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COUNTY SUPERINTENDENT OF SCHOOLS BIG HORN COUNTY MONTANA PO BOX 908 HARDIN MT 59034 Courthouse. Suite 230 121 W. Third St.. Hardin MT Home School Notification 2017-2018 Phone (406) 665-9820 FAX 406/665-9823 e-mai I: Receipt of this Home School Notification Form by the County Superintendent of Schools will ensure compliance with Section 20-5 -109(5), MCA. Please provide all information requested. A copy of each child's immunization record must be included for FIRST TIME registrants; or if a child has received immunizations since his/her immunization record was submitted, please provide a copy of the CURRENT record. Please return this form to our office by October 1, 2017 Parent/Guardian Information Please PRINT • PARENT/GUARDIAN NAME : MAILING ADDRESS : CITY STATE ZIP E- • E-MAIL: • PHYSICAL ADDRESS IF DIFFERENT FROM ~ AILING : ADDRESS : PuBLIC ScHOOL DISTRICT OF RESIDENCE i.e., DECKER, PRYOR, CoMMUNrTY, HARDIN, LODGE , GRAss, WYo..>. : : The following children are enrolled as Home School 2017-2018 : : : students for Academic Year indicated: : PLEASE PRINT Student's Name Date of Birth Grade . . Yes No May we give you I name & phone number to other Home Schoolers who would like to discuss Home Schooling D D concerns & options? : Non-public schools (including Registered Home Schools) may participate in Federally funded education programs that may be offered : : through the Public School District of Residence. These may or may not be offered through your school district of residence. Each district : . . : determines in which programs it will participate. Signature Date : Please check one: X Yes D I WISH TO RECEIVE A PARTICIPATION FORM. No D I DO NOT WISH TO RECEIVE A PARTICIPATION FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In order to assist other Home Schools in choosing a curriculum, please give a brief description or citation for the "organized course of study" {20-5-109(4), MCA) that you have decided to use. We can then generate a list of the programs that are in place and pass that information on when new Home Schools ask what others in the area are doing. You are under NO obligation to use any particular curriculum. Your name will not be used without permission. Thanks. I Cosupt\Schools\HomeSch Registration List All Home Schools Every Year 1. This Form w/Signature or FIRST TIME Home Schools 2. Immunization Record (copy) D D