The Registration Process

Print and complete all registration documents and bring them to the Franklin
Township Board of Education office of Student Registration located at 1755 Amwell
Road, Somerset, New Jersey along with the items listed below.


1. A valid birth certificate/passports are acceptable (cannot be expired)
2. Two Proofs of Residency in Franklin Township (a combination of the following:
current lease, deed, mortgage statement, property tax statement and a utility bill-
PSEG, Water, Sewer) If you are living with someone in the district, you must
print and complete a Residency Affidavit and have it notarized. In addition
to the Residency Affidavit you must supply proof that the individual listed as
the homeowner or tenant is a Franklin resident. You must bring two forms
of residency documentation for the homeowner or tenant and one for the
parent/guardian registering the student.

3. Proof of all updated immunization records (please note that all immunizations
must be signed or stamped from the doctors office to be considered official)-
As per New Jersey Administrative Code Citation 8:57-4.2-A principal,
director or other person in charge of a school, pre-school, or child care
facility shall not knowingly admit or retain any child whose parent or
guardian has not submitted acceptable evidence of the childs immunization,
according to the schedules specified in this subchapter.

4. Last/most recent Report Card, Transcript of grades, credits earned, State
I.D.# (if transferring from a NJ public school), and standardized test results
such as (GEPA, Terra Nova, etc.). Although the former school district is expected
to forward academic information to the new school district upon notification of
enrollment, it is helpful if copies of standardized test scores and the latest report
card are presented at the time of registration. Please be prepared to share the
name, address and phone number of your child's former school.
5. Photo Identification for parent or guardian registering the child.
6. If you are not the parent or legal guardian of the child, you must provide proof of
guardianship established by NJ Surrogate Court or DYFS placement.
7. If your child is or has been evaluated by any Special Education Committee, you
must bring the most recent copy of the childs IEP (Individual Educational Plan)
Note: After the registration process has been completed, our office will notify the Transportation
Office and you should receive information from them stating your childs eligibility for bus service.

If you have any questions regarding the registration process, please contact the Parent Information
Center/Office of Student Registration.

5:00 am









































Franklin Township Public Schools
1755 Amwell Road, Somerset, NJ 08873
Tel: (732)-873-2400 ext 401; Fax: (732) 873-8393
Parent Information Center/Office of Student Registration


The child whose name appears below has registered at a school within our school district. Will you
please send cumulative records, health records, test records, psychological reports, and any
additional information you may have concerning their progress to the school indicated below.

Thank you for your cooperation.

Childs Name: __________________________________________ Previous Grade: _______

PARENTS CONSENT FOR TRANSFER OF RECORDS

The ____________________________________________ School District has my permission to
(DISTRICT TRANSFERRING FROM)
transfer the full student (s) records, including achievement, behavioral and psychological, for ALL
students listed above to Franklin Township Public Schools. I understand that I may review these
records, in accordance with the provisions of the Family Educational Rights and Privacy Act of
1974.

_______________________________________________________________________________________

ADDRESS OF PREVIOUS SCHOOL

Signature of Parent/Guardian _________________________________________ Date________

Print Name of Parent/Guardian __________________________________________________

*PLEASE SEND STUDENT RECORDS TO THE FOLLOWING SCHOOL*

Conerly Road School-Grade PK-4
C.V Bush - Secretary
35 Conerly Road, Somerset, NJ . 08873
(P) 732-249-9362 (F) 732-247-7076
MacAfee Road School-Grade PK-4
Patsy Hooper - Secretary
53 MacAfee Road Somerset, NJ . 08873
(P) 732-249-9097 (F) 732-247-1408

Elizabeth Ave School-Grade PK-4
Pat Sanchez - Secretary
363 Elizabeth Ave Somerset, NJ . 08873
(P) 732-356-0113 (F) 732-271-2534
Pine Grove Manor School-Grade PK-4
Sharon Pron - Secretary
130 Highland Avenue Somerset, NJ . 08873
(P) 732-246-2424 (F) 732-843-5572

