TOOELE COUNTY SCHOOL DISTRICT Social Sec # :_____________________________

STUDENT REGISTRATION FORM Student ID#:_____________________________

14212

Student’s Last Name: ____________________________

Bunn First Name: __________________________
Marcus Middle: B
Grade: ________
8 Homeroom Teacher: __________________________________ Sex: M _____ ✔ F _____ Date of Birth: 4/29/1997
__________________
Has child attended Tooele County Schools Before? Yes _____
✔ No _____ School he/she last attended: __________________________________
TooeleJuniorHighSchool
Are you Hispanic/Latino? Yes ______ No______ ✔ Please select one or more of the following races for yourself:
Amer. Indian/Alaska Native ____ Asian _____ Black or African Amer. _____ Native Hawaiian or Other Pacific Islander _____ White _____ ✔
If American Indian, please check one: Goshute____ Navajo____ Paiute____ Northwest Band Shoshone____ Ute ____ Other _________
In what country was student born (If USA, leave blank): _______________ Date entered U.S.: __________ Date entered U.S. School: _________
Student speaks language other than English? Yes _____ No _____✔ First language spoken by student? ___________________________________
English
All languages spoken or understood by student? _______________________________________________________________________________
All languages spoken in student’s home? _____________________________________________________________________________________
Home Address: ________________________________________________
877 E 420 S City/State: _________________________
Tooele Ut Zip: ________________
84074
Mailing Address (if different): ____________________________________
877 E 420 S City/State: _________________________
Tooele Ut Zip: ________________
84074
Home Phone: _________________________
4358824923 Does your child require Special Education services? _______ 504 Plan? _______ Other? ________

Father’s Last Name: _____________________________

Bunn First Name: ___________________________
Jared & Sharon ✔ No ______
Lives w/child? Yes ______
Home Address: ________________________________________________
877 E 420 S City/State: ________________________
Tooele Ut Zip: ________________
84074
Mailing Address (if different): ____________________________________ City/State: ________________________ Zip: ________________
Home Phone: __________________________________
4358824923 Cell Phone: _________________
8015604004 Email: _____________________________________
Work Address: ________________________________________
Broken Arrow Work Phone: __________________
4358823942 Occupation:________________________

Mother’s Last Name: _____________________________

Bunn First Name: ___________________________
Sharon ✔ No ______
Lives w/child? Yes ______
Home Address: ________________________________________________ City/State: _________________________ Zip: ________________
877 E 420 S Tooele Ut 84074
Mailing Address (if different): ____________________________________ City/State: _________________________ Zip: ________________
Home Phone: __________________________________
4358824923 Cell Phone: _________________ Email: _____________________________________
Work Address: ________________________________________ Work Phone: __________________ Occupation:_________________________

Legal Guardian (if other than parent listed above):

Last Name: _________________________________ First Name: ______________________________ Lives w/child? Yes ______ No _______
Please indicate relationship to child (check one listed below):
Stepfather ___ Stepmother___ Sibling ___ Court Appointed Guardian ___ Uncle/Aunt _____ Grandparent _____ Relative _____ Other ______
Home Address: ________________________________________________ City/State: ________________________ Zip: _________________
Mailing Address (if different): ____________________________________ City/State: _________________________ Zip: _________________
Home Phone: __________________________________ Cell Phone: _________________ Email: ______________________________________
Work Address: ________________________________________ Work Phone: __________________ Occupation: ________________________

Emergency Contacts other than parent. Please provide at least one emergency contact.
1) Last Name: ___________________________________________
Bryan First Name: ____________________________________________________
John
Address: ____________________________________Home
212 Stansbury Circle Tooele Utah 84074 Phone #: ________________
4358824623 Work Phone #: ________________________________
Relationship: Stepfather ___ Stepmother ___ Sibling ___ Uncle/Aunt ___ Grandparent ___ ✔ Relative ___ Friend/Neighbor ___ Other _______

