Child:
Custody Information
CUSTODY ALERT? ______ Yes
______ No
If yes, please attach an explanation including a COPY of any court orders.
OTHER PERSONS TO CALL IN CASE OF EMERGENCY OR ILLNESS
Only parents/guardians listed above and individuals listed below may check out you child. Emergency contacts must
be 18 or older and will be required to provide ID when picking the child up.
Contact #1
Contact # 2
Name:
Name:
Phone #:
Phone #:
Cell #:
Cell #:
Relationship to child:
Relationship to child:
Contact # 3
Contact # 4
Name:
Name:
Phone #:
Phone #:
Cell #:
Cell #:
Relationship to child:
Relationship to child:
Medical Alert
Does this student have any medical conditions? ____ Yes ____ No
Please complete the “Confidential Health Form.”
Last school attended:
State:
City:
Date withdrawn:
Has the student ever been enrolled in a Special Education/Resource/504/Gifted Program? ____ Yes
____ No
If yes, what type of program?
When?
Where?
Has this student ever been enrolled in a Tennessee School? ______ Yes ______ No
If yes, please list the Tennessee School Name, City, Year:
Is this student currently under suspension/expulsion at another school? ______ Yes ______ No
If yes, what school?
Has this student been adjudicated delinquent for having committed a violent crime? ______ Yes
______ No
Arlington Community Schoolsofferseducationalandemploymentopportunitieswithoutregardtorace,color,creed,nationalorigin,
religion,sex,age,ordisability and adheres to the provisions of the Family Educational Rights and Privacy Act (FERPA).
Primary Home Language Survey
Theparent or legal guardian should complete this form during registration.
Date:
Student Name:
Sex:
Date of Birth:
School:
Grade:
Student #:
Home Telephone:
Cell Phone:
The native/home language of each student must be recorded in his/her permanent record.
 Please answer the following questions about your child’s language background:
1. What is the first language this child learned to speak?
2. What language does this child speak most often outside of school?
3. What language do people usually speak in the child’s home?
Listing another language other than Englishto any of the questions above DOES NOT qualify a student as an English language
learner. It does require, however, that the student participate in an approved language proficiency assessment to determine
language proficiency and possible ESL classification based on these assessment results. If any question is answered with
another language other than English, a copy of this form should be forwarded to the local school ESL teacher for language
assessment testing.
 Collected for Funding Purposes Only:
Was this child born in the United States? _____Yes
_____No
If no, what is the country of birth?
Date entered the United States:
Date entered schools in the United States:
Has this student ever been enrolled in an ESL program? _____Yes
_____No
In what language do you want correspondence sent to you from school?
Signature of Parent/Guardian
Date
Arlington Community Schools offers educational and employment opportunities without regard to race, color, creed, national origin, religion,
sex, age or disability and adheres to the provisions of the Family Educational Rights and Privacy Act (FERPA).
Revised 11/2014