Franklin Park School-Grade PK-4
Judy Nocero - Secretary
30 Eden Street, Franklin Park, NJ . 08823
(P) 732-297-5666 (F) 732-297-5834
Sampson G. Smith School Grade 5-6
Michelle Moskal - Secretary
1649 Amwell Road Somerset, NJ . 08873
(P) 732-873-2800 (F) 732-873-0451

Franklin Park Annex/ child Develop. Center
Jo-Ann Piagentinni - Secretary
1 Central Avenue Franklin Park, NJ . 08823
(P) 732-297-3427 (F) 732-940-8931
Franklin Middle School Grade 7-8
Noreen Leib-Secretary
415 Francis Street Somerset, NJ .08873
(P) 732-249-6410 (F) 732-246-0770

Hillcrest School-Grade PK-4
Terri Levy & Luisa Flintoff - Secretary
500 Franklin Blvd Somerset, NJ . 08873
(P) 732-246-0170 (F) 732-247-8405


Franklin High School Grade 9-12
Patricia Naulty & Evelyn Pemberton Secretary
500 Elizabeth Avenue Somerset, NJ . 08873
(P) 732-302-4200 (F) 732-302-4212


Franklin Township Public Schools
1755 Amwell Road, Somerset, NJ 08873
Tel: (732)-873-2400 ext 401; Fax: (732) 873-8393
Parent Information Center/Office of Student Registration
Pierina De La Cruz, Coordinador of Parent Information Center

The child whose name appears below has registered at a school within our school district. Will
you please send cumulative records, health records, test records, psychological reports, and any
additional information you may have concerning their progress to the school indicated below.

Thank you for your cooperation.

Nombre del Nio (s): __________________________________________ Grado Previo: ____

CONSENTIMIENTO DE PADRES PARA INTERCAMBIO DE ARCHIVOS

El Distrito Escolar de __________________________________________ tiene
(El DISTRITO PREVIO)
mi autorizacin para Intercambiar los archivos del estudiante (s), incluyendo reportes
de progreso, comportamiento y psicolgico, para TODOS los estudiantes nombrado
anteriormente al Distrito Escolar del Municipio de Franklin. Yo entiendo que yo puedo
revisar estos archivos, acordados en las provisiones de los Derechos Educacionales
de Familias y El Acto de Privacidad del 1974.


_____________________________________________________________________

DIRECCIN DE ESCUELA PREVIA

Firma del Padre/Guardin __________________________________ Fecha ________

Escribir el Nombre del Padre/Guardin ______________________________________


*PLEASE SEND STUDENT RECORDS TO THE FOLLOWING SCHOOL*

Conerly Road School- Grade PK-4
Donna Lucash & C.V Bush - Secretary
35 Conerly Road, Somerset, NJ . 08873
(P) 732-249-9362 (F) 732-247-7076
MacAfee Road School-Grade PK-4
Fee Valeri Stark & Patsy Hooper - Secretary
53 MacAfee Road Somerset, NJ . 08873
(P) 732-249-9097 (F) 732-247-1408

Elizabeth Ave School-Grade PK-4
Janet Flissar & Pat Sanchez -Secretary
363 Elizabeth Ave Somerset, NJ . 08873
(P) 732-356-0113 (F) 732-271-2534
Pine Grove Manor School-Grade PK-4
Sharon Pron - Secretary
130 Highland Avenue Somerset, NJ . 08873
(P) 732-246-2424 (F) 732-843-5572

Franklin Park School-Grade PK-4
Judy Nocero & Rosetta Stevenson -Secretary
30 Eden Street Franklin Park, NJ . 08823
(P) 732-297-5666 (F) 732-297-5834
Sampson G. Smith School Grade 5-6
Michelle Moskal & Debra Hentz - Secretary
1649 Amwell Road Somerset, NJ . 08873
(P) 732-873-2800 (F) 732-873-0451

