Registration Packet PreK - Oak Lawn-Hometown School District 123

n\ oAK LAWN-HoMErowN
f{ school DiEtricr 123
REGTSTRATION FOR 2019-2Ol 4
BY APPOINTMENT ONLY
(Walk-in registrations will not bejlccepted)
Parents interested in registering a child new to District 123 for 2013-2014 should do so
beginning on July 29, 2013. Registration then continues throughout the summer,
Mondays (dates listed below) from 3:00pm - 7:00pm.
Monday, July 29,2013
Monday, August 5, 2013
Monday, August 12,2013
Monday, August 19, 2013
Registration takes place in the District Office, located al4201 West 93rd Sheet, Oak Lawn.
A 2013-2014 New Student Registration Packet must be completed and mandatory
documentation collected (see checklist in registration packet) before scheduling an
appointment.
Please call 708{57-5020 after July 17,2013 to schedule your appointment.
*Registrar's office will be closed until July '17,2013.
District 123 Residency Requirements must be satisfied before enrollment is complete.
Please follow the steps found in the Enrollment Packet to insure a speedy enrollment
process.
Parents who have not completed the enrollment process for their studenUs on or before
Monday, August 19, 2013 run the risk oftheir studenVs not starting school on August
22,2013.
i 4201 West93rd Street - Oak Lawn,lL60453 P (708) 423-0150 F (708) 423{160 d123.or9

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OAK
LAWN.HOMETOWN
School District 123
ITEMS NEEDED TO COMPLETE YOUR STUDENT'S ENROLLMENT IN
OAK LAWN.HOMETOWN SCHOOL DISTRICT 123
Proof of Residency [Mandatory]
See Oak Lawn-Hometown School District 723 Verification of Residenq
and Enrollment form for acceptable residency documents, located in this
enrollment packet. Residency must be established before enrollment is
considered complete.
Birth Certificate IMandatory original Birth Certificate be presented]
Student will be enrolled with legal name as recorded on Birth Certificate
unless court documentation is presented showing legal name change.
*ISBE Student Transfer Form IMandatory] if transferring from another
public lllinois school. (student must be in good standing) This must be
submitted before the student's enrollment is complete.
+Office of Catholic Education - Archdiocese of Chicago - Official
Elementary School Transfer Form [Mandatory] if transferring from a
Chicagoland area Catholic Elementary School.
tlf transferring from a private Illinois school or out of state school
IMandatory] must provide certification, in writin& on school or district
letterhead, that the student is not currently serving a suspension or
expulsion imposed by the school from which the student is transferring and
what grade the student will be entering for the current school year.
**Health Record [Mandatory]
Proof of appropriate health exam and required immunizations - Kdg & 6th
Proof of Dental Exam - Kdg znd, and 6th
Proof of Eye Exam - Kdg
*Previous term's report card, current state test results, and/or current IEP
All District forms completely filled in [Mandatory]
Form
-Enrollment
_Federal Race/Ethnicity Data
Language Survey
_Media Consent
-Home
_Acceptable Use Policy
_Student lnformation Sheet
Emergency Information Sheet
-Student
of Student Records
-*Release Sheet
+lf applicable
-*Fees
**Due before the first day ofschool
Revised 01/03/13 (mto)
420'l West 93rd Street - Oak Lawn, 1160453 P (7081423-0150 F (708)423{160 d123.org

