Forms
ENROLLMENT FORMS
Section One: Enrollment
- Enrollment Table of Contents
- Chart Review Disclaimer
- Inspection of Confidential Records
- Referral Record
- Change of Status (if applicable)
- Child Plus Application form:
- Notification letter (optional if prior to school starting)
- District enrollment forms
- Head Start Parent Handbook
- Student Handbook Code of Conduct (District)
- Copy of birth certificate
- Copy of Social Security card
- Video Surveillance Policy (if applicable)
- Legal Document log or Legal Documents (if applicable)
- Optional/Other Forms
Section Two: Health
- Health Table of Contents
- Consent for Health Services
- Emergency Consent and Medical Information Release form
- Copy of Health Contact Follow-up form (if applicable)
- Documentation of Insurance/Medicaid/Chip or No Insurance/Health Coverage Form
- Health History Form 2A (2 pgs)
- Health Record - Nutrition
- Release of Information-Physical
- Child Health Record - Physical
- Hearing and Vision Screener: 3 year old (if applicable)
- Copy of immunization record
- Risk Assessment for Lead Exposure: Parent Questionnaire
- Lead Results
- Tuberculosis – Parent Questionnaire
- Release of Information-Dental
- Child Health Record - Dental
- Child Plus Growth Charts
- In House Referral (if applicable)
- Accident Report (if applicable)
- Optional/Other Forms
- Denial of Service
- Documentation of Physical / Dental Appointments
Section Three: Social Services
- Social Services Table of Contents
- Progress Notes Social Services or Child Plus Disclaimer
- Center-based Family Partnership Agreement
- Family Partnership Agreement
- Needs Assessment
- Thank you letter to family (optional)
- Parent Interest Questionnaire
- In House Referral (if applicable)
- Permission for Release and Exchange of Information (if applicable)
- Optional/Other Forms
- Denial of Service Form
Section Four: Parent Involvement
- Parent Involvement Table of Contents
- Parent notes (if applicable)
- Parent Staff Contact sheets
- Volunteer Application/Criminal History or Disclaimer
- Tardy/Absent Acknowledgement
- Tardy/Absent Notification Letter
- Absent/Drop Letter (if applicable)
- Need for Transportation Application
- Transportation enrollment (if applicable)
- Optional/Other Forms
Section Five: Education
- Education Table of Contents
- Creative Curriculum Information – Summary Form/Report of Checkpoints
- Outcomes Checklist or Creative Curriculum Signature Sheet
- Dial 3
- DECA or Ages and Stages
- Home Visit Form
- Parent Staff Contact Form
- Home Language Survey – (District)
- Migrant Survey Form – (District)
- Field Trip Permission forms (if applicable)
- In House Referral (if applicable)
- Optional/Other Forms
- Letter to Parents First Home Visit
Section Six: Mental Health
- Mental Health Table of Contents
- Parental Consent for Mental Health/Behavioral Services
- Mental Health Observations/Progress Note (if applicable)
- Positive Guidance Plan (if applicable)
- Mental Health Child Plus Progress Notes or Disclaimer (if applicable)
- Psychological and Social Development Forms (if applicable)
- In House Referral (if applicable)
- Referral for Counseling (if applicable)
- Permission for Release and Exchange of Information (if applicable)
Section Seven: Special Education (if applicable)
- Special Education Table of Contents
- IFSP/IEP or Disclaimer
- BIP (Behavioral Intervention Plan)
- In House Referral (if applicable)
- Optional/Other Forms
