P.O. Box 280
Hay Springs, NE 69347
Ph. 308.638.4434 / Fax 308.638.7500
Thursday, March 11th, 2010 

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  Enrollment Forms and Information

Note: To view the forms on this page, you must have Adobe Acrobat Reader installed on your computer. You can download it for free by clicking the button below.


Transcript Request:
http://www.hshawks.com/enrollment/transcriptrequest.pdf

Records Release:
http://www.hshawks.com/enrollment/recordsrelease.pdf

LIST OF REQUIRED APPOINTMENTS / DOCUMENTS FOR STUDENT ENROLLMENT

IN STATE TRANSFER
  • Appointment with Counselor
  • State Certified Birth Certificate
  • Current Immunization Record, Official Refusal Documents, and/or Doctor's Statement and Signature
  • Documentation of Varicella Disease (Chicken Pox)
  • Physical Form (7th Grade & Activity Participants)
  • Insurance Waiver or a complete Insurance application
  • Technology Agreement
  • School Handbook Receipt
  • School Handbook Acknowledgement
  • Student Information Form
OUT OF STATE TRANSFER OR KINDERGARTENERS
  • Appointment with Counselor
  • State Certified Birth Certificate
  • Current Immunization Record, Official Refusal Documents, and/or Doctor's Statement and Signature
  • Documentation of Varicella Disease (Chicken Pox)
  • Physical Form (All Grades)
  • Vision Exam (All Grades)
  • Insurance Waiver or a complete Insurance application
  • Technology Agreement
  • School Handbook Receipt
  • School Handbook Acknowledgement
  • Student Information Form
RETURNING STUDENT
  • Appointment with Counselor (Grades 9-12 ONLY, prior to the first day of class)
  • Immunization Record after any new immunization has been given
  • Insurance Waiver or a complete Insurance application
  • Technology Agreement
  • Physical Form (7th Grade)
  • School Handbook Receipt
  • School Handbook Acknowledgement
  • Student Information Form
EXTRA-CURRICULAR ACTIVITY PARTICPANTS
  • Physical Form
  • School Handbook Receipt
  • Insurance Waiver or a complete Insurance application
  • Attend Activities Rules Meeting
You may deliver or mail forms to:
Hay Springs Public Schools
PO BOX 280
407 North Baker Street
Hay Springs, NE 69347
(308) 638-4434

STUDENT INFORMATION

Prior to enrollment, every year of enrollment thereafter and when your information changes, the student information form must be completed.

Student Information Form
http://www.hshawks.com/enrollment/studentinfoform.pdf

CLASS SCHEDULING

High School class schedules are set by the cooperative effort of the student and school counselor. Call (308) 638-4434 to schedule an appointment with the counselor. Returning high school students will receive an appointment card each year in their enrollment packet.

Middle Level class schedules are set by the District each school year. For new Middle Level students, please call (308) 638-4434 to visit with the counselor regarding your student.

ML/HS 2008-2009 Class Schedule(subject to change)
http://www.hshawks.com/enrollment/08-09schedule.pdf

Elementary class schedules are set by the classroom teacher in cooperation with the Specials (Music, PE, Spanish, etc) teachers.

HEALTH INFORMATION

Immunizations

Nebraska Law about School Immunization

All 50 states and the District of Columbia have immunization requirements for children entering school. In Nebraska, children can't attend classes in public or private school until the school has written proof of their immunization status.

To attend school, children in Nebraska are required to be immunized against the following diseases:
  • Diphtheria, tetanus, and pertussis
  • Polio
  • Measles, mumps, and rubella
  • Hepatitis B
  • Varicella (chicken pox)
Each school in Nebraska is required to keep the immunization history of the students enrolled on file. Parents or guardians must present one of the following documents to the school to verify immunization status:
  • An immunization record showing that the child is protected by age-appropriate immunizations.
  • A statement signed by a physician that the required immunization would be injurious to the student or members of the student's family or household.
  • An affidavit signed by a legally authorized representative stating that the immunization conflicts with the tenets and practices of a recognized religious denomination of which the student is a member.
Summary of School Rules and Regulations for Immunizations 2008-2009
http://www.hhs.state.ne.us/immunization/2008-2009-School-RR-Summary-with-grades.pdf

Refusal of Immunizations for Medical Reasons
http://www.hhs.state.ne.us/immunization/2_dose_HepB_REFUSAL_OF_IMMUNIZATION_medical.pdf

Refusal of Immunizations for Religious Reasons
http://www.hhs.state.ne.us/immunization/Religious_AFFIDAVIT.pdf

Documentation of Varicella Disease (Chicken Pox)
http://www.hhs.state.ne.us/immunization/Documentation_of_Varicella_Disease.pdf

Birth Certificate

State law requires that a certified copy of a student's birth certificate be used when enrolling a new student in school. If your child is registering at District 3 for the first time, you may obtain this document from the Bureau of Vital Statistics in the state in which your child was born.

Nebraska Birth Certificate Application
http://www.hhs.state.ne.us/ced/birth.pdf

South Dakota Birth Certificate Information
http://doh.sd.gov/VitalRecords/order.aspx#Ordering

Vision Exam

State Law Requires Vision Evaluation

The Children's Vision Law
Effective with the start of the 2006-2007 school year, children are required to have a visual evaluation before entering school for the first time in Nebraska, just as they are required to have a physical examination.

