Sycamore School District #427
245 W. Exchange Street
Sycamore, Illinois 60178
Tel: 815-899-8100
Fax: 815-899-8110
Proof of Residency Form
Must be completed for Students New to our District
(Families must also prove residency if they move during the year.)
Dear parent/guardian,
Penalty for falsifying information:
A person who knowingly or willfully provides false information to a school district regarding the residency of a pupil for the
purpose of enabling the pupil to attend any school in the district without the payment of a non-resident tuition charge commits
a class C misdemeanor (not more than 30 days in jail and/or a fine not to exceed $1,500). 105 ILCS 5/10-20.12b and 730
ILCS 5/5-9-1
What does custody mean?
The facts surrounding any temporary transfer of custody will determine whether or not residency has been established. The
mere creation of a guardianship, transfer of custody, or change of address is not sufficient to establish residence for school
attendance purposes. 105 ILCS 5/10-20.12b
What if I am living with a relative or friend?
The relative or friend must be present to show proof of residency. In addition, there needs to be a notarized, signed affidavit
stating that both the resident homeowner and custodial parent are in agreement with this living arrangement.
How do I prove that I live within the district where I want to send my child?
If you own a house, rent an apartment or live with someone within the school district and you are the parent or legal
custodian with whom the child lives, then the school district is required by law to provide the child an education. District 427
requires the following information to prove residency:
Please provide two recent documents from column A AND at least one document from column B showing
proper address:
A
_____
_____
_____
_____
_____
_____
_____
_____
_____
B
Voter registration card
Current cable bill/phone bill
Current gas/electric/water bill
Driver’s license/state identification card
Current homeowners/renters insurance
papers and premium payment receipt
Current Credit card bill
Vehicle Registration
Receipt for moving van rental
Mail received at new residence
_____ Signed and dated lease and proof of last month’s
payment, e.g., canceled check or receipt (renters)
_____ Letter from manager and proof of last month’s
payment, e.g. canceled check or receipt
_____ Mortgage Papers/Valid Agreement of Sale
_____ Most recent Property tax bill and proof of payment,
e.g., canceled check or Form 1098 (homeowners)
_____ Letter of residence from Landlord in lieu of lease
(form is available at all schools & the Superintendent’s Office)
_____ Letter of residence to be used when the person
seeking to enroll a student is living with a District
resident (form is available at all schools & the Superintendent’s
Office)________________________________________________(name)
Student(s): _________________________________
Name
_________________________________
Name
Phone:___________________________________ Cell/Home
Grade/Bldg
_________________________________
Name
Address:___________________________________________
Grade/Bldg
E-mail address:____________________________________
Grade/Bldg
Proof of residency provided by: _____________________________
Parent/legal guardian signature
Approved by: ___________________
________________________________________
Parent/legal guardian printed name
Building: __________________
Date: _________________
6/2/2016
NOTIFICATION OF STUDENT RECORDS BEING TRANSFERRED TO ENROLLING SCHOOL
Dear Student Records Officer:
Please forward ALL records, (permanent, health, I.E.P., etc) for the following student(s)
who has/have enrolled in the Sycamore C.U.S.D. #427.
________________________________
____________
________________
Student Name
Date of Birth
Last Grade
________________________________
____________
________________
Student Name
Date of Birth
Last Grade
________________________________
____________
________________
Student Name
Date of Birth
Last Grade
From:
___________________________________________
Last School Attended
___________________________________________
Street Address
____________________________________________
City, State, Zip
___________________________
Area Code/Phone Number
_______________________
Fax Number
I authorize the release of ALL records for the student(s) listed above to Sycamore High
School.
___________________________________________
Signature of Legal Guardian/Parent
__________________
Date of Request
Records should be sent to Lacey Lantz, Sycamore High School Registrar.
Email: [email protected]
Phone: (815) 899-8144
Fax: (815)899-8206
SYCAMORE HIGH SCHOOL | 427 Spartan Trail | Sycamore, IL 6017
Home Language Survey
ELL Program Process
•
If yes to either question below:
o The ELL staff will screen your child for language proficiency.
o The district will provide a program service recommendation.
o Enrollment will occur.
The state requires the district to collect a Home Language Survey 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 identify the students who need to
be assessed for English language proficiency.
Please answer the questions below and return this survey to your child’s school.
