Online Registation Form K-6 | Glacial Hills Elementary

Student Last Name

Student Middle Name

Student First Name

Student Gender

Student Birthday

Month

Day

Year

Entering Grade Level

If entering PreSchool/PreKindergarten, please select one:

Please only answer this if your student is entering PreSchool or PreKindergarten.

Enrollment Start Date

Ethnic and Racial Demographics required by Minnesota Department of Education. Is the student:

Hispanic or Latino as defined by the Federal Government.

American Indian or Alaskan Native as defined by the Federal Government.

Asian as defined by the Federal Government.

Black or African American as defined by the Federal Government.

Native Hawaiian or Pacific Islander as defined by the Federal Government.

American Indian from South or Central Amercia as defined by the Federal Government.

Caucasian/White as defined by the Federal Government.

Check the phrase that best describes your student: My student first learned:

language(s) other than English.

English and language(s) other than English.

Only English

My student speaks:

language(s) other than English.

English and language(s) other than English.

Only English

My student understands:

language(s) other than English.

English and language(s) other than English.

Only English

My student has consistent interaction in:

language(s) other than English.

English and language(s) other than English.

Only English

Parent/Guardian 1 Name

Parent 1 address

Parent 1 address 2

Parent 1 address 3

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 Email Address

Parent/Guardian 2 Name

Parent 2 address

Parent 2 address 3

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 E-mail address

Student lives with:

Student's Previous School

Student has IEP in place

Emergency Contact #1

Emergency Contact #2

Non-Aspirin (Acetaminophen/Tylenol or Ibuprofen) medication will be provided when necessary and only in the case of a low-grade fever.

According to school policy, administration of ANY medication (prescription or over-the-counter) must be requested by written permission from the parent or guardian.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Please fill out the Multiple Permission Form next. After hitting SUBMIT you will be redirected to the MPF.