2016-2017 September Forms for Website

 

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2016-2017 Summer Forms

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal EMERGENCY HOME CONTACT CARD LETTER (BLUE CARD) PLEASE READ CAREFULLY! September 8, 2016 Dear Parents: Attached you will find the Emergency Home Contact Card (the Blue Card). This card contains vital contact information for the school to use if your child is sick, or in the event of an early dismissal. A separate card must be completed for each of your children attending PS 139Q. Please follow these instructions when completing the card: 1. PRINT ALL INFORMATION. 2. Complete all spaces on the card and include several phone numbers. 3. List at least three (3) adults authorized to pick up your child from school in the event of an early dismissal. Each adult you authorize to pick up your child should:  Be at least 18 years old.  Be available to pick up your child at any time during the day.  Live close to the school in order to pick up your child as quickly as possible.  Know that he/she must come to the school with photo identification to pick up your child. 4. Please make sure that all contact phone numbers listed on the card, including cell phone numbers, are up-to-date and fully activated. 5. Make sure your child(ren) knows the names of the adults you have listed on the card and that he/she (your child) has your permission to leave school with these adults. 6. Remember, if any of the contact information changes, you must submit a new card to the school as soon as possible. Please return this card to school AS SOON AS POSSIBLE, but no later than Friday, September 9th. If you have any questions, or need additional cards, please contact the school at the telephone number above. Remember, if any information on the Blue Card changes, you must contact the school for a new card! Thank you in advance for your cooperation and for your continued support of our school programs. Sincerely, Ms. Natalie L. Perez-Hernandez Principal

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal LUNCH APPLICATION – EACH FAMILY MUST COMPLETE September 8, 2016 Dear Parents: Welcome back to an exciting year for your child! Every family must either complete the school meals paper lunch application sent home today or apply online at nyc.applyforlunch.com or nyc.gov/accessnyc. Each family must complete one lunch form. Please return the paper application by Friday, September 9th if you are not applying online. Applications submitted online are processed within 24 hours of receipt, and you will receive immediate confirmation that your application was submitted. Please keep in mind that it is your responsibility for payment of lunch while your application is being processed. The Office of School Food offers healthy meals every school day. Lunch costs $ 1.75 each day. Breakfast is free for all students It is imperative you submit a complete and accurate lunch application as it is used to determine the level of federal and state funding our school receives. If you need assistance completing the lunch application, please stop by the main office and we will assist you. Thank you for your cooperation. Sincerely, Ms. Natalie L. Perez-Hernandez Principal

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal PHOTO CONSENT FORM CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE FOR PROJECTS DESIGNED TO PROMOTE P.S. 139Q AND ITS CONSTITUENTS (e.g. educational, public service, or health awareness purposes) Student’s Name Class Dear Parent/Guardian, At P.S. 139Q we are very proud of the exceptional quality of our school curriculum and the special programs available to our students. Very often we photograph and videotape class projects, performances, workshops, field trips, meetings, class projects and other events to document these activities for evaluation purposes and sharing within our school community and at the regional level. Please sign the release below so we may include your child in these photos and videotapes, which will be taken throughout the school year. Sincerely, Natalie Perez-Hernandez Principal Please sign and return by Tuesday, September 13, 2016 ........................................................................................................................................................................ To: Mrs. Natalie Perez-Hernandez, Principal Photo Consent I, _____________________________________________ hereby consent to the participation of my Print Name of Parent or Guardian child, _______________________________________ , of Class ______________________________ Print Name of Student Print Grade/Class in the taking of photographs, movies or videotapes, interviews, the use of quotes, and audio taping, at all performances, workshops, field trips, meetings, class projects, and other events that have been officially arranged and/or approved by the school. This consent shall commence, and take effect commencing on the first day of the NYC public school year, which is September 8, 2016 and shall terminate on the last day of the NYC public school year, which is June 28, 2017. I also hereby release the Department of Education of the City of New York, and its agents and employees, from all claims, demands, and liabilities whatsoever in connection with the above. Signature of Parent/Guardian: _____________________________________ Date: _______________ Parent’s Address ____________________________________________________________________