Student’s Name: _________________________________________
1. Is a language other than English spoken in your home?
Yes _____ No _____
What language? ________________________
2. Does your child speak a language other than English?
Yes _____ No _____
What language? ________________________
If the answer to either question is yes, the law requires the school to assess your child’s
English language proficiency.
________________________________________
Parent/Legal Guardian Signature
_____________________________
Date
Cuestionario sobre el Idioma en Casa
Proceso del Programa ELL
•
Si la respuesta es Sí a cualquiera de estas preguntas de abajo:
o El personal de ELL le hará la prueba a su hijo/a para Habilidad de Idioma.
o El distrito le proveerá una recomendación de servicio del Programa.
o La inscripción entonces ocurrirá.
El estado requiere que el distrito colecte un Cuestionario del Idioma en la Casa por cada
estudiante nuevo. Esta información es usada para contar a los estudiantes los cuales sus
familias hablan otro idioma que no sea Ingles en la casa. También ayuda para identificar a
los estudiantes que necesitan ser evaluados para habilidad del Idioma Ingles.
Por favor de responder las preguntas de abajo y regresar este cuestionario a la escuela de
su hijo/a.
Nombre del Estudiante: _________________________________________
1. ¿Se habla otro Idioma en su casa que no sea Ingles?
Sí _____ No _____
¿Qué Idioma? ________________________
2. ¿Su hijo/a habla otro idioma que no sea Ingles?
Sí _____ No _____
¿Qué Idioma? ________________________
Si la respuesta a cualquiera de estas preguntas es Sí, la ley requiere a la escuela de
evaluar la habilidad del idioma Ingles de su hijo/a.
____________________________________________________
Firma del Padre/Tutor Legal
_____________________________
Fecha
State of Illinois
Certificate of Child Health Examination
Student’s Name
Birth Date
Last
Address
First
Middle
Street
City
Sex
Race/Ethnicity
School /Grade Level/ID#
Month/Day/Year
Zip Code
Parent/Guardian
Telephone # Home
Work
IMMUNIZATIONS: To be completed by health care provider. The mo/da/yr for every dose administered is required. If a specific vaccine is
medically contraindicated, a separate written statement must be attached by the health care provider responsible for completing the health
examination explaining the medical reason for the contraindication.
REQUIRED
Vaccine / Dose
DOSE 1
MO
DA
DOSE 2
YR
MO
DA
DOSE 3
YR
MO
DA
DOSE 4
YR
MO
DA
DOSE 5
YR
MO
DA
DOSE 6
YR
MO
DA
YR
DTP or DTaP
Tdap; Td or
Pediatric DT (Check
TdapTdDT
TdapTdDT
TdapTdDT
TdapTdDT
TdapTdDT
TdapTdDT
 IPV  OPV
 IPV  OPV
 IPV  OPV
 IPV  OPV
 IPV  OPV
 IPV  OPV
specific type)
Polio (Check specific
type)
Hib Haemophilus
influenza type b
Pneumococcal
Conjugate
Hepatitis B
Comments:
MMR Measles
Mumps. Rubella
Varicella
(Chickenpox)
Meningococcal
conjugate (MCV4)
RECOMMENDED, BUT NOT REQUIRED Vaccine / Dose
Hepatitis A
HPV
Influenza
Other: Specify
Immunization
Administered/Dates
Health care provider (MD, DO, APN, PA, school health professional, health official) verifying above immunization history must sign below.
If adding dates to the above immunization history section, put your initials by date(s) and sign here.
Signature
Title
Date
Signature
Title
Date
ALTERNATIVE PROOF OF IMMUNITY
1. Clinical diagnosis (measles, mumps, hepatitis B) is allowed when verified by physician and supported with lab confirmation.
copy of lab result.
*MEASLES (Rubeola) MO
DA YR
**MUMPS MO DA YR
HEPATITIS B
MO DA YR
VARICELLA MO DA
Attach
YR
2. History of varicella (chickenpox) disease is acceptable if verified by health care provider, school health professional or health official.
Person signing below verifies that the parent/guardian’s description of varicella disease history is indicative of past infection and is accepting such history as
documentation of disease.
Date of
Disease
Signature
3. Laboratory Evidence of Immunity (check one) Measles*
Mumps**
Rubella
*All measles cases diagnosed on or after July 1, 2002, must be confirmed by laboratory evidence.
**All mumps cases diagnosed on or after July 1, 2013, must be confirmed by laboratory evidence.
Title
Varicella
Attach copy of lab result.