Child's Name
OAK LAI4/N.HOMETOIryN SCHOOL DISTRICT 123
VERIFICATION OF RESIDENCY AND ENROLLMENT
live at
Narne ot Adult
Addrcss
which is located within the boundaries of Oak Lawn-Hometown School District 123.
Birthdate: I I
Step l: Residency Verification (Part A)
Do you: DOwnyourownhome O Rent O Other:
You must provide documentation showing you ,ive at the address listed above. Please check and aftach
original of three (3) of the following documents. You should black out account and social security
numbers on the documents. lf you cannot produce all three (3) documents, skap to Residency (Part B).
All documents must be original, current and show your name and address.
You must provide one (1) document from Category A and two (2) documents from Category B.
Category A- One (1) document
o
E]
D
tr
o
o
D
Real estate tax bill
*Signed lease-All occupants of unit
must be listed on lease, children
included
Mortgage documenl or payment book
Residency Attestation and mosl current
Real Estate tax bill
Military housing letter
Section I letter
Other*:
* l) l2l $orks with the Villagc of C)ak La\\ n to
adhcrc to the Rental Propcrt) Ordinance 6-58.
Category B- Two (2) documents
o
o
o
o
U
D
tr
Gas bill
Electric bill
Water/Sewer bill
Phone bill (no cell)
Cable bill
Vehicle registration
Bank statement
E other:
O Driveds license/State lD
fl cn"ng" of address confirmalon
liom united Siates PostalS€rvice
E Voter Registration
O Credit card statement
D Pay check stub
O City sticker receipt
E Homeowners/Renters
lnsurance PolicJ and
Premium Payment ReceiPl
Residency must be established belore enrollment is considered complete.
The district may require a home visit and/or additional documentation to verify residency.
Step l: Residency Verification (Part B)
I am unable to provide three (3) of the above documents because: (check all that apply)
fl Our family has not had a permanent residence since
-/_/_.
Address of last permanent residence:
Last school attended:
tr Living in a shelter D Sharing housing with others due to loss of housing, economic hardship, or
similar reason tr Living at a train or bus station, park or in a car O Living in a hotel, motel,
campground, or other similar situation O Abandoned apartmenUbuilding O Disaster victim
E Unaccompanied Youth OThe child is temporarily housed, awaiting DCFS permanent foster care
placement.
O other
Your child may qualify for additional servlces-p/ease ask the registration staff for more information or
contact the District's McKinnev-Vento Liaison at 70&423-0150.
Verification of Residency and Enrollment
I of2

OAK LAWN-HOMETOWN SCHOOL DISTNCT 123
VENFICATION OF RESIDENCY AND ENROLLMENT
Child's Name:
Birthdate:
Step 2: Relationship to Student
You must provide a certified, original birth certificate. A copy will be made and the original returned to
you. lf the birth certificate is not available at the time of registration, other proof of the child's identity and
date of birth is required along with a signed affidavit.
Check one below:
E I am the natural or adoptive parent listed on the birth certificate. (Please provide custody agreement,
if applicable.)
E I was granted court-ordered guardianship (provide copy of court document).
E I receive public aid on behalf of the child (provide copy of documentation showing receipt of aid).
O I have assumed and exercise responsibility for the child and provide him/her with a fixed, nighttime
abode. P/ease ch eck each of the following boxes to be true and accurate.
O The child is living with me because
O I am at least 18 years ofage.
B The child eats and sleeps at my residence on a regular basis.
El The child is not living with me for the sole purpose of having access to the
educational programs of the school district.
Step 3: Affirmation and Warning (MusJ be completed in the presence of a District employee)
Please read the following statements and initial each:
I affirm that the information presented in this verification form, in connection with any anvestigation
of my residency or the residency and custody of the student, is true, complete and accurate.
_
I understand that knowingly orwillfully providing false information to a school district regarding the
residency of a child for the purpose of enabling that child to aftend any school in that district without the
payment of nonresident tuition is a Class C misdemeanor.
_
I understand that knowingly enrolling or attempting to enroll a child in the school of a school district
on a tuition-free basis when I know the child to be a nonresident of the school district, unless the
nonresident child has a lawful right to attend, is a Class C misdemeanor and I will be liable for payment of
tuition, fees, and all other applicable fines.
_t_t_
Dale
Adult (Signature)
Adult (Pdnt Name)
FOROFFICE USE ONLY
En ro I I m ent Pe rso n n e I ( S I g n at u re)
Enrotlment Personnet (Pdnt Name)
- Form Comptele OFo''', tncomqlete
For Office Use Only:
Date of Ve.ificalion J-l-
Signature ot Resklenct Offcec
Verification of Residency and Enrollment
2 of2

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OAK LAWN-HoMErOWi,
School District 123
OAK LAWN-HOMETOWN SCHOOL DISTRICT 123
4201 west93rdst oakLawn, IL50453
708-423-OISO
Enrollment Form for Official School Records
Date: Home School: Grade:
STUDENT'S NAME
****lt is essential for record keeping purposes that the District 123 Schools have
your child's full legal name and that this name be used on all school records.****
Full Legal Name:
(Last) IFirst) (Middle)
Address:
Telephone:
(Area Code) Phone Number
Date of Birth: _Birth Certificate#
City:
state: IL Zip:
Gender ; Male Female
Hospital Name
Fatherrs Name:
MotherJs Name:
(Last) (First) (Middle) (Legal Guardlan (y/n)
(Last) (First) (Middle) (Legal Guardian (y/n)
last School Pupil Attended:
Address:
Please List Siblings under the age of 15:
Brother:
Brother:
Brother:
Brother:
Age-
Age_
Age-
Age_
City;
Sister:
Sister:
Sister:
Sister:
State; _ Zip:
Age:
Age:
Age:
Age:-
Parent Signature:
Enrollment Form 01 12-2011[mto)

