PRESCHOOL REGISTRATION FORM FOR 2024-2025

AVAILABLE FEBRUARY 12th - MARCH 31st

ONLY COMPLETE APPLICATIONS WITH ALL REQUIREMENTS SUMITTED WILL BE ACCEPTED

Applications are available to download from our website at: https://www.teaneckschools.org/GradesPK3PK4.aspx or can be picked up at the following location:

Teaneck Early Learning Center, located at 479 Maitland Avenue. Office hours are Monday through Friday from 9:00 a.m. – 3:30 p.m.

All preschool and preschool-related registrations are conducted by appointment only at the Teaneck Early Learning Center. Complete packets can also be emailed to prekregistration@teaneckschools.org. Please call Yamile Fernandez at 201-347-3486 to schedule an appointment or with any questions.

★ If you are registering multiple children, and at least one is for preschool, the entire group will register at the Teaneck Early Learning Center. Please be sure to make an appointment.

All applications must be returned with the following: (All documents must be officially translated in English)
1. Completed Application
2. Original Birth Certificate (Passport can be used to establish an official date of birth if birth certificate is not available).
3. Record of Immunization. New Jersey State Law prohibits students from entering school without a Record of Immunization. The documentation must have the student’s legal name.
4. Physical Form (Most current within 365 days)
5. Proof of Residency – See next page for list of acceptable proof of residency. 6. Custodial documents

PLEASE NOTE: Completion of this form does not guarantee your child will be placed in our Preschool Program.

How did you hear about out Pre-K Program:

◻ District Website / Social media _______________ ◻ School Marquee
◻ Lawn Sign
◻ Banner across Cedar Lane
◻ Flier in a place of business: Name of business _______________________ ◻ Another parent or resident
◻ Other ______________________

Page | 1	Revised: 1/9/2024

	ACCEPTABLE PROOFS OF RESIDENCY

OPTION 1: IF YOU OWN A HOME

1. Please provide a copy of your current property tax bill, tax assessment card or a copy of your deed.

AND

2. Most recent utility bill (i.e. PSE&G, water company, cable, telephone bill).

OPTION 2: IF YOU LEASE

1. Please provide a current copy of your lease and it must include the name of the parent/guardian. AND
2. Most recent utility bill (i.e. PSE&G, water company, cable, telephone bill).

OPTION 3: IF YOU RENT AND DO NOT HAVE A LEASE

1. You must have the owner/landlord of the property complete an Affidavit of Landlord form. The owner of the property must sign the form and have it notarized.

AND

2. The owner must provide a copy of the current property tax bill, tax assessment card or a copy of the deed.

AND

3. Copy of your (Parent/Guardian) most recent utility bill (i.e. PSE&G, water company, cable, telephone bill).

OPTION 4: IF IT IS A PRIVATE HOME AND YOU DO NOT PAY RENT

1. You must have the owner/landlord of the property complete an Affidavit of Landlord form. The owner of the property must sign the form and have it notarized. You do not need to disclose any rent amount on the form.

AND

2. The owner must provide a copy of their current property tax bill, tax assessment card or a copy of the deed.

AND

3. The parent/guardian must provide a copy of a current utility bill (i.e. PSE&G, water company, cable, telephone bill) or any bill that shows the Teaneck address.

Page | 2	Revised: 1/9/2024

ETHNICITY AND RACE COLLECTION

In accordance with required Federal Standards [See 1997 Standards, 62 FR 58789 (October 30, 1997)], educational institutions are required to collect racial and ethnic data in the following manner:

ETHNICITY

Hispanic/Latino? (Yes or No)

Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. The term “Spanish origin” can be used in addition to “Hispanic/Latino or Latino.”

RACE

Please select one or more races from the following five racial groups:

(1) American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.

(2) Asian. A person having origins in any of the original peoples of the Far East, South East Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine islands, Thailand, and Vietnam.

(3) Black or African American. A person having origins in any of the Black racial groups of Africa.

(4) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

(5) White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Page | 3	Revised: 1/9/2024

SKYWARD ID:
	Has the student ever been enrolled in the Teaneck School system? Yes	No
	Supt Approval

HL

Disp Storm

Non Eng

504
	
REGISTRATION DATE:
	Has the student ever been enrolled in a New Jersey school system?	Yes	No
		
REGISTRAR:
	SE PK:
	Evaluation requested:
		
ENTRY CODE:
	IEP:
	Evaluation requested:
		
GRID CODE (ELEM/MS):
				
	BOTTOM PORTION OF PACKET TO BE COMPLETED BY PARENT/GUARDIAN STUDENT INFORMATION

PRESCHOOL REGISTRATION FORM FOR SCHOOL YEAR 2024-2025 TOP PORTION TO BE COMPLETED BY TEANECK PUBLIC SCHOOL PERSONNEL

Child must be 3 or 4 years old on or before October 1, 2024 to be eligible for the preschool program. PLEASE NOTE: COMPLETION OF THIS FORM DOES NOT GUARANTEE YOUR CHILD PLACEMENT IN OUR PRESCHOOL PROGRAM.

