FAMILY RESIDING WITH FRIENDS OR FAMILY

STOP: Please note: Only to be filled out by registering families living with friends or relatives who OWN a home in Reynoldsburg. If the friends or relatives you are living with are renting, the registering family must be on the lease either as a leaseholder or occupants.

Registering parents MUST provide an official piece of mail, in their name, current within a month, received at the address presented on this affidavit. This can be a utility bill, insurance statement, court notice, social service document, or official notice from their human resources department, at the time of registration and annual renewal.

REYNOLDSBURG CITY SCHOOL DISTRICT RESIDENCE AFFIDAVIT FOR HOME OWNER

STOP: Please note: Only to be filled out by registering families living with friends or relatives who OWN a home in Reynoldsburg. If the friends or relatives you are living with are renting, the registering family must be on the lease either as a leaseholder or occupants.

I, ________________________________, certify that I am the owner of the dwelling located at

_____________________________________________, City__________________________ (street address)

I, _______________________________, further certify that the following person(s) actually reside at this property, and to the best of my knowledge are not maintaining a separate residence elsewhere. I acknowledge and understand that if any of the information given on this form is not true and correct, that knowingly swearing or affirming thereof constitutes criminal falsification, a violation of Ohio Revised code Section 2921.13, a first degree misdemeanor, punishable by a maximum fine of $1000.00 and/or a maximum term of imprisonment of 6 months. Furthermore by signing this form I am accepting financial responsibility for tuition for the student(s) listed below should the student live elsewhere.

I agree that Reynoldsburg City School District, if they deem necessary, has the right to investigate my residency. I agree to allow the release of utility customer information to a representative of Reynoldsburg City Schools. I am also aware that this document is valid for the 20____/____ school year only. I understand that this agreement must be renewed yearly.

Parent/Guardian and child(ren)’s Names

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

____________________________________ (Printed Name of Owner)

______________________________________ (Signature of Owner)

Phone number owner: ________________________________

Please advise Reynoldsburg City Schools @ 501-1033 when the above occupants move from your residence. Thank you. ***************************************************************************

Before me, a notary public, came ___________________________________, who being first duly cautioned and sworn, did sign the foregoing document as his/her free and voluntary act and deed this _________________day of _______________, 20_____. My Commission Expires: _________________________.

Affix seal here

________________________________ Notary Public
(Rev: 01/12)

REYNOLDSBURG CITY SCHOOL DISTRICT OATH OF RESIDENCY FOR REGISTERING FAMILY

STOP: Please note: Only to be filled out by registering families living with friends or relatives who OWN a home in Reynoldsburg. If the friends or relatives you are living with are renting, the registering family must be on the lease either as a leaseholder or occupants.

I, __________________________________, hereby certify that I have established residency on a seven – days – a - week basis in the Reynoldsburg City School District and am not maintaining a separate residence elsewhere. I agree that Reynoldsburg City School District may use any legal means necessary to verify I am living at the address listed below and allow the release of rental information and also utility customer information to a representative of Reynoldsburg City Schools.

I further certify that this residence is located at:

__________________________________________ (Street Address)

______________________________________ (Principal Owner of Residence)

City____________________________________ Zip ________________ Phone___________________

I acknowledge and understand that if the information on this form is not true and correct, that knowingly swearing or affirming the truth thereof constitutes criminal falsification, a violation of Ohio Revised Code Section 2921.13, a first degree misdemeanor, punishable by a maximum fine of $1000.00 and/or a maximum term of imprisonment of 6 months. Furthermore, by signing this form I am accepting financial responsibility for tuition for the student(s) listed below should the student(s) not have a right to attend Reynoldsburg City Schools.

Is this student affected by any court order?	_______ Yes	_______ No

If so, identify: _________________________________________________________________________

NOTICE FOR PARENTS OF ATHLETES:
I understand that, if I enroll and participate under false pretenses, Reynoldsburg athletic teams will be forced to forfeit games on the playing of an ineligible player.

NOTE:
Permission to enroll on the basis of the information provided shall not extend beyond the current school year. This document must be renewed each school year in order for the listed students to remain in Reynoldsburg City Schools.

The Board of Education reserves the right to require additional documentation to establish residency to the satisfaction of the Superintendent or designee, including but not limited to, a current lease, deed or insurance information of the homeowner.

______________________________________ Parent’s Signature

____________________ Home Phone

______________________ Work Phone

Student Name(s)

__________________________________________

__________________________________________

__________________________________________

School of Attendance

________________________________

________________________________

________________________________

Before me, a Notary Public, came _________________________________________, who being first duly cautioned and sworn, did sign the foregoing document as his/her free and voluntary act and deed this ______________day of _________________, 20______. My Commission Expires____________.

Affix Seal Here

(Rev: 01/12)

________________________________ Notary Public