January, 2017

Dear Prospective Kindergarten Parent/Guardian:

Thank you for your interest in Our Lady of the Visitacion School. We have been an effective educational establishment since 1964 in San Francisco’s Visitacion Valley neighborhood. Our mission is to educate the whole child, and we, along with the Daughters of Charity, work hard to provide a quality Catholic education to those students who enter our school.

In this packet, you will find a Kindergarten Checklist. A child does not need to have absolute mastery over each one of the skills outlined before entering Kindergarten; however, they should be able to perform the tasks to some degree of success. Use the checklist as a guide as opposed to an absolute standard when helping to prepare your child for Kindergarten.

You will also find a copy of the preschool questionnaire in this packet. We do recommend that your child have had a successful preschool experience before applying to Kindergarten and ask that you have your child’s current teacher complete this page.

It is our goal to help you understand exactly what will be needed in order for your child to apply for and be admitted into the 2017-2018 Kindergarten class. The following steps outline the process:

Step 1 Applying to OLV:

  • Meet appropriate age requirement (5 years old by September 1, 2017).
  • Complete our school application BEFORE February 24, 2017. Be sure to include all paperwork such as record of immunizations, Birth Certificate, and Baptismal Certificate if Catholic.
  • Give a copy of our Preschool questionnaire (enclosed in this packet) to your child’s current teacher to complete and have the Preschool mail it directly to:

Our Lady of the Visitacion School

785 Sunnydale Avenue

San Francisco, CA 94134

  • Pay a non-refundable $25 Testing Fee.

Once all parts of Step 1 are completed, we will notify you of your time slot for your child to partake in the 30 minute Kindergarten Readiness Screening. This will be held on Saturday February 25, 2016 between the hours of 9:00 a.m. and 1:30 p.m.

Step 2 Readiness Screening:

  • All children are assessed for Kindergarten readiness. This process helps to ensure that your child is socially and academically ready for OLV School.
  • While students are participating in the Kindergarten Readiness test with our Kindergarten Teacher and Classroom Aide, parents have the opportunity to meet with an OLV School Administrator and complete a Parent Questionnaire.

Step 3 Admission:

  • You will receive a notice through email notifying you of your child’s admission status.
  • For students that are accepted, the following steps need to be completed to secure the child’s spot in the class:
  • Payment of the $100 non-refundable registration fee
  • Completion of all registration paperwork
  • Apply for financial aid and tuition management through TADS application is only to be done AFTER acceptance to OLV School.

If there are any further questions regarding our kindergarten program, you may email the Kindergarten teacher at , or you may call the front office at 415-239-7840 to ask general questions about the school.

Thank you again for your interest in Our Lady of the Visitacion School!

Blessings,

Mrs. Hannah Everhart

OLV Principal

Some of the skills a child should be able to do upon entering Kindergarten:

  • Recognize his/her written first and last name.
  • Print his/her first name.
  • Identify the primary colors.
  • Communicate with adults and peers.
  • Speak in simple sentences.
  • Listen to and follow 3 step directions.
  • Be aware of the feelings of others.
  • Able to sit for periods of 5-15 minutes at a time.
  • Sing the Alphabet Song.
  • Recognize the letters of the Alphabet.
  • Name and draw basic shapes such as circles, squares, and triangles.
  • Recognize numbers.
  • Count objects 1-10.
  • Count up to 20.
  • Hold and write with a pencil.
  • Color with crayons.
  • Trace and draw lines.
  • Use scissors correctly
  • Be able to use the restroom independently.
  • Can be separated from family members for up to 7 hours at a time.

PRESCHOOL/DAYCARE QUESTIONNAIRE

(Parents please fill your child’s name in the first line of this questionnaire and give it to your child’s preschool teacher.)

______has applied for Kindergarten at Our Lady of the Visitacion School for the upcoming school year. Please complete this questionnaire and return it to our school office, by regular mail or email to , as soon as possible. Please do not return to the parent for submission. Your comments will be kept confidential. This child’s enrollment process cannot be completed without this form.

We have an all day Kindergarten (8:10 am - 3:15 pm), and your input on the readiness of the child is essential in helping the school make the appropriate selection. Your forthrightness is appreciated.

Please use these codes in answering the following questions:

S= Satisfactory N=Needs Help NR=Not Ready

Self-help Skills

Independent Dresser _____Independent Toileting _____ Taking care of possessions_____

Social Skills

Demonstrates a cooperative attitude:

in general______toward other children_____toward adults_____

Works well in small groups______Exhibits self-control ______

Work Skills

Show interest in learning______Can focus on task______

Gross Motor Skills

Hopping on one foot_____ Skipping _____Uses alternate feet to walk on stairs_____

Fine Motor Skills

Can use scissors_____ Can write name independently_____ Can glue appropriately_____

Can write some numbers and letters _____ Can hold a crayon or pencil correctly_____

Listening/Speaking Skills (Please answer “yes” or “no”)

Enjoys listening to stories_____ Listens to and follows directions _____

Uses speech clearly and distinctly_____ Speaks English clearly and distinctly_____

Special Interventions

Please describe this child’s strengths and share any current challenges.