MUST BE SUBMITTED NO LATER THAN MARCH 31, 2024

STUDENT FIRST NAME (As on birth certificate)
	STUDENT LAST NAME
	MIDDLE NAME
	GENDER

M	F
	GRADE SCHOOL YEAR 24-25
	
STUDENT’S HOME ADDRESS
	CITY
	STATE
	ZIP CODE
	
STUDENT’S MAILING ADDRESS (if different from home address)
	CITY
	STATE
	ZIP CODE
	
NAME OF PARENT(S)/GUARDIAN
	PRIMARY/HOME NUMBER (preferred contact number for school notifications)
	
PERSON ENROLLING STUDENT
	TELEPHONE NUMBER
	RELATIONSHIP TO STUDENT
	
In accordance with required Federal Standards [See 1997 Standards, 62 FR 58789 (October 30, 1997)], educational institutions are required to collect racial and ethnic data in the following manner:

Ethnicity (must check one)	☐ Hispanic	☐ Non-Hispanic

Race (must check one)	☐ White ☐ Black/African Amer ☐ Amer Indian/Alaskan Nat ☐ Asian

☐ Native Hawaiian/Pacific Islander
	
BIRTHDATE
	AGE
	CITY OF BIRTH
	STATE OF BIRTH
	**COUNTRY OF BIRTH**
	
**First Entry Date into a U.S. School: (if a student is born outside of the U.S.)
	Language Spoken by Child?
	Native Language Spoken by Child?
	Home Language?
	*Did students attend an ESL class in a previous school?

Previous School/Daycare Center:

Page | 4	Revised: 1/9/2024

FAMILY 1 INFORMATION – PARENT/GUARDIAN LIVING IN THE SAME HOUSEHOLD

Parent/Guardian #1 - Relationship to Student: Mother ☐ Father ☐ Legal Guardian ☐ Foster Parent ☐
	
Last Name
	First Name
	Middle Name
	Title
	
Home Address
	
Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Resides with Student	☐Allow Web Access

Parent/Guardian #2 - Relationship to Student: Mother ☐ Father ☐ Legal Guardian ☐ Foster Parent ☐
Step-Parent ☐	DCP&P ☐
	
Last Name
	First Name
	Middle Name
	Title
	
Home Address
	
Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Resides with Student	☐Allow Web Access

FAMILY 2 INFORMATION – IF PARENT/GUARDIAN IS LIVING SEPARATELY

Parent/Guardian #1 - Relationship to Student: Mother ☐ Father ☐ Legal Guardian ☐ Foster Parent ☐ DCP&P
	
Last Name
	First Name
	Middle Name
	Title
	
Mailing Address
	
Primary/Home Telephone
	Cell/Alt Phone
	Email Address
	
Employer
	Work Telephone	Ext
	
☐Extra Mailings	☐Contact Not Allowed	☐Allow Web Access	☐ Receive Hard Copy of Report Card

☐ Receive email/phone notification

Page | 5	Revised: 1/9/2024

Please list ALL siblings currently living in household

Name of sibling
	
Age
	
Grade
	Spec Ed
	
Attending School / Not school age

					

					

EMERGENCY CONTACT INFORMATION

First Contact
	
Name	Phone	Relationship
	
Second Contact
	
Name	Phone	Relationship
	
Third Contact
	
Name	Phone	Relationship

I certify that the information provided in this registration is accurate and truthful to the best of my knowledge. I understand that it is my responsibility to inform my child’s preschool program if I move, or if I have any other changes in circumstances that could affect my child’s enrollment or placement. I understand that by participating in the preschool program, my child’s learning and development will be assessed and monitored to support further growth.

Signature of Parent/Guardian X_________________________________ Date _______________

COMPLETION OF THIS FORM DOES NOT GUARANTEE YOUR CHILD PLACEMENT IN OUR PRESCHOOL PROGRAM.