2) Last Name: ___________________________________________

Bunn First Name: ___________________________________________________
Jeannette
Address: ____________________________________Home
66 West 400 South Tooele Utah 84074 Phone #: ________________
4358822802 Work Phone #:________________________________
Relationship: Stepfather ___ Stepmother ___ Sibling ___ Uncle/Aunt ___ Grandparent ___ ✔ Relative ___ Friend/Neighbor ___ Other _______

Other persons authorized to check my child out of school: _______________________________________________________________________

_______________________________________________ Phone Numbers: _________________________________________________________
Daycare authorized to pick up my child: ________________________________________________ Phone: ______________________________

According to legal papers on file with the principal, the individual listed below CANNOT have contact with this student.
8/6/2010
Name: __________________________________________ Relationship: _______________________________ Dated: ____________________

Unless authorized by the custodial parent in person, the child will not be released to anyone other than parents and persons listed on this page. You
may change emergency contacts by coming to the school.
Sharon Bunn
______________________________________________ ____________________
8/6/2010
Parent’s/Legal Guardian’s Signature Date

February 2009
Please mark any of the following that may apply. This information helps the district determine if the student is eligible for additional services.

_____ ZH1. Lives with another family because of a loss of housing or economic hardship.
_____ ZH2. Lives in a motel or hotel.
_____ ZH3. Lives in a shelter (emergency, transitional, or domestic violence).
_____ ZH4. Lives in a car, park, campground, or public place.
_____ ZH5. Lives in a residence without adequate facilities (running water, electricity, heat, etc.).
_____ ZH6. Seeks enrollment without accompanying parent (not to include youth in foster care).

Health Information:
Glasses/contacts: _____ Hearing Aid: _____ Physical Problems: _____ Daily Medicine:_____
Health Problems:
Required assistance: Transportation: _______ Wheelchair: _______ Adult Assistance: _______ Special Equipment: ________
In case of an ACCIDENT or SERIOUS ILLNESS, I request the school to take whatever action seems appropriate.
Sharon Bunn
Parent’s/Legal Guardian’s Signature: ___________________________________________________ 8/6/2010
Date: ____________________

Please list other children in your family (18 years or younger):

Name Gender Age Birth Date School Currently Attending
Carlee Bunn
____________________________ 16
M F ✔ ________ 6/15/1994
___________________
Marcus Bunn
____________________________ ✔M F 13
________ 4/29/1997
___________________
____________________________ M F ________ ___________________
____________________________ M F ________ ___________________

Frequently, Tooele County School District and the media wish to feature student achievement, extra curricular activities, clubs, sports, and
other activities. Do you give permission for your student’s name, picture, school, age, and any honors received or activities participated in to
be utilized in school or district publications, yearbook, school directory, news media, and other publications? Yes ✔ No

Sharon Bunn 8/6/2010

Parent’s/Legal Guardian’s Signature: __________________________________________ Date:
_____________________________

I certify that I am the legal guardian or custodial parent of this student. I certify that I have read and understood the information on this
registration form, that the information entered is correct, and that I will notify the school of any changes to the information herein.

Sharon Bunn
Parent’s/Legal Guardian’s Signature: __________________________________________ 8/6/2010
Date: ______________________________

DISTRICT POLICIES: Included with the registration packet is a copy of the Fee Waiver Application, District Fee Schedule, Family
Education Rights and Privacy Act, Section 504 of the Rehabilitation Act and Americans with Disabilities Act, Safe School Policy and
Unexcused Absences/Truancy Prevention Policy. By Signing below, you are acknowledging that you received this information.
FINANCIAL RESPONSIBILITY: A parent or guardian shall, as part of the registration process, agree in writing to be responsible for
any of the student’s fees or school charges that remain unpaid at the end of the school year and which have not been waived pursuant to
District Policy. At the end of the school year, any fees or charges remaining on the student’s account that are more than 90 days old, may
be referred to a collection agency.
Sharon Bunn
Parent’s/Legal Guardian’s Signature: ___________________________________ Mother
Relationship: ________________ 8/6/2010
Date: __________

The district is requesting this information to better serve the needs of our students under the authority of PL 94-142, Title IV of the Civil Rights Law
and State Administrative Rule R227-716 (1 to 5). This information will be handled confidentially and will be used only for purposes noted in the
law or rule. This information will not subject you to unfair or discriminatory treatment.