Completion of Alternatives 1 or 3 MUST be accompanied by Labs & Physician Signature: __________________________________________
Physician Statements of Immunity MUST be submitted to IDPH for review.
Certificates of Religious Exemption to Immunizations or Physician Medical Statements of Medical Contraindication Are Reviewed and
Maintained by the School Authority.
11/2015
(COMPLETE BOTH SIDES)
Printed by Authority of the State of Illinois
Sex
Birth Date
School
Grade Level/ ID
#
Student’s Name TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN AND VERIFIED BY HEALTH CARE PROVIDER
Last
First
Middle
Month/Day/ Year
HEALTH HISTORY
ALLERGIES
(Food, drug, insect, other)
Yes
No
MEDICATION (Prescribed or
Yes List:
No
Loss of function of one of paired
Yes
organs? (eye/ear/kidney/testicle)
List:
taken on a regular basis.)
Diagnosis of asthma?
Child wakes during night coughing?
Yes
Yes
No
No
Birth defects?
Yes
No
Developmental delay?
Yes
No
Blood disorders? Hemophilia,
Sickle Cell, Other? Explain.
Diabetes?
Yes
No
Yes
Head injury/Concussion/Passed out?
Seizures? What are they like?
No
Hospitalizations?
When? What for?
Yes
No
Yes
No
No
Surgery? (List all.)
When? What for?
Serious injury or illness?
Yes
No
Yes
No
TB skin test positive (past/present)?
Yes*
Yes
No
TB disease (past or present)?
Yes*
No *If yes, refer to local health
department.
No
Heart problem/Shortness of breath?
Yes
No
Tobacco use (type, frequency)?
Yes
No
Heart murmur/High blood pressure?
Yes
No
Alcohol/Drug use?
Yes
No
Family history of sudden death
before age 50? (Cause?)
Yes
No
Yes
No
Dizziness or chest pain with
exercise?
Eye/Vision problems? _____ Glasses  Contacts  Last exam by eye doctor ______
Other concerns? (crossed eye, drooping lids, squinting, difficulty reading)
Ear/Hearing problems?
Yes
No
Bone/Joint problem/injury/scoliosis?
Yes
No
PHYSICAL EXAMINATION REQUIREMENTS
HEAD CIRCUMFERENCE if < 2-3 years old
Dental
 Braces
 Bridge
 Plate Other
Information may be shared with appropriate personnel for health and educational purposes.
Parent/Guardian
Signature
Date
Entire section below to be completed by MD/DO/APN/PA
HEIGHT
WEIGHT
BMI
B/P
DIABETES SCREENING (NOT REQUIRED FOR DAY CARE) BMI85% age/sex Yes No And any two of the following: Family History Yes  No 
Ethnic Minority Yes No  Signs of Insulin Resistance (hypertension, dyslipidemia, polycystic ovarian syndrome, acanthosis nigricans) Yes No  At Risk Yes  No 
LEAD RISK QUESTIONNAIRE: Required for children age 6 months through 6 years enrolled in licensed or public school operated day care, preschool, nursery school
and/or kindergarten. (Blood test required if resides in Chicago or high risk zip code.)
Questionnaire Administered? Yes  No 
Blood Test Indicated? Yes  No 
Blood Test Date
Result
TB SKIN OR BLOOD TEST Recommended only for children in high-risk groups including children immunosuppressed due to HIV infection or other conditions, frequent travel to or born
in high prevalence countries or those exposed to adults in high-risk categories. See CDC guidelines. http://www.cdc.gov/tb/publications/factsheets/testing/TB_testing.htm.
No test needed 
Test performed 
Skin Test: Date Read
/ /
Result: Positive  Negative 
mm__________
Blood Test: Date Reported
/ /
Result: Positive  Negative 
Value
LAB TESTS (Recommended)
Date
Results
Date
Hemoglobin or Hematocrit
Urinalysis
Results
Sickle Cell (when indicated)
Developmental Screening Tool
SYSTEM REVIEW Normal Comments/Follow-up/Needs
Normal Comments/Follow-up/Needs
Skin
Endocrine
Ears
Screening Result:
Gastrointestinal
Eyes
Screening Result:
Genito-Urinary
Nose
Neurological
Throat
Musculoskeletal
Mouth/Dental
Spinal Exam
Cardiovascular/HTN
Nutritional status
Respiratory
 Diagnosis of Asthma
Currently Prescribed Asthma Medication:
 Quick-relief medication (e.g. Short Acting Beta Agonist)
 Controller medication (e.g. inhaled corticosteroid)
NEEDS/MODIFICATIONS required in the school setting
LMP
Mental Health
Other
DIETARY Needs/Restrictions
SPECIAL INSTRUCTIONS/DEVICES e.g. safety glasses, glass eye, chest protector for arrhythmia, pacemaker, prosthetic device, dental bridge, false teeth, athletic support/cup
MENTAL HEALTH/OTHER
Is there anything else the school should know about this student?
