Re-Registration Step 1 of 3 33% Student Information:Name* First Middle Last Date of Birth* MM DD YYYY Student Cellphone #*Mom Cellphone #*Dad Cellphone #*Apartment/Trailer/House #*Street Address*Direction*NESENWSWCity*Zip Code*I give permission for Tech to photograph and film my child for the purposes of advertising and school spirit through electronic or print display*YesNoI give my consent for my child to participate in physical and outdoor activities, field trips, explorations and assessments at Tech*YesNoMy child has had a dental examination within the past year*YesNoI would like to continue my learning through:*Online Learning through an Online ProgramIn-Person LearningI have my own individual computer:*YesNoI have internet access:*YesNoThe school will be in contact with you to set up technology for your home.I have a friend who is interested in attending Tech*YesNo Technology Leadership High School Family and School Compact 2022-2023As the Principal of Tech, I will: Create a safe learning environment. Spend quality time observing teachers and your child. Respond to family needs. Communicate high expectations and ambitious success of all students. Demonstrate that barriers can be overcome through academic achievements Create Inclusive and Complete regard for the progress and personal development of all students. Develop individual students through promoting rich opportunities for learning both within and out of the classroom. As a Staff Member of Tech, I will: Provide high-quality projects and instruction in a supportive, safe and challenging learning environment. Hold four family engagements a year during which your child will demonstrate their learning, discuss academics and future secondary goals. Provide families with frequent reports on their child's progress through phone calls, meetings, electronic correspondence and/or written communication. Provide families with information on how to contact school staff: email addresses, phone numbers and/or other manners of communication to discuss family/student interests. Provide family opportunities to participate in their child's off-site explorations and school opportunities. Ensure the vision and mission of the school is achieved. As a Family Member of Tech, I will: Ensure the arrival of my child to school on time. Ensure daily attendance. Participate in decisions relating to the education of my child through a mutually respectful relationship with school staff. Communicate with the teacher with questions or concerns. Attend at least one school engagement this year. contact school with concerns, questions or ideas when appropriate. As a Student of Tech, I will: Attend school daily with timely arrival dressed appropriately. Communicate with my teacher when I have questions or concerns. Contribute, communicate and be present to my team. Follow the rules and procedures so that I can focus on my learning. Talk to an adult at the school when obstacles are in the way of my learning. Be kind, considerate and fair to my classmates, teachers and school community. I accept the family and school compact Miss CortazzoTechnology Leadership Staff* I accept the family and school compact Parent Name*Student Name* Consent for Medicaid School Based Services[Only Complete if Your Child Receives Special Education Services] School Districts in New Mexico have the opportunity to bill Medicaid for health and health related services as documented in the Individualized Education Plan/ Parents must be fully informed of the services, the frequency of the services and the length of time the services will be provided in order to bill Medicaid. Parents must sign a consent form acknowledging that they agree to have Medicaid billed for services designated in the IEP. Any time services change or more services are added, parents must be informed and must sign a new consent form. Consent for Services for Which Medicaid Will Be BilledI have been fully informed of all services listed in his/her IEP that my child will be receiving and agree to have Medicaid billed for such services. In order to bill Medicaid, I consent for my child's name, Medicaid number, services my child receives, dates covered and the code for the type of service to be given to the Medicaid agency for payment. This consent is voluntary and may be revoked at any time. If consent is revoked, it is not retroactive. I understand that if I refuse to allow access to Medicaid benefits, my child's school is not relieved of its responsibility to ensure that all required services provided in my child's IEP are provided at no cost to me. My permission below grants the above consent.Consent to Release Information to your Child's Primary Care Provider or ClinicIn order to obtain a medical order for the health service(s) your child is to receive, information including your child's name, date of birth, type(s) of health related service(s) and length of each service *(e/g/ PT, 30 minutes per week for 6 months) that he or she receives during school hours needs to be released to your child's primary care provider or clinic. This release to share information with my child's doctor or clinic begins on August 10th and is good for one (1) year. My permission below allows the district to release information to my child's primary care provider or clinic.I grant permission*YesNoStudent Name: First Last Student Date of Birth MM DD YYYY Parent Name: First Last Today's Date MM DD YYYY Primary Care Provider Name: First Last Student's Medicaid Number