fr
olK LAWN-HOMETOWN
school District 123
OAK I-AWN-HOTETOWN SCH(X)L DISTRICT I23
llfr U,S. Ir.p.rtrn ot Educ.don Rrc. rnd Ethnlclt h Strnd.rdr
DATA COLLECTION FOR
l STRUCT|OI|S: This form as to be flled out by the student s parents or guardians, and both questions
musl be answercd. Parl A asks about the student's ethnicity and Part B asks aboul the sludent s race- lf
you decline to respond lo either question, the school districl is required to provide the missing informalion
by obseNer identilication.
Student's Name:
SIS ID:
PrttA L thlr rfudrnt HbpenlcJl-eono? (A person of cuban, Mexican, Puerto Rican,
South or Central American, or olher Spanish culture or origin, regardless of race.)
Choora onlv ona.
E No, not HLD.nlcrlrdno
E Y.., tlltp.nlcJlrum
fhe qaestbn above /s aboul elhnblU, nol ace A/o mahbr wlrlch ansu,er you se/ecled conhnue aad Eqond
lp the queshbn be/ow by marin;ng one or moe boxes lo ndicale whal you cgnsltel lhlis sh./denl s Ece lo be
Plrt B. What lr tha atld.lrfa r!ca? Clrooee ona or moll.
E
Amerlcan lndlan or Ala3ka Natlve (A porson having origins in any ol the original peoples ol Norlh
and Soulh America, rncludrng Central America, and who maintains lribal afliliation or communily
atlachmenl.)
f:l A8lan (A person haung ongrns in any ol the original peoples ol lhe Far East, Southeasl Asia, or lhe
lndran
- sutronlrnenl rncludrng, lorexample, Cambodia, China, lndia, Japan, Korea, Malaysia,
Pakistan, lh€ Philippine lslands, Thailand, and Vietnam )
E Black or At lcan Amorlcen (A Person having origins in any ol the black racial groups ol Alrica )
n Natlve Hawallan or Othgr Paclllc lalandor (A p€rson having origins in any ol the original
- peoples ol Hawaii, Guam, Samoa. or Ptrrtic lal;ds )
E
Whne (A person havrng origins in any ol lhe original peoples ol Europ€, lhe Middle Easl, or
Nonh Africa.)
N@ Oala co//ecled on lhis btm musl be matiolaned by lhe school dtslt bl bl lhEe JcaB. Howevea when lhele E
Ilgahin, a c/alm, an audi, oa aaolhea acllbn lnrcloing lhts Ecord, lhe otittira/ Es@nses masl be eliined anhlt lhe
@mpbtlbn ollhe acbbn
linois Sa/s a Boerd ol Educaaion, Dlvision ol Dab An.lysts and Progress Rapodng
December 2aN9

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OAK
LAWN-HOMETOWN
School District 123
Home Language SurvEt
Student's Name
Birthdate:
The state requires the district to collect a Home Language Sunqt for every new student.
This information is used to count the students whose families speak a language other than
English at home. It also helps to identifu students that need to be assessed for English
Language proficiency.
Please answer the following questions and return this survey with your enrollment
information,
1. Is a language other than English spoken in your home?
Yes
-No
If "yes," what language?
2. Does your child speak a language other than English in your home?
If "yes," what language?
-Yes
3. -No
Which language does your child use most often to communicate with parents and
family?
English Other:
4. Which language does your child use most often to speak with friends?
English Other:
5. Has your child been enrolled in a Bilingual or English as a Second Language [ESL)
program in a previous school? _Yes _No
lf you checked "Yes" for question 5, please answer the following questions:
. How many years was your child in Bilingual or ESL classes?
. At which school did your child attend Bilingual or ESL classes?
Parent/Guardian Signature
Date

^G\
-D{
oAK LAWN-HoMETowN
school Dlrtrict 123
2o13.-2ot4 M EDIA/I N FORMATION RELEASE FORM
FOR PARENT/GUARDIAN OF STUDENTS
My child's name/photo may be released to the local media for honor rolls,
athletic events, plays, concerts, or community proiects. (Make-A-Wish, etc.)
Yes _ No
Oak Lawn-Hometown School District 123 has my permission to take
photographs/slides, film, video and/or audio tape recordings of my child,
during classroom instruction, assessment, or other school-related activities.
I understand that this media will be produced and used for educational purposes.
The media may be used on a school-related website and/or included in a school
district or educational foundation related publication. Last names of students
will not be used on lnternet proiects.
Yes No
Please review the information, sign it, and return to your school office.
Student Name
Grade:
Parent Name
Please Print
Parent Signature
Address
Daytime Phone Evening Phone Date
1111612012