Franklin Park Annex/ child Develop. Center
Jo-Ann Piagentinni - Secretary
1 Central Avenue Franklin Park, NJ . 08823
(P) 732-297-3427 (F) 732-940-8931
Franklin Middle School Grade 7-8
Noreen Leib-Secretary
415 Francis Street Somerset, NJ .08873
(P) 732-249-6410 (F) 732-246-0770

Hillcrest School-Grade PK-4
Terri Levy & Luisa Flintoff - Secretary
500 Franklin Blvd Somerset, NJ . 08873
(P) 732-246-0170 (F) 732-247-8405


Franklin High School Grade 9-12
Patricia Naulty & Evelyn Pemberton Secretary
500 Elizabeth Avenue Somerset, NJ . 08873
(P) 732-302-4200 (F) 732-302-4212


Franklin Township Public Schools
Parent Information Center/Centro de Informacion Para Padres
1755 Amwell Road, Somerset, NJ 08873
Tel: (732) 873-2400; Fax: (732) 873-8393

Parent Affidavit of Residency/Declaracion Jurada de Residencia

If a parent is subletting an apartment or home, or if more than one family shares a living
space and there is only one leaseholder or homeowner, the parent must present a
notarized Address Affidavit signed both by the primary leaseholder as well as the
parent affirming that the family is residing in this home, and must attach the lease, and/or
utility bill (PSEG).
Si un padre no tiene contrato de alquiler, o ms de una familia comparten una vivienda y
hay un solo dueo/a, el padre tiene que presentar este formulario notariado Declaracin
J urada firmado por el dueo/a y el padre afirmando que la familia reside en esta
direccin, adjunto debe estar el contrato de alquiler del dueo/a o cuenta de electricidad.

Section A: Students Information/Informacion del Estudiantes- Print/Letra de Molde

LAST NAME/APELLIDO NAME/NOMBRE GENDER/SEXO DOB/FECHA DE NACI.
1.
2.
3.
4.
5.



Section B:Parent/Guardian Information/Informacion del Padre- Print/Letra de Molde

PARENTS LAST NAME/APELLIDO DEL PADRE NAME/NOMBRE


PARENTS CURRENT ADDRESS/DIRECCION DEL PADRE



HOME PHONE/# DE LA CASA WORK PHONE/# DE TRABAJO CELL PHONE



Section C: Owner, Leaseholder/Dueo/a, o Inquilino Primario-Print/Letra de Molde

OWNERS LAST NAME/APELLIDO FIRST NAME/APELLIDO


OWNERS CURRENT ADDRESS/DIRECCION ACTUAL DEL DUENO



HOME PHONE/# DE LA CASA WORK PHONE/# DE TRABAJO CELL PHONE


RELATIONSHIP TO PARENT/RELACION AL PADRE








To be completed by parent/Para ser completado por el padre:

I, _______________________________, the parent of ___________________________
Yo , el padre de (Nombre del Estudiante)

hereby affirm that I am residing with _________________________________________
afirmo que resido con

at the following address ____________________________________________________
en la siguiente direccin

I understand that Franklin Township Public Schools has the right to conduct an Attendance
Investigation to verify my residence including a visit to the home of the primary leaseholder. I
also understand that registration in school is based on eligibility determined by my residence, and
Franklin Township Public Schools has the right to transfer students for whom falsified
documentation was provided at the time of registration. In the event that my residency changes, I
agree to notify the district and present new proof of address.

Yo entiendo que Las Escuelas Publicas del Municipio de Franklin tienen el derecho de conducir
una investigacin de asistencia incluyendo una visita a la vivienda del dueo/a. Yo tambin
entiendo que la inscripcin esta basada en la elegibilidad determinada por donde vivo, y que el
distrito tiene el derecho de transferir cualquier estudiante que se halla provedo falsa
documentacin al tiempo de inscripcin. Si mi residencia cambia, yo soy responsable de
informarles y someter nueva prueba de direccin.

