Spotswood High School - Rockingham County Public Schools
Transcription
Spotswood High School - Rockingham County Public Schools
A Rockingham County Public School SPOTSWOOD HIGH SCHOOL 368 Blazer Drive, Penn Laird, Virginia 22846 540-289-3100 • Fax 540-289-3301 The following information is required to enroll a student at Spotswood High School: D Birth Certificate D Custody Papers (If student does not reside with a natural parent.) D Proof of Residency (see attached sheet for requirements) D Immunizations - documentation must be signed by the doctor or nurse. D Grades 9, 10, 11, 12: o DTPffiTap - 3 doses, last dose must be received after age 4 - if the child has received 6 doses before the fourth birthday, additional doses are contraindicated. o Polio (all OPV or all IPV) - 3 doses of vaccine, last dose must be received after age 4 or 4 doses at any age. o MMR - 1 dose (after 12 mos. of age) and 2nd MMR or 2nd measles (rubeola) o Hep. B - (Hepatitis B) - 3 doses; if student has RECOMBIV AX HB - 2 doses o Tdap - booster required if not received prior to entering 6th grade o Varicella/Chicken Pox - All students born on or after 1/1/97 are required to have 1 dose, not earlier than 12 months of age. Documentation ofTdap or Tetanus required for entry. Note: Only 1 dose ofTdap is required even if it has been more than 5 years since the Tdap was given. D No Physical Exam required for grades 9-12. D Social Security Number (optional) D Transcript from previous school(s) D Copy of most recent report card D Copy of IEP or Special Education Records (if applicable) D Student Enrollment Form D Student Demographic Form D Emergency Care Permission Form D Demographic/Transportation Form D Parent Affirmation of Suspension Form D Consent to Exchange Information Form D Migrant Education Form D Federal Race/Ethnicity Form D RCPS School Messenger Form D Bus Rules Signature Form (remove from Student Handbook) o Student/Parent Handbook Verification Form (remove from Student Handbook) o Directory Information Form (remove from Student Handbook) o Media Release Form (remove from Student Handbook) Contact the Registrar, Debbie Correa at (540)289-3100 or (540)289-3101 to schedule an appointment to begin the enrollment process. , Building Blazer Pride ADMINISTRATIVE AND SUPPORT STAFF Administration: Principal- Dr. Stephen R. Leaman: sleaman@rockingham.k12.va.us Assistant Principal- Paul De La Garza: pdelagarza@rockingham.k12.va.us (Students A-L) Assistant Principal- Alicia Corral Clatk: acorralclark@rockingham.k12.va.us (Students M-Z) Activities Director - Tim Leach: tleach@rockingham.k12.va.us Attendance and Report Cards - Debbie McDonald: dmcdonald@rockingham.k12.va.us Bookkeeper - Lorrie Newland: Inewland@rockingham.k12.va.us Cafeteria Manager - Dena Hoover: dhoover@rockingham.k12.va.us Counseling: Director of Counseling - Sarah Lam: sarahlam@rockingham.k12.va.us (Students A-G) Counselor - Pamela Elmore: pelmore@rockingham.k12.va.us (Students H-O) Counselor - Lynn Briggman: Ibriggman@rockingham.k12.va.us (Students P-Z) Career Coach - Sarah Brown: sarahbrown@rockingham.k12.va.us Challenge Coordinator - Louise Liddle: lliddle@rockingham.k12.va.us Registrar - Debbie Correa: dcorrea@rockingham.k12.va.us Secretary - Stacey Washington: swashington@rockingham.k12.va.us Front Office Secretaries Secretary to Principal and AD - Wanda Hinkle: whinkle@rockingham.k12.va.us Julia Smith: juliasmith@rockingham.k12.va.us Debbie Hensley: dhensley@rockingham.k12.va.us Librarian - Kim Tate: ktate@rockingham.k12.va.us Nurse - Debbie Raines: draines@rockingham.k12.va.us Resource Officer - Matt Cross: mcross@rockingham.k12.va.us SOL Testing Coordinator - Amanda Bolt-Burtner: abolt@rockingham.k12.va.us Special Education Chair - Bob Lewellen: rlewellen@rockingham.k12.va.us It is the policy of the Rockingham County School Board to comply with all applicable state and federal laws regarding non-discrimination in employment and educational programs and services. It is an equal opportunity employer and educational agency. The Rockingham County School Board will not discriminate in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment or in educational programs and services on the basis of race, color, national origin, religion, sex (including pregnancy), gender, marital or economic status, age, disability, genetics, or veteran status and prohibits retaliation against