Spring ECFE Program Registration

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Glencoe-Silver Lake Public Schools Independent School District #2859

The purpose and intended use of this data is to enable the school staff to effectively and safely provide service to you and your family. You have the right to refuse the needed information; however, if you do not complete all information you may not receive services needed. The information we collect will be maintained in the office and may be shared with authorized school personnel.

Email *

I am registering my child for...

(check the box for each class you would like to attend)

Looking for Summer Registration? Click Here

Music, Movement, and More! (Thursdays 5:15-6:15 pm, March 14-May 9)

Movement & Nature (Fridays)

Parent/Child Mixed Ages (Tuesdays)

Infants (Thursdays)

Required

Legal last name of enrolling student *

Legal first name of enrolling student *

Middle name of enrolling student *

Home address *

Mailing address, if different than home address

Date of birth *

YYYY

Gender *

Female

Male

What is the race/ethnicity of your child (select all that apply)?

White

Black/African/African American

Hispanic or Latino

Asian

Native Hawaiian or Other Pacific Islander

American Indian/Alaskan Native

Other, single race

Other, two or more races

What are your primary home languages (select all that apply)?

English

Spanish

ASL (American Sign Language)

Other:

Child lives with *

Both parents

Mother only

Father only

Joint custody

Foster parents

Other:

Required

Please list other children in household under the age of 5, their birth dates, and gender (see example)

Is custody shared with another home, or are there any special circumstances in the child’s living situation?

Yes

Clear selection

If yes, please explain.

Does your child have any food allergies? *

Yes

If yes, please list.

Is there anything else about your child (home life, personality, etc.) you want us to know in order to better work with your child? Please describe.

What is your annual household income? (this is used to determine class fees) *

Immunizations: Minnesota immunization law requires that in order for a child to enroll in child care, early education programs, or school, a parent must show they have received immunizations or an exemption. *

I will provide a copy of my child’s current immunization records to the GSL Health Office (you or your medical provider may fax copies to 320.864.2475 or 320.864.6320, or email to BJerabek@gsl.k12.mn.us).

My child has a medical exemption from immunizations; I will submit a statement to this effect, signed by a health care provider, in order to be considered exempt.

Based on my beliefs, I wish for my child to be exempt from one or more immunization requirements; I will submit a signed and notarized statement to this effect.

Required

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