* Do you have a need for before or aftercare? (Not Guaranteed) Yes__ No__ Before ___ Aftercare___ Both_____

*Has your child received any Specialized Services: Speech ____ Occupational Therapy____ Physical Therapy____

Other: ____________________________

Page | 6	Revised: 1/9/2024

		**PLEASE MAKE SURE TO-- ANSWER  INITIAL ALL QUESTIONS – ON THE LINE AFTER**

SPECIAL SERVICES:

Has your child ever been referred for a special education evaluation? Yes ☐ No ☐ ___________

Has your child ever been evaluated by a special education child study team? Yes ☐ No ☐ ___________

Has your child ever been classified for special education/related services or for speech services? Yes ☐ No ☐ _______

Do you have any reason to suspect that your child may have a learning, emotional or physical issue? Yes ☐ No ☐ ____

Student has an IEP (Individualized Education Program:	Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of IEP: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager:	Yes ☐ No ☐	Teaneck Case Manager Name: _________________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________ If not, why? ___________________________________

SPECIAL SERVICES:

Student has an ISP (Individualized Service Plan):	Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of ISP: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager: Yes ☐ No ☐	Teaneck Case Manager Name: _______________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________

SPECIAL SERVICES:

Has your child ever had a 504 Accommodation Plan: Yes ☐ No ☐ ________ Student has a 504 Accommodation Plan: Yes ☐ ___________	No ☐ ___________

Parent/Guardian provided copy of 504 Accommodation Plan: Yes ☐ No ☐ ___________

Referred by Teaneck Case Manager:	Yes ☐ No ☐	Teaneck Case Manager Name: _________________________________

Referred to Special Services by Registrar: Yes ☐ No ☐ ___________

SPECIAL SERVICES

Early Intervention by NJ state: Yes ☐ No ☐

Do you have a meeting with a case manager: Yes ☐ Date of meeting: ________________	No ☐?

Referred by Teaneck Case Manager:	Yes ☐ No ☐	Teaneck Case Manager Name: ______________________________

Referred to Special Services by Registrar: Yes ☐ No ☐

Parent/Guardian signature: X________________________________________ Date: ___________

Page | 7	Revised: 1/9/2024

CERTIFICATE OF RESIDENCY

I, __________________________________ hereby certify that the statements hereinafter set forth are true: (Name of parent/Legal guardian*)

I am the __________________________ of _____________________________________________________ (Father, Mother, Legal Guardian*)	(Student Name and Age)

______________________________________________________________________________________ who

is an applicant for admission to the Teaneck Public Schools?

This applicant/student resides with me and _________________________________________________________ (List all individuals with whom you reside)

____________________________________________________________________________________________

at ___________________________________________________________________ in the Township of Teaneck. (Residence address)

We have been in actual residence at this address since _______________________________________________ (Month / Day / Year)

Mark the forms of proof you are providing to demonstrate your physical address: Refer to Options 1-4 from page 2 ◻ Copy of Tax Bill or Tax Assessment Card and utility bill
◻ Copy of Deed and utility bill
◻ Copy of Current Lease Agreement and utility bill ◻ Affidavit of Landlord – see option 3 or 4
◻ Other (pending approval)

1. Does Parent/Guardian OWN ☐ or RENT ☐ home address: _______________________________________________

2. If Mother/Father of applicant/student lives in a separate household:

Reason:	◻ Divorced	◻ Separated	◻ Other: _________________________________________

Address: ___________________________________________________________________________________

3. Is there a custodial court order or written agreement designating the district for school attendance?
Circle YES ☐ or NO ☐. If yes, please submit a copy of the written agreement to this form at the time of registration.

4. Does the student reside with one parent for the entire year? Circle YES or NO. If so, with which parent at what address: _________________________________________________________________________________________

5. If the student does not reside with one parent for the entire year, explain the portion of time the student resides with each parent and at what addresses. _____________________________________________________________________________________________

Page | 8	Revised: 1/9/2024

STUDENT NAME: ___________________________________ DOB: _____________ AGE: ____ GRADE: _____	IEP: YES	NO

PARENT/LEGAL GUARDIAN: ___________________________________________________ PHONE: ________________________

LAST PERMANENT PLACE OF RESIDENCY IN NJ:

ADDRESS: ________________________________________________________________________

CITY, STATE, ZIP CODE: ____________________________________________________________

Number of years/months at last permanent address: ____________________________________

Move in date: _______________________	Move out date: _________________________

LAST SCHOOL ATTENDED: __________________________________________________________ GRADE AT LAST SCHOOL: ________

LAST PERMANENT PLACE OF RESIDENCY OUT OF STATE:

ADDRESS: ________________________________________________________________________

CITY, STATE, ZIP CODE: _____________________________________________________________

Number of years/months at last permanent address: ____________________________________

Move in date: ___________________________ Move out date: _____________________________

LAST SCHOOL ATTENDED: ___________________________________________________________ GRADE AT LAST SCHOOL: ________

STUDENT IS PRESENTLY:	IN A SHELTER	IN A MOTEL/HOTEL	DOUBLED UP WITH FAMILY/FRIENDS	KNOWN TO DCP&P

OTHER _______________________________________

CURRENT PHYSICAL LOCATION OF STUDENT RESIDENCE: ______________________________________________ AS OF ______________

RESIDENCE STATEMENT: _______________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Under penalty of perjury under the laws of this state, I declare that the information provided here is true and correct and of my own personal knowledge

and that, if called upon to testify, I would be competent to do so. I also understand that I must notify the Teaneck Public School District of any changes as

soon as they occur. I give my approval for this document to be shared with the District McKinney-Vento Liaison.