anyone who files a complaint of discrimination, participates in such a proceeding, or otherwise opposes discrimination. §lFCOfIr§W(Q)(Q)]] IHIll JHI s CCJHH[J)([]lIL 3(&$ ~h31Z(B)ff' ~ff'8ij~~ [?l@B'i1m Ltel8ff'rdJ, ~ir~ill'HiaJ 2~$~@ 5~lOla~~@-31 (OJ[)) ~~m!liilt(Q)a21Bl~-33l1Ol~ 0 It is required that your primary residence (911 or physical address) be located within the Spotswood High School attendance area. As proof that you are residing here you must provide a minimum of three (3) of the following six (6) items: 1. A notarized statement - Certification of Residence form from the. owner of the house where the person is living within the SHS attendance area, listing the names of the person and their child(ren) and a visit by a school official. 2.Notarized rental/purchase agreement for a house within the SHS attendance area with the person's name and address on it. 3.Recent utility bills (electric, telephone, gas, etc.) with current name and address within the SHS attendance area. 4. Current Drivers license and automobile registration with current name and address within the SHS attendance area. 5.Current Car insurance and property insurance policies with current name and address within the SHS attendance area. 6.Recent Income tax W2 form and property tax bill with current name and address within the SHS attendance area. You may also expect a home visit from a school official to verify that you are living in the SHS attendance area. No student will be enrolled at Spotswood until these requirements have been met. § 22.1-264.1. Misdemeanor to make false statements as to school division or attendance zone residency; penalty. Any person who knowingly makes a false statement concerning the residency of a child, as determined by § 22.1-3, in a particular school division or school attendance zone, for the purposes of (i) avoiding the tuition charges authorized by § 22.1-5 or (ii) enrollment in a school outside the attendance zone in which the student resides, shall be guilty of a Class 4 misdemeanor and shall be liable to the school division in which the child was enrolled as a result of such false statements for tuition charges, pursuant to § 22.1-5, for the time the student was enrolled in such school division. (2005, c. 178; 2006, c. 143.) Building Blazer Pride STUDENT ENROLLMENT FORM ROCKINGHAM COUNTY PUBLIC SCHOOLS (Please print) Date _ First Name that student wishes to be called _ Grade ----- Sex ---------- Student's Mailing Address ------------------------Phone No. --------City _ Zip _ Student's Cell Phone No. ---------Student's 911 Address (if different than mailing) -----.,..,------ ------,-,---_ City Zip Birth Cert. No. Place of Birth --------------------- _ Last School Attended ----------------Address of Last School Attended -------------------------~----~--~City State Zip Telephone No. of Last School Fax No. of Last School With whom does this student reside? Circle one: Mother/Step- Mother/Grandmother/F _ oster/GuardianiOther Name ~Home Phone No. Address (if different than child's) _ _ Employer Work Phone No. Cell Phone No. _ Email Address _ -------------------- Circle one: Father/Step-Father/Grandfather/Foster/GuardianiOther Name HomePhoneNo. Employer Work Phone No. Cell Phone No. _ Email Address _ _ ---------------------- If the parent(s) listed above are not the biological parents, please complete this section: Mother/Father: Address: Name -------------------------- Home Phone No. ----- -------------------------------------------- Employer Work Phone No. Cell Phone No. Office Use Birth Certificate Email Address Social Security _ Physical _ Federal Race Proof of Residence _ PAGE 2 Number of Other Children Younger Brothers __ Older Brothers CUSTODY: in the Family: Younger Sisters __ Older Sisters Is there a custody order on this child? If so, who has custodial rights to pick up this child from school? (Please provide the school with a copy of the legal document.) What is the language spoken most frequently in the home (if other than English)? Is there a language other than English spoken in the home? Yes No _ NOTE: Ifhome language is other than English, or yes is answered, an ELL Student Identification and sent to the Central Office. Most Recent Two Schools Previously If not listed above, *High Schools: *Middle Schools: *Elem. Schools: Grade(s) Attended _ Form MUST be completed Guidance please circle