TCSD is committed to providing educational opportunities to students without regard to race, color, sex, national origin, or disability. If you
have questions, please contact Title IX Coordinator @435-833-1900.

For School Use Only

Entry Date: _________________ Student ID#: ___________________
0 Special Programs: Special Education _________ 504 ________
Is student eligible for busing? Yes ______ No ______
Lives more than 1 1/2 miles (Elementary) ___ Lives more than 2 miles (Secondary) ___ Pickup Bus #: __________ Dropoff Bus #: __________
Immunizations Record: Yes ______ No ______ Exemption registered: Yes ______ No ______
Emergency Immigrant ______ Refugee ______ Homeless ______ Student is PHLOTE: Yes ______ No ______
 ~Tooele County School District~
HOME LANGUAGE SURVEY
(Given to ALL New Students)

School Tooele Jr Hi Student ID 14212

Last Name Bunn First Name Marcus

Date of Birth 4/29/1997 Place of Birth Salt Lake City, Utah

Years in the United States 13 Number of Years in School: In U.S. 8 Outside U.S. 0

Grade Level 8 Was Student Receiving Language Acquisition Support? Yes ✔ No

Previous School Attended (if Out of District)

Address of School

KEY: A-Asian, B-Black, C-Caucasian, H-Hispanic,

I-Indian (Alaskan Native), P-Pacific Islander

Ethnicity of: Father C Mother C Student C

What was the First Language the Student Learned to Speak? English

What Language(s) does the Student Speak Now?

What Other Languages are Spoken in the Home by Adults or Caregivers?

(If a language other than English might be an influence on student learning, a screening assessment
will be given to determine if the student would benefit from additional support)

Is there anything that we should know that would help your child be successful in this school?

The purpose of acquiring this information is to determine Individual Language Development Plans
(ILDP’s) for students who may qualify as English Language Learners and to implement Alternative
Language Services for our students (ALS).
 Tooele County School District
STUDENT HEALTH PROFILE
2010-11

If the student has no health problems, fill in top portion, check “None” (#1 below) and sign.
Last Name: Bunn First Name: Marcus
Birth Date: 4/29/1997 M ✔ F Grade: 8 Teacher:
Parent Name: Jared & Sharon Bunn Home Phone: 4358824923
Work Phone:
Medical Provider: Regence Office Phone: 1-888-367-2119

PARENTS: You must contact the school if your child has a health concern that needs to be
addressed at school.

Does your child have any serious health concerns? Briefly describe current medical problems that
Yes may result in an emergency at school.
✔
1. None
2. Asthma
3. Diabetes
4. Seizures
5. Life threatening allergies
6. Chronic conditions
7. Medical conditions to be addressed at school
Does your child ride the bus? Yes ✔ No

List all medications child is taking at school:

1. Name Dosage Time Given
2. Name Dosage Time Given
3. Name Dosage Time Given
List all medical treatments or procedures done at school:
1. Procedure Time
2. Procedure Time
3. Procedure Time

Special Needs: i.e., location in classroom, wheelchair, hearing aids, etc.

I give permission to share the information on this card with school personnel who have a need to know
my child’s health concerns. Yes ✔ No

If changes in above information occur during the school year, please notify the school to
update form.

Parent/Guardian Signature: Sharon Bunn Date: 8/6/2010

TCSD is committed to provide educational opportunities to students without regard to race, color, sex, national origin, or
disability. If you have questions, please contact Title IX Coordinator, Assistant Superintendent @(435)833-1900.