^G\
oAK LAWN-HoMETowN
|{ school District 123
Acceptable Use Policy
Authorization for Electronic Network Access
On November 26, 2009, the Board of Education approved the District Policy regarding Access to Electronic
Networks (Policy 6:235). This policy can be reviewed on our website (www.d l23.org).
Students and their parents/guardians must review and sign this Aulhorizqtion for Electronic Ne.|tork Access.
I understand and will abide by the above Authorizotion for Eleclronic Nehrork Access.I
understand that the District and/or is agents may access and monitor my use ofthe Internet,
including my email and downloaded material, without prior notice to me. I further understand
that should I commit any violation, my access privileges may be revoked, and school
disciplinary action and/or appropriate legal action may be taken. In consideration for using the
District's electronic network connection and having access to public networks, I hereby
release the School District and its Board members, employees, and agents from any claims
and damages arising fiom my use of, or inability to use the Intemet.
Student Nrme
SchooVGrade
Student Signsture
Date
*Students are req[ired to have a parenVguardian read and agr€e to lhe following:
I have read this ,{ al horizqtion for Electtonic Networl Access. I understand that access is
designed for educational purposes and that the District has taken precautions to eliminate
controversial material. However, I also recognize it is impossible for the District to restrict
accass to all controversial and inappropriate materials. I will hold harmless th€ District, its
employees, agents, or Board members, for any harm caused by materials or software obtained
via the network. I accept full responsibility for supervision ifand when my child's use is not
in a school setting. I have discussed the terms ofthis ltlrolization with my child. I hereby
request that my child be allowed access to the Distdct's Intemet.
+***This signed Media Consent qnd Aulhorization for Eleclronic Network Access forn will be in elfect os long as
your child is in altendance in q District I23 school, unless vrilten nofirtcation to the contrary is received by the
principal.****
Perent/Guardian Name (Please print)
Drte
ParenVGuardian Signature
Revised o4hgl2o11 mto

Oak Lawn-Hometown School District 123 - Student Information Sheet
- Please make corrections as needed.
Student's Legal Name Birth Date Grade Room Bus # ID Number
Student Address:
lnclude Apt. #
if Applicable
Parent Name
Student Home Phone
ParenUs or Guardian/s who LIVE WITH student
Relationship
Has Custody
Email Address
Fees Paid
Employer
Work Phone
Cell Phone
Additional Phone
Parent Name
Relationship
Has Custody
Email Address
Employer
Work Phone
Cell Phone
Additional Phone
ParenUGuardian who DOES NOT LM WITH student
Parent Name
Relationship
Has Custody
Email Address
Home Address
Home Phone
Work Phone
Employer
Cell Phone
Addt'l Phone
List 2 or 3 RelativeVNeighbors who will care for student if parenUguardian cannot be reached
Emergency Contact I
Relationship HomePhone
Home Address
Cell Phone:
Emergency Contact 2
Work Phone:
Relationship HomePhone
Home Address
Cell Phone:
Emergency Contact 3
Work Phone:
Relationship HomePhone
Home Address
Cell Phone:
Work Phone:
Oak Lawn-Hometown School District 123 is dedicated to ensuring district property tar dollars ar€ spent to educate
lheir neighborhood resident children. Students who live and sleep in residences of District 123 attend school tuition
free. Howeyer, students found to be non-residents of the district snd pr€sent f&lse information regsrding the student's
residency are in yiohtion of the residency policy and may face legal action as well as an annual tuition charge of at least
$&tl 1.00.
Signature of ParenVGuardian:
Dated:

Oak Lawn-Hometown School District 123 - Emergency Information Sheet
(please make corrections as needed)
Student's Legal Name Birth Date Grade Room lBus# ID Number
Student Address:
lnclude Apt. #
if Annlicahle
Student Home Phone
General Health Concerns/Medications
E
I
My child has no healtvmedical concerns
My child does not take m€dication
E My child has lhe following medication and/or rr ears the follo*ing device (such as glasses. h€aring aid, retainer
€tc.):
El
My child had the follo\r'ing health/medical concerns:
Authorization, Release and Indemnity Agreement - to be completed by parenVguardian
I. the undcrsiSned parcnt/guardian of undersland and agree that in the c\ent of illness or injur-1 thcrc is no legal obligati()n on
thc part of School District l2-1. ils emplolees . agcnts or voluntccrs.lo p()\'ide or armngc for medical lrcatment of until I or
onc of thc indi\iduals designated by me on this shcct or the studenl inlbrmation shcct can be contactcd. Accordingl).1
crprcrsl; irgrec t') the foll()\\ ing inslru(ti()n.:
I authorirc School District l2.l authorities to rclcase m] child te an) pcrson listed on thc student information sheet for an)
rcas()n.
If. in the j uditmcnt of Sch(xt I)istricl 123 authoritics. cmcrgcncl mcdical treatment is nccdcd. I authorizc them to contact and
e\change inlormation \rith: I)r. Telephonc:
lf. in the.judgment of Sch(xt I)istrict 123 authoritics. emergencl mcdical treatmcnt is nccded. I aurhorizc thcm ro rransfnrt
my child lo r hospital as dirccted br emcrgencl g:rsonncl. and to c

fh 9fl:,'*HI-HoMErowN
CONSENT FOR RELEASE OF STUDENT RECORDS
Educational Records
Mental Health and/or Developmental Disability Records
I hereby give my consent to:
(School, Agency or Person)
(Address)
(Crty)
(stale)
(Zip Code)
To release the information listed below regarding:
Student:
Birth date:
Grade:
New Address:
(Address) (C'ty) (State) (Zip Code)
To:
(School, Agency, or Person)
(Address)
(C'ty)
(Slate)
(Zip Code)
Please check all that apply:
GENERAL EDUCATION RECORDS
_Progress Reports
Attendance Records Reports
_Health History/lmmunization Records
Group Achievement Test Scores
Cumulative Record
SPECIAL EDUCATION RECORDS
_lEP's
_Multidisciplinary (MOC)
Psychological Evaluations
Speech/Language Reports
Occupational/Physical Therapy
Other
The reason for this release is:
Relocation
Other (please speciry)
This consent expires one year from the date below. However, we understand that we have the right to revoke
this consent in writing any time.
Signalure of ParenUGuardian
Relationship
Student sagnature is required if mental health and developmental disability records are being released and the
student is 12 years of age or older.
Signature of Student
Date
The signature of an adult watness is required if mental health and developmental disability records are being
released-
Adult Wtness
Date
Cc: Siudent File
4201West93rd Street - Oak Lawn, lL 60453 P (708) 423-0150 F {708) 423{160 dl23.or9

fr
gAX LAWN-HoMETOW,V
scnool Dl.arlct 1z!
Address (include Apt#):
Student Name:
Registration Receipt Form
GRADES K-E
New Enrollees
Phone:
School:
(An individual form is required for each student.)
Fees Paid
by s/31/13
Fees Paid
6l t3 - 7t3ul3
Grade:
Fees Paid
8/1/13 & Later
Books
$85.00
$100.00
$ 130.00
Technologv
$60.00
$60.00
$60.00
Subtotsl S1/t5JO $r60Jo $rmJ)0
Gym Shirt (6th, 7th, 8th gr only) $6.00 s6.00 $6.00
Gym Shons (6rh, 7rh, 8th gr only $9.00 $9.00 $9.00
Gvm Lock (6th. 7th. 8th sr onlv) $5.00 $5.00 $5.00
*Optional Educational
Fn'rn.latinn D^nati^n
$ 10.00 $ 10.00 $10.00
"The optional fee is a donation to the School District 123 Educational Foundation. The Foundation helps to bridge
the gap between the "basics" and the "extras" by raising funds and distributing financial and other resources fot
the benefit of our students. A few of the items sponsored by the Foundation include:
. Mini Grants for Teachers
. Technology Equipment
. OLHMS SWAT team
. Science Sleuths Summer Program
Method of Paym.eot
Cash payments will only be accepted in person. DO NOT send cash with your student.
-
-
Check Payable to Oak Lawn-Hometown School District 123 Check $
Pleaac place ctudent name & ID numbs in lnclno cccdon of chccL
I paid online at uurar-dJ.23-org Online Confirmation f
I paid with a credit card.(not odine) Charge Account #
Expiration Date
Securitv Code:
Visa Mastercard Discover_
Your secari$r codeftr your Maletcord Visa or Dtioael card is a lhree-digil number on the back o/your credil
carl rnnedulely/ollowing your main card number.
Other
I understend thet cfeclo leturncd for lnsufddcnt fundc will bc pleced wtth e collection agency and
en addltiond fee of fis.m wil apply.
Parent / Guardian Signature:
Date:
4201 Wesl93rd Street - OakLawn,lL60453 P (708)423{150 F (708)423-0160 dl23.or9