To be completed by Primary Leaseholder/Owner: Para ser completado por el Dueno/a:

I hereby affirm that______________________________________________________________
Yo afirmo que (Name of Parent and Child-ren) (Nombre del Padre y Estudiante-s)

are residing with me at ___________________________________________________________
residen conmigo en (insert address) (direccin)

I understand that Franklin Public Schools has the right to conduct an Attendance Investigation to
verify the residence of the parties named in this affidvit, including a visit to my home and
interviews with my neighbors. I can be contacted at the number (s) listed below should the
District require further information.

Yo entiendo que Las Escuelas Publicas del Municipio de Franklin tienen el derecho de conducir
una investigacin de asistencia para la verificacin de vivienda de las personas nombradas en esta
declaracin incluyendo una visita a mi hogar e interrogar a mis vecinos. Me pueden contactar en
los nmeros de telfonos enlistados aqu si el distrito necesita ms informacin.

Signatures/Firmas:

Parent Signature/Firma del Padre: _____________________________________________

Primary Leaseholder/Firma del Dueo/a: __________________________________________

State of New Jersey
SS:
County of __________________________________

Sworn to before me this ___________ day of _________________________, Year ___________

____________________________________________________
Notary Public
FRANKLIN TOWNSHIP PUBLIC SCHOOLS
NJ Family Care Health Insurance

Dear Parent/Guardian:

More than a quarter-million New J ersey children lack health insurance, and that number
is likely to grow as the economy deteriorates. If our child does not have health insurance
you may qualify for low cost or no cost health insurance through the NJ FamilyCare
Program. NJ FamilyCare is not a welfare program, but rather the State of New J erseys
way of providing affordable health coverage for kids and certain low-income parents.

NJ FamilyCare is a federal and state funded health insurance program created to help
New J erseys uninsured children and certain low-income parents and guardians to have
affordable health coverage. NJ FamilyCare is for families who do not have available or
affordable employer insurance, and cannot afford to pay the high cost of private health
insurance.

How to qualify can be viewed in 12 languages, and the entire application process can be
completed by mail or online. All enrollment packets contain postage free envelopes. To
find out if you qualify for NJ FamilyCare call 1-800-701-0710, for hearing impaired
individuals TTY 1-800-701-0720. Multi-lingual operators are available and calls are
accepted Mondays and Thursdays between 8:00 a.m. & 5:00 p.m. You may also apply
online at www.njfamilycare.org.

NJ FamilyCare Advantage is another low cost health insurance program offered through
Horizon NJ Health that your family may be eligible for. To qualify you must meet the
following guidelines:

Without health insurance for more than six months
Your children must be under the age of 19
Eligibility id based upon household income and the number of people in your
family

If you have questions about the NJ FamilyCare Advantage program call the Horizon NJ
Health Outreach Center at 1-800-637-2997. You may call toll free from 8:00 a.m. until
7:00 p.m. Monday through Friday. You may access the NJ FamilyCare Advantage
program online at www.horizonnjhealth.com as well.

You may also contact your school nurse for any questions or assistance regarding
healthcare insurance for your child.

IMM-19 (Side 1)
SEP 06
New Jersey Department of Health and Senior Services
Vaccine Preventable Disease Program
PO Box 369
Trenton, NJ 08625-0369
ANNOUNCING
THE NEW JERSEY IMMUNIZATION INFORMATION SYSTEM (NJIIS)
To New J ersey Parents and Guardians:
In order to attend any licensed day care, preschool, public, parochial or private school in New
J ersey, your child must meet state mandated immunization requirements. A record of these
immunizations, supplied by your healthcare provider, is maintained by the school on a state
approved form (A45). This record is essential for admission to any new school to which your child
transfers, for entrance into high school and for college entrance. The New J ersey Immunization
Information System (NJ IIS) has been developed to provide a confidential population-based
electronic database that collects and stores vaccination data for New J ersey residents. This registry
is already in use at more than 400 sites throughout New J ersey, with more than 600,000 patient
records currently in the system. The immunization Information System is the first step in creating
electronic health records for New J ersey school students.
New J ersey public schools are assisting in this project by inputting data from the students
Immunization Record. Participation in this program is free and will provide you with a permanent
record of your childs immunizations, as well as reminders of the need for any additional doses. It
will exist for your child long after graduation when immunization records may be needed for foreign
travel or other situations. It will be available to you for summer camp requirements and should you
change healthcare providers.
Your childs immunization record is confidential. It is available only to you, the Health Department
and its related service agencies (your childs school) and the health provider(s) you choose. If you
change providers, only the new provider will be able to send you reminders.
To enroll in the system, simply sign the consent form on the back of this letter and return it to your
childs school nurse within seven days.
If you have any questions, you may call your childs school nurse.
We hope that you will take advantage of this opportunity to promote the well being of your child.
PLEASE COMPLETE THE REVERSE SIDE OF THIS SHEET AND
RETURN IT TO YOUR CHILDS SCHOOL NURSE!
- OVER -


