*Provide copy of Legal Custody/ Guardianship Documentation if not listed on the birth certificate.*
(Who will be receiving mail, report card, etc. from the school)

Birth Certificate

Immunization Records

Tribal Enrollment

Parent Tribal Enrollment

Previous School Records (New Student)

 

I certify that the above information is true and correct to the best of my knowledge.

2026-2027SY

For the safety of all students and compliance with the CHS Policy parents/ guardians are required to provide a list of approved adults 18 and over who can check out their minor/ school aged child throughout the school year.

Enrollment of Students over 18 Years of Age. Any student who is eighteen years of age sign a Contract with the School Principal agreeing to abide by all rules and regulations of the school including Attendance Policies. Students over the age of 18 who check themselves out of school shall be subject to the same attendance policy requirements as students under the age of 18. Parents/guardians of students over the age of 18 will be notified when the student is absent from school, and truancy policies will be followed in accordance with this Attendance Policy.

ONLY THE FOLLOWING PERSON(S) HAVE MY CONSENT TO CHECK OUT MY STUDENT FROM CRAZY HORSE SCHOOL.

NO OTHER PERSON(S) WILL BE ALLOWED TO TAKE MY CHILD FROM CRAZY HORSE SCHOOL.

Adults that can check student out:

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2026-2027SY

When a student must be taken home early from school for possible illness, early releases, etc. If you (the parent/ guardian) cannot be reached by phone and are not home, we are asking for a list of four (4) relatives or emergency contacts (in your local home area) where your student can be taken in case of such events. By signing this form, you are giving Crazy Horse School permission to take your student to the residence(s) listed below when you are not home/ cannot be reached by phone.

List by preference (first choice, second choice etc.)

Residence's student can be dropped off at:

Unexpected school closures will be posted on the Crazy Horse School Website, Facebook Page, and sent out via NASIS Messenger System to your phone via phone call & text message.

This consent form covers; Crazy Horse School, School Nurse/ EMT, Indian Health Services, and other Emergency Medical Services to have your consent as the parent/ guardian to provide medical care and dispense medications to your student attending Crazy Horse School during the school year. It is against the law for a school to provide routine medical care or dispense medications to a minor without the consent of the parent/ guardian.

*All students must have a bus contract on file regardless of where they reside.
This covers field trips, activities transportation etc.

1. Follow directions from the bus driver.
2. The bus driver will assign seats if necessary.
3. Always stay in your seat when the bus is in motion.
4. Absolutely no fighting, pushing, or shoving on the bus.
5. Absolutely no damaging the bus, or the bus equipment.
6. Keep your head, hands, and feet inside the bus always.
7. No food or drinks on the bus unless you have approval from the bus driver.
8. No pets or animals on the bus.
9. Clean up your trash on the bus.
10. No profanity or foul language on the bus.
11. If a student's behavior endangers the occupants of the bus, the driver will stop the bus and call law enforcement to remove the student(s) causing the disruption.

Violation of the bus rules can result in your student losing their bus riding privileges. Should your student break the bus rules, you may be asked to transport your student to and from school and to any activities or you may be required to ride the bus with your student. All the buses and school vehicles have cameras.

By signing this form, you agree that your student will follow all the bus rules. You also understand and agree to the terms if your student does not follow the rules or if your student breaks the rules.

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Crazy Horse School is requesting your permission as the parent/ guardian to use your child's photograph and/or video for the purpose of school sanctioned social media, school website, local newspapers, documenting publications (yearbook), newsletters, bulletin boards, and Channel 92.

 

By signing this form, you are consenting to the use of your child's photograph and likeness to be used for the above-mentioned purposes.

Counseling Consent Form

2026-2027SY

Parent/ guardian understands all school staff statewide are mandatory reporters and must comply with these laws for the safety of all students.

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ISEP Intensive Bilingual Program

Certification Form

2026-2027 SY

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The information stated above is as accurate to my knowledge. I understand that all records will be released for
school enrollment purposes. Any records that are not required will be returned to the parent/ guardian.

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Federal Code: 25 CFR 32.3: "It's the responsibility of the feral government to provide comprehensive education programs and services for Indians and Alaskan Natives."

Federal requirements direct schools to assess the English language proficiency of students. The progress begins with determining the language(s) spoken in the home of each student. BIE has contracted with WIDA (World Class Instructional Design and Assessment) to provide English learner assessments and supports identified in the Home Language Survey.

BIE Mission: "Provide quality education opportunities from early childhood through life in accordance with the tribes needs for cultural and economic well-being..."

Crazy Horse Purpose Statement: "The Tasunke Witko Owayawa Tiospaye will inspire our Wakanyeja to develop to their full potential, individually and collectively, by combining Lakota Lifeways with global learnings."

Purpose of Survey: The responses to the home language survey will assist in determining if a student's proficiency in English should be tested. This information is essential for the school to provide adequate instructional programs and services.

Criteria for Screening: If a language other than English is identified for any of the primary language questions above, your child will be recommended for screening.

McKinney Vento Enrollment/ Referral Form

The purpose of this form is to address the requirements of the McKinney -Vento Act, Title X. Part C of the No Child Left Behind Act. This document will be used to share with school staff and partnering agencies to ensure all providers have the necessary information to support the child and his/her family.