The visual evaluation must be completed by an optometrist, physician, physician assistant, or advanced practice registered nurse within six months prior to the child's entry into school. The required evaluation must consist of testing for amblyopia (lazy eye), strabismus (misalignment of the eyes caused by a muscle imbalance), internal and external eye health, and testing sufficient to determine visual acuity (ability to distinguish objects and shapes).

If parents have questions, they are encouraged to talk with healthcare providers about the requirements. The law is designed to provide an evaluation of the child's vision that is more complete than most vision screenings, enabling parents, healthcare providers and schools to better identify children whose vision may not be sufficient to enable the child to learn to his or her full potential.

School Vision Exam Form
http://www.nechildrensvision.org/documents/SchoolVisionEvaluation_001.pdf

Physical

A physical exam (preparticipation physical evaluation) is required for all students entering a Nebraska school for the first time, all 7th graders, Kindergarteners, and any students wishing to participate in extra-curricular activities.

Preparticipation Physical Evaluation Forms
http://www.nsaahome.org/textfile/spmeds/PPE.pdf

Prescription Medication

Designated school personnel can administer medication to Hay Springs Public School students only when a note of consent accompanies the medication that is brought to school, in its original container.
Note of Consent for Prescription Medication
http://www.hshawks.com/enrollment/permissionforscriptmeds.pdf

Over-The-Counter Medication

Designated school personnel can administer Over-the-Counter medication as directed on the product label to District #3 students only when permission has been granted by the parent/guardian.

Note of Consent for Over-the-Counter Medication
http://www.hshawks.com/enrollment/otcpermissionslip.pdf

Insurance

We must either have an application for the Student Assurance Insurance or a completed Insurance Waiver for each student enrolled.

Insurance Waiver
http://www.hshawks.com/enrollment/insurancewaiver.pdf

Kids Connection is health care coverage for qualified children developed by the State of Nebraska.  It includes both the Children’s Health Insurance Program (CHIP) and the Nebraska Medical Assistance Program (also known as Medicaid).  Its purpose is to provide health care to low-income and low-income uninsured children all across the state.

Kids Connection Application (Nebraska residents)
http://www.hhs.state.ne.us/med/kidsconx.htm

The Children's Health Insurance Program (CHIP) provides health insurance at little or no cost to South Dakota children who meet certain eligibility guidelines. CHIP provides health insurance coverage to uninsured children whose family income is up to 200 percent of the federal poverty level (monthly income of $3,534 for a family of four). Children who already have private health insurance may also be eligible for CHIP paying deductibles, co-payments and other medical services not covered by their private policy.

CHIP Application (South Dakota residents)
http://dss.sd.gov/medicalservices/chip/

Student Assurance Insurance form will be provided to each student on or before August 20th. This form is also available in the school offices after August 4th of each year. For more information, log onto: http://www.sas-mn.com

Hot Lunch Information

Hot Lunch bills are mailed monthly. All lunches and milk purchases are payable in advance.

You may apply at anytime for free and reduced benefits but know that benefits cannot begin until the date your complete application is received by the school district. You are responsible for any balance incurred on your family lunch account up to the date that your application is received. Free and Reduced status does not apply to Morning Milk or Extra Milk at Mealtime.

Price List
K-5-----$2.25
6-12-----$2.75
Adult-----$3.00
Milk-----$.30
2nd Entree-----$.50
2nd Dessert/Cookie-----$.25

Free & Reduced Lunch Application
http://www.nde.state.ne.us/NS/forms/nslpforms/application.pdf

Free & Reduced Lunch Application Form for Self-Employed
http://www.nde.state.ne.us/NS/forms/nslpforms/Self-employment-E.pdf

Morning Milk Form for Elementary Students
http://www.hshawks.com/enrollment/ammilk.pdf

Extra Milk at Mealtime Form
http://www.hshawks.com/enrollment/extramilkatmealtime.pdf

TECHNOLOGY AGREEMENT

Technology Agreement Form
http://www.hshawks.com/enrollment/technologyagreement.pdf

SCHOOL HANDBOOK

08-09 Handbook
*Pending Approval at Board Meeting*

Handbook Receipt
*Pending Approval at Board Meeting* (link to page in handbook)

Handbook Acknowledgement
*Pending Approval at Board Meeting* (link to page in handbook)

SCHOOL SUPPLY LIST

Hay Springs Kindergarten and Mirage Flats Kindergarten and First Graders' supplies are purchased by the respective teachers. $10 is due the first day of school for these supplies.

All other grades K-12, not previously mentioned, have required supplies as indicated on the supply list. Please send the student with their supplies the first day of school.

Supply List K-12
http://www.hshawks.com/enrollment/hayspringssupplylist.pdf

SCHOOL YEAR CALENDAR

2008-2009 Calendar
http://www.hshawks.com/enrollment/08-09schoolyearcalendar.pdf

ACTIVITIES

Price List
Jr. High Participation-----$35.00
High School Participation-----$45.00

Fee Waiver
A copy of the student fee waiver policy is available in the school office. Just check the "share information with other programs" box on the back of the free & reduced lunch application to apply.
http://www.nde.state.ne.us/NS/forms/nslpforms/application.pdf

EMPLOYEE

Letterhead
http://www.hshawks.com/enrollment/letterhead.pdf

Purchase Orders
http://www.hshawks.com/enrollment/purchaseorders.pdf

Leave Request
http://www.hshawks.com/enrollment/leaverequest.pdf

Fix-It-Tickets
http://www.hshawks.com/enrollment/fixittickets.pdf

 
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