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal TRIP CONSENT FORM (Page 1 of 2) PARENT NOTIFICATION/CONSENT FORM DAY TRIP Name: ____________________________________ Class: ____________________________________ School (list additional trip sponsors when applicable): P.S 139________________ Trip Date: __/___/___ Trip Coordinator_______________________________________________________________________ Destination: __________________________________________________________________________ Departure Site:_ P.S. 139_______________________ Departure Time: ______________________ Return Site: ___P.S. 139______________________ Return Time: _________________________ Mode of Transportation: ________________________________________________________________ Purpose of Trip: ______________________________________________________________________ ____________________________________________________________________________________ Specific Clothing/Equipment Required for this Trip: ___________________________________________ This trip will include the following physical and sports activities (e.g., swimming, horseback riding, ice skating, skiing, boating, etc.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ a) I understand that there are risks of injury associated with the above-listed physical and sports activities and I consent to my child’s participation in all these activities except for the following: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ b) Please indicate below any permanent or temporary medical or other condition, including special dietary and medication needs, or the need for visual or auditory aids, which should be known about your child: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ c) I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child. d) I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies. e) I agree and understand that I am responsible for the actions of my child. I release the school from all claims and liability that arise in connection with the trip, except if due to the negligence of school officials. Continued on Page 2

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal TRIP CONSENT FORM (Page 2 of 2) f) I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site. g) I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, he/she will be subject to school disciplinary procedures and possible criminal prosecution. h) I understand that students who violate the school's discipline code may be excluded in the future by the school from participating in a trip. i) In an emergency I can be reached at: Day: (___) _________________ Evening: (___) _____________ Additional Contact: Name: _____________________ Day: (___) ________ Evening: (___) __________ j) I give my permission for my child to participate in this school trip. ___________________________________________________ (Signature of Parent/Guardian) ________________________ (Date) STUDENT DECLARATION (to be signed by Middle School and High School students) I have read this form and I understand that I am to act on this trip in the same responsible manner in which I am expected to conduct myself in school. _________________________________________________ ________________________ (Signature of Student) (Date)

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal September 8, 2016 WALKING TRIP CONSENT FORM – Kindergarten Only Dear Parent/Guardian, As part of our learning experiences here at P.S. 139Q from time-to-time we take our Kindergarten students on “Nature Walks” and “Neighborhood Explorations”, so they can discover various parts of their natural environment and familiarize themselves with the wonderful neighborhood they live in. We take these walks to enhance the learning experiences and lessons that we are focusing on in the classroom. In order for us to take your child on these wonderful walking experiences we need to have your permission on file. Please sign and return the attached tear-off today, or return it to school no later than Tuesday, September 13, 2016. Your consent will be effective for the 2016-2017 school year. As always, thank you for your support of our students and our school programs. Sincerely, Natalie Perez-Hernandez Principal  ------------------------------------------------------ CUT HERE-----------------------------------------------------  ATTENTION: KINDERGARTEN TEACHER KINDERGARTEN WALKING TRIP PERMISSION SLIP I, _________________________________________ hereby consent to the participation of my Print Name of Parent or Guardian child _____________________________________, of class_____________________________ Print Name of Student Print Grade/Class in the “Nature Walks” and/or “Neighborhood Explorations” that have been officially arranged and/or approved by the school. Signature of Parent/Guardian: _________________________________ Date:_______________

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal CELL PHONE POLICY (PAGE 1 of 2) The Chancellor’s Regulation A-413 permits school-based policies on the use of electronic devices by students. Student Cell Phones and Other Electronic Devices Policy In order to ensure a safe environment, enabling communications between children and their families, before and after school, cell phones may be brought to school. Cell phones and electronic devices are to be turned off, and not to be used during the school day. This includes (but not limited to) locations such as outdoor lineup, cafeteria, classrooms, bathrooms, gym, hallways, stairwells, and play yards; as well as during meal service (breakfast and lunch), after school programs, field trips and on all school buses. During Test Administration During test administration, students are not permitted to bring electronics. In 2012, the New York State Education Department established a policy prohibiting cell phones and other electronic devices. On assessment days, students will be asked to turn over any electronic device at the start of the school day. Administration will collect, label and store said items until the end of the day. If any student is found to be in possession of these electronic devices, after this collection, their tests may be invalidated. Confiscation If a student uses an electronic device in violation of school policy, or in a manner that causes disruption to instruction or school activities or programs, staff should direct the student to comply with school rules, and notify administration. Levels of response may include – directive to put the device away, if seen and not used; to confiscation of the device and returned at the end of the day; to confiscation of the device to be picked up by parent. Where applicable, measures will be implemented in a progressive fashion. Subsequent confiscations may result in revocation of privilege of bringing devices to school. P.S. 139 is not responsible for stolen/lost phones. Use of Electronics Scholars who use cell phones, computing devices, and/or portable music and entertainment system in violation of any provision of the DOE’s Discipline Code, the school’s policy, Chancellor Regulation A-413, and/or the DOE’s Internet Acceptable Use and Safety Policy will be subject to discipline in accordance with the guidance interventions and disciplinary responses set forth in the Discipline Code. (Continued on Page 2)