If you would like to discuss this student’s health with school or school health personnel, check title:
 Nurse
 Teacher
 Counselor
 Principal
EMERGENCY ACTION needed while at school due to child’s health condition (e.g., seizures, asthma, insect sting, food, peanut allergy, bleeding problem, diabetes, heart problem)?
Yes  No  If yes, please describe.
On the basis of the examination on this day, I approve this child’s participation in
PHYSICAL EDUCATION
Print Name
Address
Yes 
No 
Modified 
(If No or Modified please attach explanation.)
INTERSCHOLASTIC SPORTS
(MD,DO, APN, PA)
Yes 
No 
Signature
Modified 
Date
Phone
Sycamore High School
Registration Information/Directions for the 2016-17 School Year
All students taking classes at Sycamore High School are required to register before they may
attend classes. There are three ways available for students to register: mail-in registration,
drop-off registration, or walk-in registration.
Mail-in or Drop-off Registration is easy to complete. It alleviates the need for parents to come to
school in August and allows students and parents to avoid the long-lines associated with Walkin Registration. This year, students that complete mail-in or drop-off registration will have
Express Registration Pick-up on August 5th from 10a-1p. This will allow those students to pickup schedules, handbooks, ID’s, and parking permits with a minimal wait.
1. Mail-in Registration: A personal check, or Web Store payment is accepted. Do not
forget to include your payment. Registration will not be processed without it. In
addition, all other required forms on the Registration Checklist must be received at
Sycamore High School no later than July 27th, 2016.
2. Drop-off Registration: A personal check, or Web Store payment is accepted. Do not
forget to include your payment. Registration will not be processed without it. In
addition, all other required forms on the Registration Checklist must be dropped off in the
Main Office (Monday-Thursday 8-12 and 1-4). Dropped-off registration packets will be
accepted through July 27th, 2016.
3. Walk-in Registration: For those who do not meet the July 27th Mail-in/Drop-off
Registration deadline, all materials can be turned in and fees paid at Sycamore High
School Walk in registration on August 4th from 3:00p-7:00p.
There will be no registration packets accepted after July 27th. Students will
be required to attend Walk-in Registration.
Important Dates:
July 27:
All Mail-in and Drop-Off Registration Packets must be returned to Sycamore
High School (Don’t forget to include your payment)
August 3:
Express Pick-Up for students
Registration (10:00 am-1:00 pm)
August 4:
Walk-in Registration (3:00 pm-7:00 pm) A $20 late fee will be charged for
any registration received after August 4th.
August 9:
Freshmen Orientation (6:30 pm-8:30 pm)
August 17:
1st Day of School (Full day)
August 25:
Back to School Night—All parents are welcome (7:00 pm)
that completed
Mail-in or Drop-Off
Important Financial Information for the 2016-17 School Year
Financial Assistance: NEW! If you need to set up a payment plan, visit
www.syc427.org and download the deferred payment plan application. We require 30% of
your total as a down payment. Note: Activity tickets will need to be paid separately, and no
parking permit can be purchased until all fees are paid in full. This application is for High
School students only. Contact the Middle school or Elementary schools for their payment
plan options.
If you think you will qualify for Free/Reduced lunch, please visit www.syc427.org, select
“Parents”, than “Lunch information”. This is an online application to determine your benefits. If
you are approved for Free/reduced lunch, please print off the notification letter, and the Fee
waiver form, and return to the High school along with income documentation, i.e. 4 most recent
pay check stubs, Social security payments, unemployment benefits etc. Incomplete
application and documents will result in a denied application. Please note, this
application is not available until 7/20/16
Please contact Karen Wolf (815-899-8160) with any questions.
IDs: All students need to carry a valid 2016-17 ID with them at all times. IDs are used to
identify students, to admit students into school and all school functions, and to purchase
breakfast/lunch in the cafeteria. Students can pick-up their IDs at registration.