IMM-19 (Side 2)
SEP 06

NEW JERSEY IMMUNIZATION INFORMATION SYSTEM (NJIIS)
CONSENT TO PARTICIPATE

CHILD INFORMATION (please print) PARENT/GUARDIAN INFORMATION
Name

Name

Date of Birth

Relationship

Address

Address

I have read the information about the New J ersey Immunization Information System (NJ IIS) and
understand that the purpose of this program is to keep a central record of my childs immunization history
and to remind me when immunizations are due. I understand that I can obtain a copy of my childs record
from my medical provider, my local health department, or my childs school nurse.
There is no cost to participate in this program.
Yes, I would like to participate in this program.
No, I do not wish to participate in this program.
Signature of Parent / Guardian

Date

New Jersey Department of Health and Senior Services
Vaccine Preventable Diseases Program
PO Box 369
Trenton, NJ 08625-0369
PLEASE RETURN THIS FORM TO YOUR CHILDS SCHOOL NURSE
WITHIN 7 DAYS
FRANKLIN TOWNSHIP PUBLIC SCHOOLS
Nursing Services/Servicios de Salud

Date/Fecha: _______________________

Dear Parent/Guardian:

There have been new laws enacted to protect the privacy of student health information. In
order to be in compliance with the Family Educational Rights and Privacy Act (FERPA),
we must have the parents/guardians permission to share medically related information
with appropriate staff members at the school. This medically related information would
include, but would not be limited to, information on allergies, history of asthma,
medication, hearing/vision problems, seizures, etc. This confidential information would
be shared only with appropriate staff members with the intent of making them aware of
any potential problems that may arise while your child is in school.

___________ I give permission to share my childs medical information.

___________ I do not want to share my childs medical information.

Student Name ________________________________________________

Parent/Guardian Signature _________________________________________________


Estimado Padre/Guardian:

Una ley ha sido promulgada para proteger la privacidad de informacin de salud de todo
estudiante. Para nosotros obedecer con (FERPA) Family Education Rights and Privacy
Act, nosotros necesitamos permiso de los padres/guardianes para compartir informacin
medica con los empleados apropiados de la escuela. Esta informacin medica puede
incluir, pero no es limitada a, informacin sobre alergias, historial de asma,
medicamentos, problemas de odos o de la vista, convulsiones o ataques, etc. Esta
informacin confidencial ser compartida solamente con los empleados apropiados con la
intencin de informarles de algn problema que pueda ocurrir mientras su hijo/a esta en
la escuela.

__________ Yo doy permiso para compartir informacin mdica de mi hijo/a.

__________ Yo no doy permiso para compartir informacin mdica de mi hijo/a.

Nombre del Estudiante ______________________________________________

Firma del Padre/Guardin ______________________________________________

Rev. 01/09
TO BE COMPLETED BY PARENT

FRANKLIN TOWNSHIP PUBLIC SCHOOLS
Health Appraisal Form

Name_________________________________________________________ M( ) F( ) Grade_______ Age_____
(Last) (First) (Middle)
Address_______________________________________________________ Phone (______) _________________

DOB_________________________________ Place of Birth___________________________________________
(Month) (Day) (Year)
Where is the student coming from?