below any Rockingham County Public School the student has attended in the past: Broadway, East Rockingham, Spotswood, Turner Ashby Elkton, J. Frank Hillyard, Montevideo, Wilbur Pence CRES, EES, FRES, JCMES, JWES, LSES, LEES, MES, MVES, OES, PKYES, PES, PYES, RBES, SRES Has your child's school been notified of your plans to withdraw? Yes No _ Has your child ever been home schooled as a result of an approved religious exemption? Yes Myres~enceisloc~edinilie Rockingham County. Parent/Guardian Was your child involved in any special programs ___ Special Education ~~ Challenge (Gifted) ___ Other - Please specify Are immunizations complete? _ yes regarding No --- my residence is accurate. Signature at their previous school? - Is there a current IEP? --- _ Alternative Education ~ _ no (DPT, MMR, POL, HepB) Does your child have a handicap or other special need that may affect his/her performance? Doctor: _ ~B~r~oa~d~w~a~y~~E~a=s~t~R~o~c=~=·=ng_h=a=m~~~S~p~o~b~w~o~o~d~~~T~u=r~n~e~r~A=s=h=b~y~~at (Circle one) I certify that the above information Please describe: Counselor _ ----------------------------------- ----------------------------~---------EXTRA-CURRICULAR SPORTS - HIGH SCHOOL STUDENTS ONLY • • My child participates in an after-school athletic program If yes, which athletic program(s)? YIN ---=-_...,...-:-~ Revised 3120J 5 Revised 7-13-10 §JPC(]) 'rs~y([J) (])]J) ~]K G IHI §CCJHI((J)O IL !D e;;tJ1JoIffraIP lhic/Tr &1!J1J§ JPo rt (f}J ti({}!J1l IFo rm Required Field ~ATE _ GR.A~E lLASTNAME _ MIDDLE FffJI?S7!'NAME Check Appropriate Action ( ] New Address ~fiRTH~ATE [ ] New Student _ §EX: [ ] Withdrawal [] Male NAME [ ] Retained [ ] Female it'AfI.!ENT(§) OR GlU AlRlIJ)llAN(S) _ ~OMEPHONE 9 RR _ RE§mENCE CELL~HONE _ A][))~IRE§§ (HOME) House # and Street Town and Zip Code 9R R ALT ADDRE§S House # and Street Town and Zip Code Required Field TRANSPORT AnON NEE~§: AM [ ] Residence Address [ ] Alt Address [ ] Not Riding ]PM [ ] Residence Address [ ] Alt Address [ ] Not Riding For School Use FOR 'TRANSPORT A 'JI'liON OFFICE USE ON1L 1{ Powerschool # , Will Ride Bus # am time Entered into Powerschool I II "Will Ride Bus # pm time Faxed to Transportation (433-2460) I I I I ROCKINGHAM COUNTY PUBLIC SCHOOLS EMERGENCY CARE PERMISSION Student Student: Mailing Address: Birthdate: ------------------------------------------- HomeRoom: 911 Address: Parenti Guardian: Guardian e-mail: Mother Information Gender: Grade: ----------------------- Bus: AM _ PM Home Phone: ------------------------------------------- Primary #: Name Employer: Home: Telephone: Father Information Work: Cell: Work: Cell: Name . Employer: Home: Telephone: #1 Information IGuardian Relationship Name Employer. Telephone: Home: Work: #2 Information Guardian Cell: Name Relationship Employer: Irelephone: Home: Emergency Contact Work: Cell: Information he individuals below have authorization to pick up my child and can be reached during school hours at the numbers listed. Name: Re: Phone: Name: Re: Phone: Name: Re: Phone: Cell: ------------------------- Cell: Cell: ------------------------- In an emergency, the school has permission to call our family doctor or dentist below Physician's Dentist's Phone: Name: Name: Phone: If an emergency OCCUflI and we cannot be contacted. the school has our permission to take the child to the doctor or hospital at our expense. The doctor and/ or hospital medical staff have my permission to provide the treatment necessary for the well-being of our child. The RockinghamCountyPublicSchooldivisionis committedto protectingtheprivacy,security.andintegrityof individuallyidentifiableinformationreceived fromyou,on behalfof yourchild.We mayuseyourinformationto providetreatmentto yourchildor to discloseinformationto otherhealthcareproviders as indicatedon thisform.The schooldivisionis preparedto maintaincompliancewiththe HealthInsurancePortabilityandAccountabilityAct(HlPAA)andother regulatoryrequirementsbyadoptingandadjustingpoliciesandprocessesas necessary. 1. His/her last Tetanus shot was given about 2. Is your child allergic to any medicine, food, or other substance? List allergies: 3. Does your child have the following o D diabetes asthma List medication condition(s) D seizures as diagnosed --- - - 0 Yes -- --- -. - - --- _ .. -------- o No by a physician? D allergy to insect bites needed: 4. Prescription medication 5. Other medical conditions Parenti Guardian For School Use Only __ Emergency Alert Form your child takes on a regular basis: the school should know about: Signature' Date' o School/Private o Medicaid D-FAMI5-- Insurance .