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal CELL PHONE POLICY (Page 2 of 2) Tear-Off -----------------------------------------------------------------------------------------------------------------------I have read the P.S. 139’s Student Cell Phone Policy based on “The Chancellor’s Regulation A-413”. _____________________________________ Student’s Name _____________________ Class _____________________________________ Parent’s Signature _____________________ Date

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal E-Mail List and Translation Bank Dear Parent/Guardian, E-Mail Update Please update your email address so you can be kept informed of everything happening at P.S. 139. Translation Bank We have a very diverse population at P.S. 139 that speak many languages and we would like to continue our Translation Bank – a Resource for parents who do not speak English as a first language. We welcome the parents who will be willing to translate during special events (Meetings, Parent/Teacher Conferences) and to explain to other parents in their language what is being done in the classrooms and to help explain any questions they might have about homework or special events. If you speak another language and would be willing to help another parent with their translation needs from time-to-time, please check the appropriate box below. If you have any questions or concerns, please feel free to contact me at the phone numbers or e-mail address below. Cell Phone: 347-563-4461 School: 718-459-1044 x 114 E-mail: nlipton@schools.nyc.gov Thank you in advance for your support of these projects. Sincerely, Nina Lipton/Parent Coordinator ------------------------------------------------- Cut here Attention: Nina Lipton, PC ------- ** Please Print Clearly** ----------------------------- E-Mail Update/Translation Bank Child’s Name _______________________________ Child’s Class ____________________________________ Parent’s Name___________________________________ E-mail Address __ __ __ __ __ __ __ __ __ __ __ __ @ __ __ __ __ __ __ __  Yes, I am willing to assist parents with Translation Needs – I can translate the following languages. Language(s) (other than English) Spoken: _______________________________________ Language(s) (other than English) Written: ________________________________________

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Public School 139Q- The Rego Park School 93-06 63rd Drive, Rego Park, New York, 11374 (718) 459-1044 Fax (718) 997-8639 Natalie L. Perez-Hernandez, Principal Stephanie Lazarus, Assistant Principal Kindergarten – Allergy/Health/Cultural Consideration Letter Dear Parent, Does your child have any allergies or special dietary considerations that we should be aware of? In order to ensure that your child’s health needs are considered, please complete the tear–off at the bottom of this letter and return it to school by mail (to the above address, Attention: Nina Lipton), or you may respond with the required information by e-mail to Ms. Lipton at: nlipton@schools.nyc.gov. Please return by Friday, September 9th. If you have any questions, please feel free to contact Ms. Lipton by email or phone 347-563-4461. Thank you. Sincerely, Natalie Perez-Hernandez Principal PLEASE RETURN TO SCHOOL IMMEDIATELY IMPORTANT INFORMATION ABOUT MY CHILD Attention: Nina Lipton NO, MY CHILD DOES NOT HAVE ANY ALLERGIES, SPECIAL DIETARY REQUIREMENTS, SPECIAL HEALTH NEEDS OR CULTURAL CONSIDERATIONS. YES, MY CHILD DOES HAVE ALLERGIES, SPECIAL DIETARY REQUIREMENTS, SPECIAL HEALTH NEEDS OR CULTURAL CONSIDERATIONS, AS I HAVE INDICATED BELOW: Child’s Name ____________________ Parents’ Signature ___________________________ Child’s Class ___________________ Date ________________

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