______

How long has this child been enrolled at your preschool? ______

In your opinion, is this child ready for a full-day, well-balanced yet academically rigorous Kindergarten Program?______

Additional Comments

______

Name of Preschool ______

Teacher Name ______Email Address______

Please check here if the teacher may contact you for additional information. ______

Send completed form to:

Our Lady of the Visitacion School

Attn: Kindergarten Teacher

785 Sunnydale Avenue

San Francisco, CA 94134

or email to Kindergarten teacher Miss Julia Meyers

OFFICE CHECKLIST: $25/child Testing Fee Birth Certificate Baptismal Communion Immunization Report Card  Test Scores HLS Reg. Fee

School Year 2017-2018

APPLICATION FOR GRADE ______(Grade child will be in for 2017-2018 school year)DATE ______

______/______/______

STUDENT’S LAST NAME FIRST MIDDLE PLACE OF BIRTH BIRTHDATE SOC SEC #

______

LEGAL LAST NAME (if different)

ADDRESS:PHONE:

______(______)______U.S. CITIZEN:  YES  NO GENDER:  M  F

ETHNICITY: ______PRIMARY LANGUAGE SPOKEN AT HOME: ______

SCHOOL STUDENT NOW ATTENDS:ADDRESS: GRADE:

______

Do you have any tuition money due to another school for this student? (if so, please provide explanation)______

********************************************************************************* FAMILY INFORMATION *************************************************************************

LEGAL CUSTODY: CHILD RESIDES WITH: BOTH PARENTS FATHER MOTHER GUARDIAN - relationship: ______

FATHER (NATURAL)MOTHER (NATURAL) ADOPTIVE, STEP, or FOSTER PARENT, GUARDIAN

NAME
HOME/CELL PHONE
EMAIL
ADDRESS
BIRTHPLACE
CITIZEN / US: OTHER: / US: OTHER: / US: OTHER:
RELIGION
ETHNIC HERT.
OCCUPATION
WORK PHONE
DECEASED / DECEASED

BROTHERS/SISTERS WHO ATTEND(ED) OLV SCHOOL:OTHER RELATIVES WHO ATTEND(ED) OLV SCHOOL: YOUNGER SIBLING WHO MAY ATTEND OLV IN FUTURE (include name and current age):

______

Contact information (phone, email, address, etc) for relatives who have attended OLV:

______

*********************************************************************************SACRAMENTAL RECORD***********************************************************************************

BaptismFirst Holy CommunionConfirmation

Date______

Church______

City, State, Country______

Verified by______

If child is not Catholic:Is child baptized?______Religion:______

Parish Affiliation:

Parish in which you live______Parish Church you attend______

*********************************************************************HEALTH/MEDICAL INFORMATION***********************************************************************************

Does your child have any medical, physical or emotional problems that may, in any way, affect his/her performance in school or school activities? Please describe:

______

______

Is your child using medication prescribed by a doctor for a specific condition? If so, please describe:

Condition:______

Medication/Dosage and Side Effects:______

Emergency Procedures Regarding Medication or Condition: ______

Physician: ______

******************************************************************ADDITIONAL INFORMATION NEEDED*******************************************************************************

Why do you wish for your child to attend a Catholic School? ______

______Along with this form please be sure to submit the following in order to complete your application:

$25 per child testing fee

Copy of Birth Certificate

Copy of Baptismal Record (if Catholic) and Copy of 1st Communion Record (if Catholic grades 3 and up)

Copy of Immunization and Health Record (for K only)

Completed Home Language Survey

Report Card and Standardized test scores (grades 3 and up)

Note that after acceptance to OLV School families must pay registration fee, apply for financial aid, and sign up for tuition management through the TADS online system.

Application Revised December 2016

2017-2018 Tuition Information

Please keep this page for your information.

2017-2018 Non-Refundable Registration Fees:

  • New Students - $100 per child
  • Returning Students (non 8th or non Catholic 2nd grade) - $100 per child
  • 8th Grade Catholic Students (includes class sweater, graduation, and confirmation) - $300
  • 8th Grade Non-Catholic Students (includes class sweater and graduation fee) - $220
  • 2nd Grade Catholic or any student participating in 1st Communion in spring 2017 - $150

New student registration due upon acceptance to OLV School.