School insurance forms can be picked up in the main office during business hours or during
Walk-in Registration. Please note: Insurance checks should be made payable to Student
Plans, Inc. Parent should write on the check: “Sycamore Schools 2016-17
Senior Pictures: Information pertaining to individual portrait times will be mailed to seniors.
Student Activity Ticket: Students can use this to gain entrance into any home athletic event
(excluding post-season games) and two plays per year, as well as one Orchesis Dance show
ticket. Students may include this as part of the registration fees. This fee cannot be part of a
payment plan.
Student schedules will not be mailed out but may be picked up during Express Pick-Up
(August) or during Walk-in Registration (August).
Supply Lists: Supply lists will be posted for classes on our school website. www.syc427.org
Registration Checklist
Please check that you have completed the following. All forms MUST by signed and
returned.
 Student Fees—using your student’s course request list, check the appropriate fees on
the enclosed form and return it with a check, or Web Store payment
 Student Demographic Form—Verify and/or correct information. Be sure to sign the
bottom of the form
 Student Health Information—completed and signed
 Acceptable Use Policy—signed by student and parent
 Parent Understanding Form—check the boxes and sign
Required for Freshmen:
 Physical—completed and signed by a physician. Student will not be allowed to start
school without a Physical.
Required for Seniors:
 Graduation Diploma Information Sheet Completed
Optional for Juniors and Seniors
 Parking Application Completed
IMPORTANT:
Express Pick-Up is for students who have preregistered through the Mail-in or the Drop-off
Registration process. Express Pick-up will be held on Wednesday, August 3, 2016 from 10-1.
PARENTS DO NOT NEED TO ACCOMPANY THEIR STUDENTS. Students will pick-up the
following items:
▪ ID
▪ Parking Permit
▪ Parent-Student Handbook/Planner
▪ Schedule
Express Pick-Up is only for students that complete Mail-In
Registration or Drop-Off Registration
OFFICE USE ONLY
STUDENT REGISTRATION INFORMATION FORM
ID# ______________________________
School ____________________________
Grade ________ Homeroom __________
Academic Year _____________________
PARENT E-MAIL ___________________________________________________
STUDENTS
LEGAL NAME ______________________________________________________
LAST
FIRST
MIDDLE
SOC SEC NO. _____________________________
ADDRESS ___________________________________________ _________________________________ ________________________
STREET
CITY
STATE
ZIP CODE
PHONE #
COUNTY _________________________
___ MALE ___ FEMALE
LANGUAGE SPOKEN AT HOME ______________________
ADDRESS MAIL TO:
MR./MRS./MS.
__________________________________________
STUDENT
RESIDES WITH ___________________________________
STUDENT’S
DATE OF BIRTH _______________________
MO
DAY
YEAR
STUDENTS
PLACE OF BIRTH ______________ _________________ ______________
COUNTY
CITY
STATE
GUARDIAN (1)
NAME _______________________________________
HOME ADDRESS
(Other Than Students) ______________________________________________
RELATIONSHIP ________________________________________
PHONE #1 _______________________________________
PLACE OF EMPLOYMENT _______________________________
PHONE #2 _______________________________________
GUARDIAN (2)
NAME _______________________________________
HOME ADDRESS
(Other Than Students) ______________________________________________
RELATIONSHIP ________________________________________
PHONE #1 _______________________________________
PLACE OF EMPLOYMENT _______________________________
PHONE #2 _______________________________________
(Optional)
Is the parent and/or guardian a member of the military regardless of status? _____ Yes
_____ No
If yes, what branch and status? _________________________________________________________
FOR EMERGENCY USE – UPDATE YEARLY
“ATTENTION PARENTS: MUST BE UPDATED AND SIGNED YEARLY.”
IF UNABLE TO CONTACT PARENS IN CASE OF EMERGENCY OR ILLNESS, WHOM SHALL WE CALL AND TO WHOM MAY WE RELEASE YOUR CHILD?
1.
____________________________________________________
PHONE #1 ___________________________________
(Emergency Contact Person – Other than Parent)
PHONE #2 ___________________________________
2.