Parent/Guardian signature: X ________________________________Date X_______________

Parent/Guardian print name: X_________________________________________________

OSS: ___________________________Date_________

FOR OFFICE USE ONLY ELIGIBLE UNDER MC KINNEY-VENTO ☐YES     ☐ NO

RESIDENCY: ___________________________________________________________________________________________________

DISTRICT OF RESPONSIBILITY: ___________________________________________________________________________________

NOTIFICATION SENT TO:	SCHOOL PRINCIPAL	BUSINESS ADMINISTRATOR	DIRECTOR OF SPECIAL SERVICES	McK-V COUNTY LIAISON

Page | 9	Revised: 1/9/2024

Home Language Survey Parent/Guardian Questionnaire

PLEASE PRINT

This home language survey is to be completed at the time of registration by all who are registering within the Teaneck School District. The information provided is used to determine if another language is spoken in the home. The questions should be completed by the primary caregiver (with translators available, if and when needed).

Child’s name: ____________________________________________	Date: __________ (first)	(middle)	(last)

Child's Date of Birth: ____________________________________________

Person completing the survey: ☐ Mother ☐ Father ☐ Grandparent ☐ Guardian ☐ Other

Please tell us about your child:

1.	What language did the child learn when he/she first began to talk? __________________________

2.	What language does the family speak at home most of the time? ____________________________

3.	What language(s) does the primary caregiver (s) speak to the child most of the time? ____________

4.	What language(s) does the child speak to his/her primary caregiver (s) most of the time? _________

5.	What language(s) does the child speak to his/her brothers and sisters most of the time? __________

6.	What language does the child speak to his/her friends most of the time? _______________________

7.	In which language do you wish to receive information from the school? _______________________

8.	What name do you use for your child (if different from above)? _____________________________

Sources:
Questions 1 – 8 are based on the NJ DOE Home Language Survey that was adapted from the sample survey in A Manual for Community Representatives of the Title VI Steering Committee, published 9/76 by the Institute for Cultural Pluralism, Lau General Assistance Center, San Diego University, San Diego, CA 92182

Page | 10	Revised: 1/9/2024

Skyward Family Access is a web-based application that allows you to track information regarding your child’s progress for the current year. You may access this program by connecting to our secured server to view assignments, attendance, report card grades, and other school information.

Skyward Family Access Parental Use and Responsibility Acknowledgement

I, ______________________________________________________________________________________, (parent/guardian name)
Parent/Guardian of

________________________________________________________________________________________ (student name)

________________________________________________________________________________________ (school student will be attending)

acknowledge that I have requested and received authorization to use Skyward Family Access. I understand that I share the responsibility of keeping safe the data of my child(ren). My responsibilities include reporting any security concerns to the school district, guarding my password, changing my password on a regular basis, and promptly logging off of my Skyward Family Access session when finished or before leaving my computer. I understand that the school district may without prior notification disable my accounts as part of the overall security procedures.

X_________________________________ Print Parent/Guardian Name

X____________________________________ Signature of Parent/Guardian Name

Date: ____________________________

NAME OF PARENT/LEGAL GUARDIANS WHO ARE ALLOWED FAMILY ACCESS
	Parent/Guardian initial receipt of login and password

		

Page | 11	Revised: 1/9/2024

AFFIDAVIT OF LANDLORD

STATE OF NEW JERSEY) SS:
COUNTY OF BERGEN)

I _____________________________________ of full age, and being duly sworn upon his or her oath, according to law, deposes and says:
1. I am the owner of property located at _____________________________________________, in the Township of Teaneck.
2. ____________________________________ is a tenant and has been a tenant at the above premises since ______________(month/day/year). A copy of this tenant’s lease, if same is in written form, is attached hereto. In the event that tenant does not have a written lease, the pertinent terms of said lease are as follows:
A. Circle one of the following: Month to Month / Year to Year B. Rental amount $ _______________ per ______________ C. The names of permissible tenants are as follows:

1. ____________________________

2. ____________________________

3. ____________________________

4. _______________________________

5. _______________________________

6. _______________________________

3. I am making this affidavit knowing that the Board of Education of the Township of Teaneck will rely on same

in determining whether ________________________________ will be considered a pupil who is entitled to

an education free of charge.

I understand that if any of the statements made by me are willfully false that I am subject to punishment.

____________________________________

(LANDLORD) Sworn and subscribed before
me this _______ day of ________

__________________________ (A Notary Public)

Page | 12	Revised: 1/9/2024