Returning student registration DUE APRIL 7, 2017

2017-2018 Tuition Rates:

Number of Children / One / Two / Three / Four
Participating Families (TADS Required)
School & Tuition Fees / $4,550 / $8,100
(1st child 4,550 +2nd child 3,550) / $11,150
(1st child 4,550 + 2nd child 3,550 +3rd child 3,050) / $13,700
(1st child 4,550 + 2nd child 3,550 + 3rd child 3,050 + 4th child 2,550)
Non-Participating Families (TADS Required)
School & Tuition Fees / $4,850 / $8,700 / $12,050 / $14,900
Non TADS this rate is only for families if they will not fill out TADS financial aid application. It is the full cost of education per child reflecting the whole cost to send children to OLV School without the assistance of the DOCF Subsidy. / $9,500 / $19,000 / $28,500 / $38,000

Methods of Payment

There are two options offered for payment of tuition.

  • Option 1–full payment as automatic bank withdrawal, cash, or check payable to OLV. Note that even if you pay through cash or check, you will still have a TADS tuition management account. Families who pay the full tuition rate and can make full payment on or before August 1, 2017 will receive a $100 discount on tuition. The discount is only available to those paying the full tuition amount.
  • Option 2–ten monthly payments through your TADS tuition management account. You are encouraged to pay this account through direct automatic bank withdrawal set up through TADS, however cash and checks brought into OLV School office can also be credited to your monthly payments.

This year there will be no extra fee for the TADS financial aid application or tuition management account through TADS.

Date/日期/ Fecha:
Student’s Name/學生姓名/
Nombre del estudiante:
Student’s Grade/學生年級/
Grado del estudiante:
School Site/學校/ Escuela:
School Address/學校地址/
Direccion de la Escuela:
  1. Which language did your child first learn when s/he began to talk?
貴子女最初學講何種語言？¿Qué idioma aprendió primero cuando comenzó a hablar el estudiante?
  1. Which language do you use most frequently to speak with your child?
閣下常用何種語言與貴子女交談？¿En qué idioma le habla al estudiante con más frecuencia?
  1. Which language does your child use most frequently at home? 貴子女在家中常用何種語言？¿Qué idioma habla con más frecuencia el estudiante en su hogar?

  1. Which language do the adults use most frequently at home?家中各成年人常用何種語言交談？¿Qué idioma hablan con más frecuencia los adultos en el hogar?

Parent/Guardian Name (print name)/ 家長／監護人（請用正楷填寫家長／監護人姓名) / Padre/Madre/ Encargado/a (escriba su nombre):
Parent/Guardian Signature/家長／監護人簽署/Firma del/a padre/madre/encargado/a:

SFUSD Curriculum & Instruction, Multilingual Pathways Department

750 25th Avenue, San Francisco, California, 94121 (415) 379-7773

Home Language Survey version: August 2016-2017 SY

San Francisco Unified School District - School Health Form

Completed by Parent or Caregiver:

Child’s Name: / ______ / Birthdate: / ______ / Male / Female / School: / ______
Last, First / month/day/year
Address: / ______ / Phone: / ______/ ______/______ / Grade: / ______
Street / Zip / Home / Cell / / Work

Release of Health Information: I give permission to share the results of this examination with the School ______

Signature of Parent/Caregiver Date

NOTE: Kindergarten entrance physical examination to be done no earlier than March of the year the child enters Kindergarten

Completed by health provider:

IMMUNIZATION RECORD (EACH child should have a completed or updated official/ yellow Immunization Record)

Dose given Month / Day / Year / Tuberculin Skin Test (Mantoux/PPD)
Date: ______

Vaccine

/ 1st / 2nd / 3rd / 4th / 5th
Polio: / Induration: _____mm Impression: □ Negative □ Positive
DTaP/DT (Diphtheria, Pertussis, Tetanus) / Chest X-Ray/RX: required with Positive TB Skin Test
CXR Date:______Impression: □ Negative □ Positive
Td/ Tdap (Tetanus, Diphtheria, Pertussis)
Hib (Haemophilus influenza type B) / RX treatment & duration: _____ / ______
MMR (Measles, Mumps, Rubella) / Not to be given before the 1st birthday /  Child has no risk factors for TB and does not require TB test
*see back for risk factors
Health Provider Signature
Hepatitis B
Varicella (Chickenpox) / Had Varicella disease - Approximate date ______

HEALTH EXAMINATION – Date of Exam______

Results: / Relevant findings: / Follow-up/Referral Needed :
Health/Developmental History
Physical Examination / Ht: ______BP: ______
Wt: ______BMI: ______%
Dental Assessment
Developmental Evaluation
Vision Screening / R: 20/__ L: 20/__
Audiometric (hearing) Screening / 500 / 1000 / 2000 / 4000
Right:
Left:
Nutritional Assessment
Lab Tests / Urine____ Lead ____ Blood test for anemia______
Other

(If you do not want your child to have an exam, you may sign the waiver form, PM 171B, obtained from your child’s school) See other side for more details.

