Fargo-Gage Elementary(K-6th) 2022-2023 Enrollment
Please complete the enrollment form
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Student's First Name *
Middle *
Last *
Social Security Number *
Grade *
Gender *
Required
Age *
Date of Birth *
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Birthplace( city and state) *
Is any language other than English spoken in the home? *
If yes, what is the primary language spoken?
Ethnicity *
Is student a member of an Indian Tribe *
Race-check all that apply *
Required
Mailing Address *
Physical Address *
Has your address changed from last year(if you are a returning student) *
Student resides with *
Legal/Custody Papers?  Please note, the school must have a copy of the court order on file declaring custody arrangement. *
Last School Attended *
Parent/Guardian/Mother's First name *
Parent/Guardian/Mother's Last name *
Parent/Guardian/Mother's Cell Phone Number(no dashes) *
Parent/Guardian/Mother's Street Address *
Parent/Guardian/Mother's City, State, Zip Code *
Parent/Guardian/Mother's Email Address *
Parent/Guardian/Mother's Place of Employment *
Parent/Guardian/Mother's Work Phone Number *
Parent/Guardian/Father's First Name *
Parent/Guardian/Father Last Name *
Parent/Guardian/Father's Cell Phone Number(no dashes) *
Parent/Guardian/Father's Street and or Mailing  Address *
Parent/Guardian/Father's City, State, Zip Code *
Parent/Guardian/Father's Email Address *
Parent/Guardian/Father's Place of Employment *
Parent/Guardian/Father's Work Phone Number(no dashes) *
Student's cell number(no dashes) *
List individuals whom the student is allowed to leave with *
Emergency Contact Name(s) other than parent or guardian, name and contact number *
Medical Information(allergies, health concerns, etc.) *
Does the child reside 1.5 miles from the school?
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2022-23 Handbook Policy Acknowledgement- A  copy of the Fargo-Gage School’s Handbook can be found on the school’s website at www.fargo.k12.ok.us. It is located under the Administration tab, by clicking on the Forms & Handbook link. The handbook is available for immediate viewing. Please sign below(by using your initials) acknowledging you received the location of the handbook information.             *
Please identify below whether you give your permission for this student being enrolled to be included in pictures and/or videos taken while attending Fargo-Gage Public Schools. The pictures and/or videos may be released via various forms of media. *
Student Internet Access Conduct Agreement-                            Every student, regardless of age, must read or have this read to them, and sign below.  I have read, understand, and agree to the terms of the foregoing acceptable use and Internet Safety Policy.  Should I commit any violation or in any way misuse my access to the school district's computer network and the internet, I understand and agree that my access privileges may be revoked and school disciplinary action may be taken against me. Initial below *
Parent/Guardian-                                                          If student applicant is under 18 years of age, a parent or guardian must also read and sign this agreement.  As the parent or legal guardian of the above student, I have read, understand, and agree that my child or ward shall comply with the terms of the school district's Internet Usage Policy for the student's access to the school district's computer network and the internet.  I understand that access is being provided to the students for educational purposes only.  However, I also understand that it is impossible for the school to restrict access to all offensive and controversial materials, and I understand that my child's or ward's responsibility for abiding by the policy.  I am therefore, signing this policy and agree to indemnify and hold harmless the school, the school district, and the Data Acquisition Site that provides the opportunity to the school district for computer network and internet access, against all claims, damages, losses, and costs of whatever kind that may result from my child's or ward's use of his/her access account if and when such access is not in the school setting.  I hereby give permission for my child or ward to use the building approved account to access the school district's computer network and internet.               *
OSIIS - Authorization to use or share protected health information to school or Day Care.  I hereby authorize the Oklahoma Immunization Information System to Fargo-Gage School. *
Administer medication listed below, a non-prescription medication which I am hereby supplying to you, or will supply when required. This is to be given in accordance with the written, signed and dated instructions that will accompany the medication in a sealed bag. Non-Prescription Medication Name: *
Administer medication listed below, a filled prescription medication which I am hereby supplying to you, or will supply when required. This is to be given in accordance with the directions for administering the medication as listed on the label on the bottle or vial, or in accordance with any written, signed and dated instructions of the prescribing Physician. Any prescribed medication must be supplied to the school in the original container with the prescription label attached. Prescription Medication Name: *
Carry and Self-Administer medication listed below, a filled prescription which I am hereby supplying to you, or will supply when required. This is approved for carrying and self-administration by the student by the laws of the State of Oklahoma, and is used in accordance with the directions for administering the medication as listed on the bottle or vial, or in accordance with any written, signed and dated instructions of the prescribing Physician. Prescription Medicine Name To Carry & Self-Administer: *
I understand that under state law, the Board of Education, the School District, or employees of the School District, shall not be liable to the student, or the student's result, or the student's parent(s) or guardian(s), from acts of omissions of personal injuries to the student, which result from acts or omissions of school employees administering the medication I have hereby authorized. Parent Initials (Acknowledging read and understood as outlined above) * *
The following documents are required for enrollment. *
Required
Please note that upon the final process of enrolling students, actual parent signatures will be gathered acknowledging you have read and accepted the terms of these forms.  You will complete this process during enrollment for the child's school.   I acknowledge that the information contained in this enrollment packet is accurate. *
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Parent Initials *
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