January 2008
PRINT NAME: Marcus Bunn SCHOOL: Tooele Jr Hi

5:48 ACCEPTABLE USE POLICY Approved June 16, 2009

A. PURPOSE

Tooele County School District (TCSD) provides a number of electronic resources such as access to the
Internet, email, student information services and other web-based applications. Content filters are
used to ensure the safety of all who are TCSD electronic resources. These resources provide the means
necessary for students, teachers, administrators and staff to complete assigned tasks and further
educational goals. Each of the guidelines below must be strictly adhered to; failure to do so will result
in disciplinary action. Resources provided by TCSD are to be used for research and to enhance
instruction. This legal and binding document shall be reviewed and signed annually. A signed copy will
be kept on file in Tooele County School District’s Instructional Technology Department.

B. GUIDELINES

1. User Privacy:
a. Respect and protect the privacy of others
b. Do not distribute, view, use or copy data or passwords on computers/networks for which you
are not authorized.
c. Computer/network etiquette will be observed as data/images reside on the Internet
indefinitely.
2. User Security:
a. Protect the integrity, availability and security of all technology resources.
b. Refrain from vandalism, do not destroy or damage computers or data resources residing on
TCSD networks.
3. User Rights:
a. The use of electronic resources is a privilege not a right.
b. Respect the intellectual property of others. Do not plagiarize or make illegal copies of music,
games, movies or academic works.
c. In a case of probable cause, there is no expectation of privacy.
4. User Responsibility:
a. Communicate in a professional, reasonable and clear manner.
b. Report any threats or objectionable materials received electronically.
c. Do not intentionally access, transmit, copy or create pornographic content, threatening or
obscene language, and unethical, discriminatory or illegal communications on any electronic
device owned by TCSD or on TCSD networks or property.
d. Do not use TCSD resources to further acts of a criminal nature.
e. Do not spam (send unsolicited mailings) sell, advertize or otherwise conduct personal business
at the expense of TCSD.
f. Guest Access:
g. Guests are permitted on the TCSD network by invitation only. Guests are required to abide by
each tenet of the Acceptable Use Policy.
C. DISCIPLINARY ACTION

Violation of the Acceptable Use Policy will result in actions such as but not limited to:
a. Verbal warning
b. Written warning
c. Loss of electronic/computer privileges which may necessitate a change in
enrollment/employment status.
d. Suspension, expulsion or termination and/or referral to law enforcement for prosecution.

D. ACCEPTABLE USE POLICY ENFORCEMENT

District administrators and school principals are authorized to monitor the use of instructional
resources to ensure conformity to this policy. Administrators reserve the right to examine, use and
disclose any information found on the schools networks in order to maintain/secure the health, safety
and discipline of any network/computer user. Any information found on district owned machines may
be used in disciplinary actions and may be admitted as evidence in civil or criminal investigations.

E. SEARCH AND SEIZURE

Tooele County School District reserves the right to provide a safe and threat-free learning environment
for its students, teachers, administrators, staff and guests. In the event of probable cause, Tooele
County School District administration and/or law enforcement will conduct a reasonable search of TCSD
property and applicable devices and will seize any illegal or such materials as are in violation of this
Acceptable Use Policy.

F. LIABILITY

Tooele County School District will not be held liable for individuals obtaining illegal information, explicit
images, or objectionable content as a result of violating the Acceptable Use Policy. TCSD electronic
resources are to be used in an instructional manner.

I HAVE READ AND FULLY UNDERSTAND THE TOOELE COUNTY SCHOOL DISTRICT ACCEPTABLE USE
POLICY AND WILL ABIDE BY ITS STIPULATIONS:

Marcus Bunn 8/6/2010

COMPUTER/NETWORK USER SIGNATURE DATE

Sharon Bunn 8/6/2010

PARENT/LEGAL GUARDIAN SIGNATURE DATE