____________________________________________________
PHONE #1 ____________________________________
(Emergency Contact Person – Other than Parent)
PHONE #2 ____________________________________
__________________________________________________________________________________________________________________________
OTHER CHILDREN IN THE FAMILY:
NAME
SCHOOL ATTENDING
GRADE
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
OTHER PERSONS LIVING IN THE HOME
____________________________________________________________________________
RELATIONSHIP TO STUDENT
____________________________________________________________________________
SCHOOL LAST ATTENDED
NEW STUDENTS ONLY – HAS STUDENT BEEN ENROLLED
(If not District #427) ___________________________________ IN DISTRICT #427 BEFORE? IF SO, WHAT SCHOOL?__________________________
The above information is correct to the best of my knowledge _____________________________________________________________________________
SIGNATURE OF PARENT OR GUARDIAN
DATE
SYCAMORE SCHOOLS DISTRICT #427
STUDENT HEALTH INFORMATION
Student Name__________________________________ Grade_____ School __________ Date_____________
Parent Name ___________________________________ Physician’s Name ____________________________
Please provide the health information requested below and sign where indicated. If you have specific issues or
concerns about your child’s health, contact the school nurse.
Allergies: (food, drug, insect, other)
Diagnosis of Asthma?
Child wakes during
night coughing?
Birth defects?
Developmental delay?
Blood disorder?
Hemophilia, Sickle Cell,
Other? Explain
Diabetes?
Head injury?
concussion/passed out?
Seizures? What are they
like?
Heart problem/shortness
of breath?
Heart murmur/high
blood pressure?
Dizziness or chest pain
with exercise?
Yes No
Medications: (list all prescribed or taken on regular basis)
Indicate Severity
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Eye/Vision problems?___________ Glasses  Contacts 
Last exam by eye doctor _________
Other concerns? (crossed eye, drooping lids, squinting,
difficulty reading)
Ear/Hearing problems?
Yes No
Bone/Joint problem
Injury/scoliosis?
Loss of function or one
of paired organs?
(eye/ear/kidney/testicle)
Hospitalizations?
When? What for?
Surgery? (list all)
When? What for?
Serious injury or
illness?
TB skin test positive
(past/present)?
TB disease
(past/present)?
Tobacco use (type,
frequency)?
Alcohol/Drug use?
Family history of
sudden death before
age 50? (cause?)
Dental
 Braces
Other concerns?
Yes No
Yes No
Yes No
Yes No
Yes* No
*If yes, refer to local health
department
Yes No
Yes No
Yes No
Yes No
Bridge Plate
other:
Yes No
Information may be shared with appropriate personnel for health and
educational purposes.
Yes No
Parent/Guardian signature
Date
ADDITIONAL HEALTH INFORMATION
ALLERGIES YES _____ NO _____
1. What causes an allergic reaction? ______________________________________________________
2. What are the symptoms of the reaction? _________________________________________________
3. Use of epipen needed? Yes No (if YES – please provide one to school)
OTHER HEALTH CONCERNS (Include ADD/ADHD, depression, bipolar disorder, orthopedic conditions,etc)
____________________________________________________________________________________
____________________________________________________________________________________
THIS FORM MUST BE
COMPLETED AND
RETURNED TO SHS
Sycamore High School Parent Understanding Form—2016-2017 School Year
The following are statements that require a parent/guardian to read and sign. Please check either yes or
no, stating your agreement or disagreement, for each statement.
yes
no
1) Release of Basic Student Registration and Medical Information: If your child is a
regular bus rider or intends to take the bus on field trips, it is sometimes necessary to have
basic information such as address, parent/guardian information, phone numbers,
emergency numbers so parents/guardians can be contacted if medical attention is needed.
yes
no
2) Emergency Medical Treatment: The school nurse or administration is authorized to
secure medical care and ambulance transport to Kishwaukee Community Hospital, the
nearest hospital facility, in a time of emergency.
yes
no
3) Student Award/Honor Information: The district from time to time announces
listings of students receiving awards and honors. My child’s name is okay to be released
for the purpose of identifying students who excel.
yes
no
4) Drug and Alcohol Survey: An anonymous random written survey is given by The
DeKalb County Partnership for a Safe, Active and Family Environment in the spring. The
purpose of this survey is to help organize, mobilize, and find solutions to the factors that
cause or contribute to alcohol and tobacco use in the community. My child can participate
in this survey.
yes
no
5) Community Trips: At different times during the school year, students are able to
attend local events at NIU or other places within the Sycamore and DeKalb communities.
I give permission to my child to ride a district bus to these events. Advance notice will be
given of these trips.
yes
no
6) Student Handbook: A copy of the Student handbook will be posted to our website.
I intend to become acquainted with its contents. It is my responsibility to read and review
this handbook with my child.