- ROCKINGHAM COUNTY PUBLIC SCHOOLS Parental Affirmation Regarding Previous Student Suspension/Expulsion Virginia law requires that, prior to admission to any public school of the Commonwealth, a School Board shall require the parents, guardian, or other person having control or charge of a child of school age to provide, upon registration, a sworn statement of affirmation indicating whether out-of-school disciplinary measures have been imposed upon the student at a private school or in a public school division in the Commonwealth or in another state for an offense in violation of school or School 130:u-d policies relating to weapons, alcohol or drugs, or for the willful infliction of injury to another person or for destruction of school property or privately-owned property while located on school property. Any person making a materially false statement or affirmation that will be guilty upon conviction of a Class 3 misdemeanor. The registration document shall be maintained IlS a part of the student's scholastic record. (Virginia Code Section 22.1.3.2) l'l.EASE C()l\tPI.ETE AND SIGN 'nu: STATEMENT 1, the" \lI\drr~.igliC'11. truthtully BEl.OW declare lInt! ;\f1If1li that =.~. h;hl\l;\:i not (drdc OIlC) Ic('dvC'd oul'l)f.:;dHllJ\ suspcl\:ii()1\ (1';)1:~I\Ykllgth 01 time) :ll\ti/Of c,puhilJlI illll private ~ll.:ho()1or pllb\i~ ,1dll)()1 ill Vil~iiii;ll.H· nuothcr ~I;\lc; IllI all ()Ifen:;c ill vio\;lIiol\ of school Ot' SdH)()1 Jh>atd policies I('titing 11.1wcnpl.HiS, ulcoltol ()/' dlll!!.'i, or for the willful infliction or injury _'d' __ ' ._____.~ • -e her person or for destruction of school property or privatc\Y-l)wl1cd property while located UII 5(11001 propelty. I \11\(kl~;ti\J1d Ih!!I, 1'1)1' PIIJllIJ:;C; of thh uffinnation. "willful infliction of injury tl} another" 111(,<111:.; a maliciou: Jll-;::;nlllt with the intent to cuusc serious bodily injury. II) allot I undcr stuud that if I mukc u materially Iulsc allirmation I shall be guilty upon conviction of a Cla33 3 misdcmcunor. I am aware that this aflirmation will be maintained as a part of my student's scholastic record. Parent, Date guardian, or person having control of child ., ~~, RO(~KiNG'HA'~rC'0 PJ,lJ)Ll£;S(.fjQQt5 New federal race and ethnicity categories Student Name _ Homeroom: ----------------------- Address _ School attending ------------------- Date of birth ----- Student number----------------- Please answer both part 1 and part 2 by checking the boxes that best describe your son or daughter. Part 1 ;" What is the student's ethnicity? (choose only one) D No, not Hispanic/Latino D Yes, Hispanic/Latino (a person of Cuban, Mexican, Puerto Rican, South American, Central American or other Spanish culture or origin, regardless of race) No matter what you selected in part 1, please continue to answer by marking one or more boxes in part 2 to indicate what you consider your student's (or your) race to be. Part 2' What is the student's race? (choose one or more) D American Indian or Alaska Native (a person having origins in any of the original peoples of North America and South America, including Central America, AND who maintains tribal affiliation or community attachment) D Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam) D Black or African-American (a person having origins in any of the black racial groups of Africa) D Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands) D White (a person having origins in any of the original peoples of Europe, the Middle East or North Africa) Parent or guard ian signature _ Date It is the policy of the Rockingham County School Board to comply with all applicable state and federal laws regarding non-discrimination in employment and educational programs and services, The Rockingham County Public Schools will not aiscnminete on the basis of race, religion, gender, national origin, disability, economic status, or age as to emptoymentsx educationalprograms and activities, FOR SCHOOL USE ONLY I am the observer who completed this form due to parent/guardian refusal to re-identify. I Sianature.Observer I Date CUUNTY PUBLIC SCHOOLS RECORDS ANDIOR PROTECTED HEALTH KUl,;I'\Ii'JuHAM CONSENT TO RELEASEIRECEIVE INFORMATION