Within NJ ____________________________(which school in NJ) Out of State _________________(which state)

Out of country ____________________ (which country)

Fathers Name__________________________________ Employer/Phone________________________________

Mothers Name_________________________________ Employer/Phone_________________________________

Guardian_______________________________________Employer/Phone_________________________________

EMERGENCY CONTACT PERSON AND NUMBER________________________________________________

FAMILY PHYSICIAN/CLINIC_____________________________________ PHONE______________________

LANGUAGE SPOKEN AT HOME_______________________________________________________________
CHILDREN IN FAMILY
Name DOB Name DOB
_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

HEALTH HISTORY

DISEASE HISTORY TYPE/YEAR DISEASE HISTORY TYPE/YEAR
Allergies Diabetes

Drug Sensitivities Heart Disease

Lyme Disease Otitis Media

Hepatitis Rheumatic Fever

Neuromuscular Disease Strep Infections

Asthma Mononucleosis

Chicken Pox Vision Disorder

Convulsive Disorder Hearing Disorder

ADHD Congenital Defects


OPERATION/INJURIES (PLEASE SPECIFY):
1.
2.
3.

MEDICATIONS:______________________________________________________________________________
_____________________________________________________________________________________________

ALLERGIES:
Drug_________________________________________________________________________________________
Environmental_________________________________________________________________________________
Food_________________________________________________________________________________________


Speech
Problems______________________________________________________________________________________


Date__________________________ Parent/Guardian Signature______________________________________

FRANKLIN TOWNSHIP PUBLIC SCHOOLS

STUDENT HEALTH AND PHYSICAL EXAM FORM

TO BE COMPLETED BY FAMILY PHYSICIAN OR PEDIATRICIAN

Students Name: Birth Date:
Sex: Male Female
DISEASE HISTORY TYPE/YEAR DISEASE HISTORY TYPE/YEAR
Allergies Diabetes
Drug Sensitivities Heart Disease
Lyme Disease Otitis Media
Hepatitis Rheumatic Fever
Neuromuscular Disease Strep Infections
Asthma Mononucleosis
Chicken Pox Vision Disorder
Convulsive Disorder Hearing Disorder
ADHD Congenital Defects
OPERATION/INJURIES (PLEASE SPECIFY)
1.
2.
3.
ADDITIONAL COMMENTS:



IMMUNIZATIONS:
Vaccine Type DISEASE
DATE
1st Dose
Mo/Day/Yr
2nd Dose
Mo/Day/Yr
3rd Dose
Mo/Day/Yr
4th Dose
Mo/Day/Yr
5th Dose
Mo/Day/Yr
6
th
Dose
Mo/Day/Yr
DT(a)P/DT/Td



OPV



MMR



Measles



MCV



PCV



Hepatitis B



Varicella



Flu



HIB



Lead Level: Date of Last Lead Test:
Mantoux (PPD) Date Administered Date read and Results:


MEDICATIONS:
____________
ALLERGIES:
Drug:
Environmental:
Food: ___________________
BOTH SIDES OF THIS FORM MUST BE COMPLETED

TO BE COMPLETED BY FAMILY PHYSICIAN OR PEDIATRICIAN

FRANKLIN TOWNSHIP PUBLIC SCHOOLS
Students Name: Exam Date:

Height: Weight: Pulse: B/P:
Vision: Uncorrected Right: Left:
Vision: Corrected Right: Left:
Hearing Screen: Right: Left:

Normal Exam Abnormal Findings:
Head
Eyes
Ears
Nose
Throat
Lymph Glands
Heart
Lungs
Abdomen
Hernia
Genitalia
Skin
Orthopedic
Scoliosis
Neurological
Speech
Nutrition


Any limitation of activity? No Yes (please explain)




Physicians signature: Date:


Physicians Name, Address, and telephone number:






COMPLETE BOTH SIDES



MM 11/06