-----------------------------------------------------------------------------------------------------------------------
STUDENT NAME: _______________________________________________________
STUDENT ID NUMBER: _______________________
PARENT/GUARDIAN SIGNATURE: ________________________________________
Sycamore CUSD #427
Photo & Video Release Form for Students
Student _______________________________ Grade_________ School _______________________
I hereby grant Sycamore CUSD #427 and Spartan TV (collectively referred to as the “School District”) permission to
use my likeness and voice in one or more photographs, video recordings, and audio recordings (collectively,
“Recordings”) in any and all of the School District’s websites, social media sites, news releases, television
productions, newsletters, athletic programs, performing art programs, school yearbooks, school newsletters,
publications or other media, whether now known or hereafter existing, controlled or authorized by the School District
(“School District Media”), in perpetuity, and for any other use by the School District.
I agree that Sycamore CUSD #427 will own any and all rights of the resulting Recordings and that the School District
has the right to use said Recordings. I understand that these Recordings may be edited and used in other School
District Media. I understand and acknowledge that I do not have any right to inspect or approve any of the
Recordings or the publication of said Recordings. I further understand and agree that the School District may publish
said Recordings, may stream the Recordings in a live video format on School District Media, and may identify the
students by name in the publication.
I understand and acknowledge that I will not receive any compensation for the Recordings or the publication of said
Recordings, and will not make any monetary or other claim against the School District for the use of any of the
Recordings. With respect to any student information and recordings taken as a result of this agreement, I hereby
waive any and all protections afforded me and my student under the Illinois School Student Records Act and the
Family Educational Rights and Privacy Act. I agree to hold the School District, its Board of Directors, administrators,
employees, agents, and assigns harmless against any and all claims, liability, loss, or damage, including attorney’s
fees, caused or in any way arising out of the publication of the Recordings.
DISCLAIMER: The School District’s video recordings of student activities, including those that are livestreamed on School District Media, cannot be edited to limit or prevent the publication of individual students
participating in these activities. If a student does not want the School District to publish video recordings of
the student participating in these activities, the student must make a written request to the School District to
withdraw from participating in the activity.
I also understand and agree that by signing below, I have read this Release Form and understand its
contents. In the event that I wish to revoke my consent and permission granted by this Release Form, I must
make a written request to the School District stating that it may no longer use my likeness in Recordings. I
acknowledge that I may revoke consent at any time.
Name: (print full name):
Signature:
Parent/Guardian Name (if subject is under 18):
Parent/Guardian Signature:
582375v1
Can we call on you?
We are proud to be a part of a community that promotes and supports education. One way
to promote collaboration and cooperation is to work in partnership with parents.
If you are available to help cultivate a positive relationship by sharing your gifts, talents, and
time with Sycamore High School, please complete the form below and return it with the
registration information.
_________________________________________________
NAME
_________________________________________________
ADDRESS
_________________________________________________
PHONE
_________________________________________________
EMAIL ADDRESS
Area(s) available to help:
_____ Registration Help
_____ Guest Speaker: Enrichment time on Late Start Thursday 8:00am- 8:30am
Topic:________________________________________
_____ Organize food for Teacher Potluck (Monthly)
_____ Coat Check for Dances
_____ Other: _______________________________________
Sycamore CUSD #427
2016 - 2017 School Calendar
15
16
17
Teacher Institute
Teacher Work Day
First Day of Student
Attendance
M
1
7 8
14 15
21 22
28 29
August 2016
T W TH
2 3 4
9 10 11
16 17 18
23 24 25
30 31
7
14
27
28
No School - Institute Day
End of 1st 9 Weeks (MS, HS)
SIP Day Dismiss @ 1:00
No School - Vacation Day
S
October 2016
