Eden Central School

Registration for New Student

Expected Enrollment Daterequired (mm/dd/yyyy)

School Yearrequired

Student Information

Legal First Name required

Middle Namerequired

Legal Last Namerequired

Preferred Name / Nickname

Student DOB:required

Legal Gender*

M F

Please upload Birth Certificate

A BIRTH CERTIFICATE IS REQUIRED. IF YOU CANNOT UPLOAD ONE TODAY, YOU WILL NEED TO DELIVER ONE TO SCHOOL BEFORE YOUR CHILD CAN START ATTENDING.

Max file size: 10 MB

Is Hispanic/Latino*

Yes No

Race*

Entering Grade Levelrequired

Is your student attending an Act 166 private Prekindergarten program?*

Yes No

Town of Residencerequired

Town

Does your student have a current IEP?*

Yes No

Primary Disabilityrequired

Permission is granted for the school to bill Medicaid for my special education student.

Yes No

Does your student have a current 504 plan?*

Yes No

504 Plan Type*

Academic Medical

Does your student have a current EST?*

Yes No

EST Type*

Academic Medical

Does your student have a current plan that is not listed above?*

Yes No

Other Type of Planrequired

Does your student receive English Language Services?*

Yes No

Previous School

Previous School Name and Address required

If this is the first time your child has been enrolled in school enter "None"

I give permission for my student's previous school records to be transferred to the school I am currently enrolling my student in.*

Yes No

Is your student currently suspended or expelled from another school*

Yes No

Residency

Physical Address including street, city, state, and zip coderequired

Click Yes to read additional information about residency.

Yes No

The Lamoille Union School Board is responsible for ensuring the education of pupils who are residents in the Lamoille North Supervisory Union School District. This is comprised of the following towns: Belvidere, Cambridge, Eden, Hyde Park, Johnson and Waterville. In addition, the Board has a responsibility to the taxpayers of this District to be sure that the District is only educating those students whose parents, legal guardians or custodians live in this District, or who meet the legal exceptions to the residency requirement. (example: towns such as Wolcott, where the local District does not include middle or high schools, and students may attend middle and high schools in neighboring districts, tuitioned by their home district) State law allows the district to refuse to accept or to dismiss students who are not legal residents of the district.

In order to determine whether a student is a legal resident as defined by Vermont law, the District must require proof of residency for new students as described below. An exception is if you are homeless and live in any of the following situations: in a shelter, motel, vehicle or campground; on the street; in an abandoned building, trailer or other inadequate accommodations, or doubled up with friends or relatives because you cannot find or afford housing. Contact your school principal and ask about the McKinney-Vento Homeless Education Assistance Act.

Parents, legal guardians or custodians of students must provide proof of primary residency in one of our six towns to the school when enrolling a new student for the first time, when re-enrolling after withdrawal, or if a student’s residency is questionable by providing one of the following:

Current tax bill with parent/legal guardian’s name and address (monetary information blacked out)
Current mortgage papers or closing statement showing parent/legal guardian’s name and address
Formal rental agreement showing name, address and telephone number of the landlord and parent/guardian as renter
A notarized letter from the landlord stating the address of the residence being leased and the name(s) of the lessee(s), along with the landlord’s address and telephone number.In some cases where residency is questionable, the District may also require completion and notarization of the “Affidavit Concerning Pupil Residency”.

Provide Proof Residency:

EXCEPT FOR HOMELESSNESS, RESIDENCY DOCUMENTATION IS REQUIRED. IF YOU CANNOT UPLOAD ONE TODAY, YOU WILL NEED TO DELIVER ONE OF THE FOLLOWING DOCUMENTS TO SCHOOL BEFORE YOUR CHILD CAN START ATTENDING. -Current tax bill with parent/legal guardian’s name and address (monetary information blacked out) - Current mortgage papers or closing statement showing parent/legal guardian’s name and address - Formal rental agreement showing name, address and telephone number of the landlord and parent/guardian as renter - A notarized letter from the landlord stating the address of the residence being leased and the name(s) of the lessee(s), along with the landlord’s address and telephone number - If homeless, contact Jen Hulse at jhulse@lnsd.org.

Max file size: 10 MB

Parent/Contact Information

Who has legal custody?required

Legal Custody Otherrequired

Who has physical custody?required

Physical Custody Otherrequired

If both parents do not have legal and physical custody, please provide the school with the court custody documentation.

Parent/Guardian Legal First Namerequired

Parent/Guardian Legal Last Namerequired

Parent/Guardian 1 Email Addressrequired

Parent/Guardian 1 Home Numberrequired

Parent/Guardian 1 Mobile Numberrequired

Is the mailing address the same as above?*

Yes No

Parent/Guardian 1 Mailing Addressrequired

Relationship to Studentrequired

Other Relationshiprequired

Is there a second parent/legal guardian?*

Yes No

Parent/Guardian Legal First Namerequired

Parent/Guardian Legal Last Name required

Parent/Guardian 2 Email Addressrequired

Parent/Guardian 2 Home Numberrequired

Parent/Guardian 2 Mobile Numberrequired

Is the mailing address the same as above?*

Yes No

Parent/Guardian 2 Mailing Address

Relationship to Studentrequired

Parent/Guardian 2 may pick up from school?

Yes No

Is there an emergency contact in case a parent/guardian listed above cannot be reached?*

Yes No

Emergency Contact 1

Emergency Contact 1 Name

Emergency Contact 1 Phone Number

Does this person have permission to pick your child up from school?

Yes No

Is there a second emergency contact?

Yes No

Emergency Contact 2

Emergency Contact 2 Name

Emergency 2 Contact Number

Does this person have permission to pick up your child from school?

Yes No

Is there anyone legally forbidden to have access to this student?*

Yes No

Please list by name the person forbidden access.

Please upload legal court document related to this restricted person.

Max file size: 10 MB

Act 166: Universal Prekindergarten Tuition Request Form

By requesting pre-kindergarten tuition funds, I agree to:

complete the registration process with my resident school district, which includes proof of residency and proof of age. Schools will provide up to $3,884 for school year 24-25 per school year to one pre-qualified pre-kindergarten provider if the child’s registration is complete before the start of the school year.

I understand that my child’s tuition will be prorated based on the date that I fully complete registration and/or update the information if my child was enrolled last year. (10 hours per week for 35 weeks).

follow the attendance policy provided by the pre-kindergarten program and ensure that my child attends pre-kindergarten consistently. I understand it is my responsibility to notify the Supervisory Union/Supervisory District if we move or if my child stops attending pre-kindergarten or changes programs;
authorize the release of information between my child’s prekindergarten program to communicate with my school district about my child’s development, enrollment, attendance, registration and suspension/expulsion.

I acknowledge that I have read and agree with the information provided in this document.

I plan for my child to attend (Private Prekindergarten Program Name):required

Authorized Signature

Your typed name below serves as a signature certifying the accuracy of the above informationrequired

Date required (mm/dd/yyyy)

Please Note:

A new student cannot begin to attend classes until the receiving school has received proof of age, verification of residency, medical records, and (if applicable) special education records, and verification of custody.

After this form is submitted, you will receive an immediate automated acknowledgement. After it is processed further by our registrar and your parent portal is created, you will receive an email message containing a username and password to login into our student information system and complete the remaining forms.

All forms need to be filled out before the registration is considered complete.