DOB: __ Student: Social Security Number: 1__ 1__ - ---- -- I understand that different agencies provide different services and benefits. Each agency must have specific information in order to provide services and benefits. By signing this form, I am allowing the Rockingham County Public School system and the identified agencies to exchange authorized information to effectively provide or coordinate services or benefits. By signing this authorization, I am giving my permission to have the following confidential o • information about my child to be exchanged: Assessment Information Medical Diagnosis • Educational Records Information Criminal Justice Records Psychological Records Employment Records Social History SpeechlLanguage Reports • Immunization Records III Official Administrative Record (name, address, parent's name and address, SSN, grade level completed, academic record, class standing, attendance data, extra curricular activities, citizenship) o Financial o o o o o Drug and alcohol abuse diagnoses or treatment information is exempt from this release and protected by Federal substance abuse confidentiality rules (42 CFR part 2). A student's disciplinary file is not protected information and may be released without consent to other school districts within the State of Virginia or to law enforcement agencies. I hereby authorize o (please check appropriate location): Director, Pupil Personnel Services ROCkingham County Public Schools 100 Mount Clinton Pike Harrisonburg, VA 22802 o (School Name) bR. STEPHEN R. LE1i1Yl AN (Principal) (Address) Pf)JN LAfRb vA ( S4D ) 31DI rn - To be able to exchange I this information zz~4le (Phone) (Address) (SZ/D ) z~tt - with the following other agency(ies}: 3301 (Fax) (Please include address) Are more agencies listed on back? For the purpose of: o Eligibility Determination o IEP (review, revision, andlor implementation) o Service Coordination and Treatment Planning o Educational Planning o Other (be specific): Unless otherwise revoked, this authorization expire one year from the date signed. (school/grade will expire on __ placement, 1__ YES 0 NO 0 (mental health) course selection, etc.) 1__ . If there is no date entered, the authorization will I can withdraw this consent at any time by notifying the referring agency. This will stop the listed agencies from sharing information after they know my consent has been withdrawn. I have the right to know what information about me has been Shared, and why, when, and with whom it was shared. If I ask, each agency will show me this information. I want all the agencies to accept a copy of this form as a valid consent to share information. If I do not sign this form, information will net be shared and I will have to contact each agency individually to give them infermation about me that they need. I understand that an agency may condition eligibility for benefits or services en previding this information. There is a potential fer any information disclosed pursuant to.this authorization to.be subject to redisclosure by the recipient and, therefore, no.lonqer protected by the provisions of the IDEA, FERPA, or HIPAA regulations. Date: __ Signature: Signature of ParentlGuardian/Surrogate/Adult or Authorized Representative Relationship to student: ' __ 1__ Student _ Revised: 4110106 Revised 81201 I Rockingham County Public Schools ELL Student Identification Form and Home Language Survey This form is to be completed for all students newly enrolled in Rockingham County Public Schools who are English Language Learners (ELL) and/or were born outside the United States. Forms should also be updated at the beginning of each school year for each ELL student in the school division. Keep a copy in the student's Scholastic Records file, and send the original to the ELL secretary in the Central Office. Directions: Student's LAST name, FIRST name Sex Today's date Date of birth _ _ School _ Grade ------------------- _ Parents/Guardians _ EngliSh-speaking family member or contact person _ Country where student was born _ Date student first moved to U.S.A. _ Date Student first entered VA'School Student's native language _ _ Number of years of school in home country Is student literate in his/her native language? (Y yes N no U unable to determine) = = = Language spoken most frequently in the home FOR OFFICE USE ONL Y _ Does the family have refugee status, 