T W TH F
19-21
21
22-23
26-30
HS Finals
End of 2nd 9 Weeks (MS, HS)
No School - Winter Break
No School - Winter Break
16
17
20
20
24
SIP Day Dismiss @ 1:00
No School - Institute Day
No School - President Day
Emergency Day
End of 2nd Trimester (ELEM)
3
13
14
School Resumes
SIP Day Dismiss @ 1:00
No School - Vacation Day
S
M
F
5
12
19
26
S
6
13
20
27
S
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31
December 2016
T W TH F
1 2
4 5 6 7 8 9
11 12 13 14 15 16
18 19 20 21 22 23
25 26 27 28 29 30
S
M
February 2017
T W TH F
1 2 3
5 6 7 8 9 10
12 13 14 15 16 17
19 20 21 22 23 24
26 27 28
S
M
S
M
September 2016
T W TH F
1 2
4 5 6 7 8 9
11 12 13 14 15 16
18 19 20 21 22 23
25 26 27 28 29 30
S
3
10
17
24
5
No School/Labor Day
November 2016
T W TH F
1 2 3 4
6 7 8 9 10 11
13 14 15 16 17 18
20 21 22 23 24 25
27 28 29 30
S
5
12
19
26
11
21
22
23
24
25
End of 1st Trimester (ELEM)
No School - P/T Conferences
No School - P/T Conferences
No School - Vacation Day
No School - Thanksgiving
No School - Vacation Day
F
6
13
20
27
S
7
14
21
28
2-3 No School - Winter Break
4 School Resumes
16 No School - MLK Day
F
3
10
17
24
31
S
10 End of 3rd 9 Weeks (MS, HS)
4 27-31 No School - Spring Break
11
18
25
F
5
12
19
26
24 Last Day of Classes
S
6
25 Teacher Work Day
13 25-26 Emergency Days
20 29 Memorial Day
27 30-31 Emergency Days
6/1 Emergency Days
S
M
S
M
S
3
10
17
24
31
S
1
8
15
22
29
M
2
9
16
23
30
S
4
11
18
25
March 2017
T W TH
1 2
5 6 7 8 9
12 13 14 15 16
19 20 21 22 23
26 27 28 29 30
April 2017
T W TH F
S
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30
No School
1st/Last Day of School
S
January 2017
T W TH
3 4 5
10 11 12
17 18 19
24 25 26
31
M
S
M
1
7 8
14 15
21 22
28 29
May 2017
T W TH
2 3 4
9 10 11
16 17 18
23 24 25
30 31 1
Emergency Day
SIP Day Dismiss @ 1:00
"Empowering all learners to succeed in their world"
Approved by B.O.E. on January 26, 2016
Back to School Night
August 25th, 2016
Parents Report to the Auditorium
Introduction
7:00-7:10
1st Hour
7:20-7:27
2nd Hour
7:32-7:39
3rd Hour
7:44-7:51
4th Hour
7:56-8:03
5th Hour
8:08-8:15
6th Hour
8:20-8:27
7th Hour
8:32-8:39
Study Halls will not meet. Social Workers, Guidance Counselors, School
Nurse, and Technology Coordinators will be available in the cafeteria to
answer questions. The Library will also be open.
Annual Notice
NOTICE
In compliance with the 1986 Federal AHERA law, we are hereby notifying all interested parties of the location of
the district’s asbestos management plans. Every school building has a copy in the office, which can be viewed with
a prior notice. Location of asbestos containing building materials and assumed asbestos containing building
materials will be listed by building in the management plan. All district management plans are also on file at the
Administration Office.
IPM Policy Statement
F or
School Pest M anagement
Pol icy Statement
Structural and landscape pests can pose significant problems to people, property, and the environment; however,
the pesticides used to solve these problems carry their own risks. It is therefore the policy of Sycamore School
District to use Integrated Pest Management (IPM) programs and procedures for control of structural and
landscape pests.
IPM Procedures
It is the policy of Sycamore School District to utilize IPM principles to manage pest populations adequately. While
the goal of this IPM program is to reduce and ultimately eliminate use of toxic chemicals, toxic chemicals may
become necessary in certain situations. The choice of using a pesticide will be based on a review of all other
available options and a determination that these options are unacceptable or are infeasible, alone or in
combination. Cost or staffing considerations alone will not be adequate justification for use of chemical control
agents. The full range of alternatives, including no action, will be considered.
When it is determined that a pesticide must be used in order to prevent pest levels from exceeding action
thresholds, the least-hazardous material will be chosen. The application of such pesticides is subject to the Federal
Insecticide, Fungicide, and Rodenticide Act (7USC 136 et seq.), School District policies and procedures,
Environmental Protection Agency regulations in 40 CFR, Occupational Safety and Health Administration
regulations, and state and local regulations.
Pest Management
Pests will be managed to
 reduce any potential human health hazard or to protect against a significant threat to public safety
 prevent loss or damage to school resources, structures or property
 prevent pests from spreading in the community, or to plant and animal populations beyond the school
site
 enhance the quality of life for students, staff, and others