SACRAMENTO RIVER DISCOVERY CHARTER SCHOOL

APPLICATION FOR ADMISSION — School Year _______/_______

Student Name:  ________________________________________________________________________

                          Last                                      MI                                                   First                                                               

Birthdate: _______/_______/_______      SS# __________-______-__________     rMale     rFemale

Address_________________________________________________________________________________

                Street/PO Box                                                          City                                          Zip

Parent/Care Provider:___________________________________________________________________

Home Phone ___________________  Work Phone______________________  ______________________

                                                                                    Father                                   Mother

 Student’s Current Grade __________  Current School:___________________________________________

Siblings also submitting applications for enrollment:

________________________________________     _________/________/_________       ___________

Last Name                           First Name                                              Birthdate                                Grade

________________________________________      _________/________/_________       ___________

Last Name                           First Name                                              Birthdate                                Grade

Ethnicity (Optional)

r American Indian/Alaska Native     rAsisan/Asian American     rPacific Islander      rHispanic

 rFilipino/Filipino American     rBlack/not of Hispanic Origin    rWhite/not of Hispanic Origin     r Other

Special Services

rTitle I       rSpeech       rRSP       rGATE        r Bilingual Ed        r Indian Ed        r Migrant Ed

Home Language Survey:  California Education Code requires schools to determine the language(s) spoken at home by each student.  This information is essential in order for schools to provide meaningful instruction for all students.  Your cooperation in helping us meet this important requirement is requested.

Please answer the following questions.

Which language did your child learn when he/she first began to talk? _______________________

What language does your child most frequently use at home? ______________________________

Which language do you most frequently speak to your child? ______________________________

Name the language most often spoke by the adults at home: _______________________________

ADMISSION REQUIREMENTS AND PARAMETERS

Students:

·         Take responsibility for my own learning and not adversely affect other student’s right to learn

·         To assist in the maintenance and care of the school and the classroom.

·         To attend school every day (ten absences per school year is qualification for expulsion).

Parents/Care Providers:

·         To participate in the learning community of your student by volunteering a minimum of 5 hours per month at the school, working on a designated volunteer project, or a school-related function.

·         To be responsible for your students transportation to and from school.

·         To participate in at least 2 conferences per year with your student’s teacher(s).

Attendance at the Charter School is a choice.  If my student does not meet attendance requirements and adhere to the above parameters as well as those listed in the Discovery Charter School Charter, I understand that he/she will be required to return to the district of residence.

________________________________________          ____________________________________

Signature of Parent/Care Provider                                        Signature of Student

Please return completed Application for Admission to:

DISCOVERY CHARTER SCHOOL

P.O. BOX 1298 • RED BLUFF, CA  96080