1-94? _ Other language(s) spoken in the home _ FOR OFFICE USE ONL Y W-APT PALS QRI-IV Fall Mid-Year (Circle One) Spring STAR Year Administered Student Score Grade Level Cluster IRI D Grade-Level benchmark D Running Record Other Lexile™ (Circle One) Instructional most recent date administered Reading Level D (most recent date administered) Stanford Diagnostic ReadintJ (most recent date administered) Composite (Overall) Proficiency ACCESS for ELLs (most recent date administered) ELL Status Fill in the appropriate number or letter, using the keys below. Level FOR OFFICE USE ONL Y Pre K - 3 Grade Adjusted CPL {Composite Proficiency Score) D _ _ PK 1 Entering = Score D Literacy Proficiency Score D ACCESS Tier D D Pre-kindergarten Level 2 Beginning N = No ELL assistance Level 3 Developing R = Refused needed. English is the student's second language; however, student was not found in need of ELL services. *Note: ACCESS for ELLs score or W-APT score needed Level 4 Expanding Level 5 Bridging First Year Person completing this form ELL TeacherlTutor_-,--Send the original completed form to the ELL secretary, Central Office. Keep a copy on file in the student's Scholastic Record. _ Rcvd Source _ yes __ Shenandoah no Valley Migrant Education Program JMU MSC 9007 Harrisonburg, VA 22807 Phone: 540.5683666 Fax: 540.568.6374 wwwsvrnep.jrnu.edu ELIGIBILITY QUESTIONNAIRE 1. In the last 3 years, have you or your spouse worked in (or looked for work in) any of these jobs: ***( Please note if you have done any of the following work whether or not it was in Virginia) • Poultry processing plant line work (Tyson, Cargill, Perdue, Pilgrim's Pride, Georges); • Growing or harvesting a crop of fruit, vegetables, or trees; • Work on a dairy or poultry farm or in the fishing industry; • Or caring for animals on a farm or ranch? Yes No If the answer to number 1 is "yes", Please complete the rest of this form: 2. When did you move to the area? month ------ year _ 3. Name(s) of Child(ren) enrolling in school today: Name -------------------------- Age Name -------------------------- Age _ Grade -----_ Grade Age _ Grade ----- Name -----------------------4. Parent/Guardian information (if student is a minor): Name . Address Telephone number ----------------------------------------- City ____________________ Zip code 5. School Child(ren) will be attending: 6. Please fax this form to the SVMEP office at 540.568.6374 Name of intake person _ **Based on the information provided a representative from the Shenandoah Valley Migrant Education Program will contact you about the services offered by the Migrant Education Program. Migrant Education is a NCLB Title One, Part C program that provides supplemental educational services to children of miqrant agricultural workers, people who have moved to this area (or have moved frequently) to find agricultural work. We specialize in addressing the needs of second language learners who have had interrupted educational histories. ~ e ROCK(NGHAMC0 PUBLIC SCHOOLS SCHOOLMESSENGER t~~ ~ To the Parent of: ----------------------Grade: -----Rockingham County Public Schools are implementing a new emergency and inclement weather notification system. As part of this effort, we are in the process of updating the phone numbers and e-mail addresses at which you may be contacted. , The following list contains phone numbers and e-mail addresses we currently have on file for you student. Please review this information and modify it as needed. You will also be able to manage this information in the PowerSchool parent portal. Thank you! Telephone: Please indicate the phone numbers at which you want to receive recorded phone messages. Cross out any existing numbers if you do not wart to receive calls at those numbers. Main Phone Number: (Used for attendance calls) Additional Phone #2: Additional Phone #3: _ SMS: Please indicate the phone numbers at which you want to receive text messages. Cross out any existing numbers if you do not want to receive text messages at those numbers. SMS Phone #1: SMS Phone #2: SMS Phone #3: E-mail: Please indicate the e-mail addresses at which you want to receive notification messages. Cross out any existing e-mail addresses if you do not want to receive e-mail messages. E-mail Address #1: E-mail Address #2: E-mail Address #3: ........ _-_ _--_ ....•..................................... _ - - ..---- .. -':-~