Examination revealed no condition relevant to the school program, e.g. allergies, asthma, cardiac condition, diabetes, epilepsy, etc.

Medical condition identified – emergency care plan attached (emergency care plan template can be downloaded at

Medication taken at school – Name of medication: ______Medication taken at home – Name of medication: ______

(If medication is taken at school, complete a medication form for each medication (medication form template can be downloaded at

Restriction from physical activity – please specify______
Name of Health Provider:
Address:
Phone: / Child under my care since ______.
Signature of Health Provider:______Date: ______

SFUSD School Health Form 2008/2009Page 1

GUIDE TO IMMUNIZATIONS REQUIRED FOR SCHOOL ENTRY

Grades K-12

REFERENCE: Health and Safety Code, Division 105, Part 2, Chapter 1, Sections 120325-120380; California Code of Regulations, Title 17, Division 1, Chapter 4, Subchapter 8, Sections 6000-6075

IMMUNIZATION REQUIREMENTS: To enter or transfer into public and private elementary and secondary schools (grades kindergarten through12), children under age 18 years must have immunizations as outlined below.

VACCINE / REQUIRED DOSES
Polio / 4 doses at any age, but... 3 doses meet requirement for ages 4–6 years if at least one was given on or after the 4th birthday; 3 doses meet requirement for ages 7–17 years if at least one was given on or after the 2nd birthday.
Diphtheria, Tetanus, and Pertussis
Age 6 years and under
DTaP/DT (diphtheria, tetanus, pertussis)
Age 7 years and older (Pertussis is not required)
Td/Tdap
7th grade
Td/Tdap booster / 5 doses at any age, but... 4 doses meet requirements for ages 4–6 years if at least one was on or after the 4th birthday.
4 doses at any age, but...3 doses meet requirement for ages 7–17 years if at least one was on or after the 2nd birthday. If last dose was given before the 2nd birthday, one more (Td/Tdap) dose is required.
1 dose not required but recommended if more than 5 years have passed since last DTap, DT or Td dose.
Measles, Mumps, Rubella (MMR)
Kindergarten
7th grade
Grades 1–6 and 8–12 / 2 dosesboth on or after 1st birthday.
2 dosesboth on or after 1st birthday.
1 dose must be on or after 1st birthday.
Hepatitis B
Kindergarten
7th grade / 3 doses at any age
3 dosesat any age or 2 doses of 2 dose formulation
Varicella
Kindergarten
Out-of-state entrants (grades 1–12) / 1 dose
1 dose for children under 13 years; 2 doses are needed ifimmunized on or after 13th birthday.

EXEMPTIONS: The law allows (a) parents/guardians to choose an exemption from immunization requirements based on their personal beliefs, and (b) physicians of children to elect medical exemptions. The law does not allow parents/guardians to elect an exemption simply because of inconvenience (a record is lost or incomplete and it is too much trouble to go to a physician or clinic to correct the problem). See the back of the blue California School Immunization Record (PM 286) for instructions and the affidavit to be signed by parents/guardians electing the personal beliefs exemption. For children with medical exemptions, the physician's written statement should be stapled to the CSIR. Schools should maintain an up-to-date list of pupils with exemptions, so they can be excluded quickly if an outbreak occurs.

TB Skin Test (with result)……Given in the United States within 1 year before first admission to school in San Francisco

OR

Signature of examiner attesting to no risk factors for TB

Risk Factors for TB in Children

  • Have a family member or contacts with history of confirmed or suspected TB
  • Are in foreign-born families and from high-prevalence countries (Asia, Africa, Central and South America)
  • Adopted from any high-risk area
  • Travel to countries with high rate of TB
  • Live in out-of-home placements
  • Have, or are suspected to have, HIV infection
  • Live with an adult with HIV seropositivity
  • Live with an adult who has been incarcerated in the last five years
  • Live among, or are frequently exposed to, individuals who are homeless, migrant farm workers, users of street drugs, or residents of nursing homes
  • Have contact with individuals(s) with positive TB skin test(s)
  • Have abnormalities on chest X-ray suggestive of TB
  • Have clinical evidence of TB

Screening should be performed by CXR in addition to skin test and symptom review in HIV infected or suspected HIV, other immunocompromised conditions or if child is taking immunosuppressive agents such as chronic predisone or TNF blockers

THE KINDERGARTEN/FIRST GRADE HEALTH EXAMINATION

A completed physical is required for children entering school. The physical examination of kindergarten must be done after March 1st for the same year that they entered school. First graders, the examination must be done not more than 18 months prior to entry. Lack of evidence of a physical examination will result in denial of enrollment.

SFUSD - School Health Form 2008/2009Page 2