Parent/Guardian: This form serves as the official record of the eligibility determination for each individual child included in the student count for the Title VI Indian Education Formula Grant Program. If you choose to submit a form, your child could be counted for funding under the program. The grantee receives the grant funds based on the number of eligible forms counted during the established count period. You are not required to complete or submit this form unless you wish for your child(ren) to be included in the Indian student count. This form should be kept on file with the grant applicant and will not need to be completed every year. Where applicable, the information contained in this form may be released with your prior written consent or the prior written consent of an eligible student (aged 18 or over), or if otherwise authorized by law, if doing so would be permissible under the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g, and any applicable state or local confidentiality requirements.

Name and address of Tribe or Band that maintains updated and accurate membership data for the individual listed above:

I verify that the information provided above is true and correct to the best of my knowledge and belief.

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Definitions:
Indian means an individual who is (1) A member of an Indian Tribe or Band, as membership is defined by the Indian Tribe or Band, including any Tribe or Band terminated since 1940, and any Tribe or Band recognized by the State in which the Tribe or Band resides; (2) A descendant of a parent or grandparent who meets the requirements described in paragraph (1) of this definition; (3) Considered by the Secretary of the Interior to be an Indian for any purpose; (4) An Eskimo, Aleut, or other Alaska Native; or (5) A member of an organized Indian group that received a grant under the Indian Education Act of 1988 as it was in effect on October 19, 1994.

Student Information:

Write the name of the child, date of birth, grade level, name of school and school district. Only name one child per form.

Tribal Membership:

Write the name of the individual with the tribal membership, if it is not the child listed. Only one name is needed for this section, even though multiple persons may have tribal membership. Select only one identifier: the child, child's parent or grandparent, for whom you can provide membership information.

Write the name and address of the organization that maintains updated and accurate membership data for such Tribe or Band of Indians. The name does not need to be the official name as it appears exactly on the Department of Interior's list of federally recognized Tribes, but the name must be recognizable and be of sufficient detail to permit verification of the eligibility of the Tribe. Check only one box indicated whether it is a Federally Recognized, State Recognized, Terminated Tribe or Organized Indian Group. Write the enrollment number establishing the membership for the child, parent or grandparent, if readily available, or other evidence of membership.

Attestation Statement:

Provide the printed name of parent/guardian and signature, address, phone number and email of the parent or guardian of the child. The signature of the parent or guardian of the child verifies the accuracy of the information supplied.

Paperwork Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-0021. The time required to complete this portion of the information collection per type of respondent is estimated to average: 15 minutes per Indian student certification (ED 506) form; including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to:

Office of Indian Education,

U.S. Department of Education,

400 Maryland Avenue,

S.W., LBJ/Room 3W238, Washington, D.C. 20202-6335

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Dear Families, A free dental program will be in your child's school. Your child will receive preventative dental services that include a dental screening, tooth cleaning, sealants, fluoride varnish, silver diamine fluoride and tips on how to care for their teeth.

• Silver Diamine Fluoride (SDF) is an antibiotic liquid used on cavities to help stop the cavity process within the enamel (white part of tooth) and treat tooth sensitivity.
• Additional SDF application may be recommended.
• If tooth decay is not arrested, the decay will progress. In that case the tooth will require further treatment, such repeat SDF, a filling or crown, root canal treatment, or extraction.
• The affected area will stain black permanently, this is an indication SDF is working. Healthy tooth structure will not stain.
• Tooth-colored fillings and crowns may discolor if SDF is applied to them. Color changes on the surface can normally be polished off. The edge between a tooth and filling may keep the color.
• If SDF gets on skin or gums, a harmless brown or white stain may appear and will disappear in 1-3 weeks.
• Every reasonable effort will be made to ensure the success of SDF treatment. There is a risk that the procedure will not stop the decay and no guarantee of success is granted or implied.
• If allergic to SILVER SDF isn't a therapeutic option.

Your student is AGE 18 OR OLDER or WILL BE this school year please fill out this contract.

• The student agrees to maintain daily attendance and arrive on time to all scheduled classes.
• Excessive unexcused absences (5 days or more per quarter) may result in a review of the student's enrollment status.
• The student or declared responsible party (parent/guardian) is responsible for contacting the school when absent and providing valid documentation when needed.
• The student understands that truancy laws still apply under Tribal and State expectations for high school enrollment.

• The student will follow all school rules outlined in the Student Handbook and Code of Conduct.
• Disruptive, disrespectful, or unsafe behavior will result in disciplinary action up to and including removal from the school setting.
• Bullying, harassment, use of drugs/alcohol, nicotine/tobacco, or possession of weapons will not be tolerated under any circumstances.

• The student agrees to complete all assignments, participate in classroom activities, and seek support when needed.
• The student is expected to take full responsibility for monitoring their academic progress, meeting graduation requirements, and attending tutoring interventions if required. Failure to maintain academic progress may result in formal academic improvement plan or withdrawal consideration.

• The student agrees to show respect for all staff, students, property, and school traditions, including honoring the cultural values of the Lakota Nation.
• The student will present themselves appropriately, use respectful language, and contribute to safe, inclusive school culture.

• As an adult student, you are expected to communicate directly with school staff regarding your educational progress, attendance, and disciplinary matters.
• While parental involvement is still welcomed, the school will prioritize direct communication with the 18+ student unless a FERPA release is signed.

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• Excessive absences or tardiness
• Inappropriate behavior or violations of the student handbook
• Refusal to attend tutoring, counseling, or assigned support services

• Will be documented and reviewed by the school administration
• Will be communicated to the student and their emergency contact or guardian
• May result in probation, extended contract terms, or dismissal from enrollment

This contract will be reviewed monthly. Adjustments may be made as needed based on the student's progress or circumstances.