Weston Elementary BK-2 Registration Form

Weston Elementary Begindergarten - 2nd Grade Enrollment Form

Please fill this form out completely. An Imlay City Weston Elementary Office staff member will contact you to set up a follow-up appointment for you to sign the application and bring in the required documentation. You will also need to provide the following required pieces of documentation:- Original birth certificate with the raised seal, Up-to-Date Immunization Record (Available at the Health Department), Picture Identification, and Two proofs of residency with your name and current address (Utility bill, bank statement, Lease or purchase agreement or car registration, etc.)
Child's Full Name*

First NameMiddle NameLast Name
Child's Date of Birth*

MonthDayYear
Gender*
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Grade Level*
Special Education*
Language Spoken by Child*
Language Spoken at Home*
Speech*
Ethnicity: is this student (or are you) Hispanic/Latino?*

No, not Hispanic/LatinoYes, Hispanic/Latino
Race*
Please list any health considerations, allergies, or medications taken by your child:*
Transportation
Will your child need busing to/from school? (In-District Students only, if any questions please call the bus garage at 810-724-9852)*

YesNo
Residency
Will you be needing a school of choice form or a release from your home district?*

YesNo
Parent and/or Guardian Information
Birth Father's Name

First NameLast Name
Birth Father's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Father's Mobile Phone Number

Area CodePhone Number
Birth Father's Employer
Birth Father's Work Phone Number

Area CodePhone Number
Birth Father's Email
example@example.com
Is Birth Father in Active Military?

YesNo
Birth Mother's Name

First NameLast Name
Birth Mother's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Mother's Mobile Number

Area CodePhone Number
Birth Mother's Employer
Birth Mother's Work Phone Number

Area CodePhone Number
Birth Mother's Email
example@example.com
Is Birth Mother in Active Military

YesNo
Non-Custodial Parent Information

Court documentation must be provided and included in your child's school record if non-custodial parent cannot pick up student from school.
Non-Custodial Parent Name:

First NameLast Name
Who has legal Custody?
Is student allowed to leave with non-custodial parent?

YesNo
Emergency Contacts (other than parents/guardians)
Family Information

Please list any siblings, along with their birthdate:
Brothers
Sisters
Other Student Information
Presently, is your family living in any of the following situations? Check one box:*

Staying in a shelter, temporary trailer, or waiting for foster care placementDoubled up-sharing the housing with others/relatives due to loss of housing, economic hardship or similar reasonLiving in a motel or hotel due to loss of housing, economic hardship or similar reasonLiving in a motel or hotel due to loss of housing, economic hardship or similar reasonIn a emergency or transitional shelterMoving from place to placeLiving with an adult that is not a parent or legal guardianNone of the above
Parent Statement of Child's Health Condition

Dear Parents, Every elementary student attending school is entitled to derive benefits from the Health and Physical Education program in Imlay City Schools. In order for the staff to know the physical limitation(s) of your child, we would like you to check the following statements applicable and list any physical disabilities of your child.
Please select one from below:*

My child has a physical condition that makes it mandatory that he/she be excluded from physical education activities. Please note the physical condition below.My child has physical limitations that should be considered during physical education activities. Please note the physical limitations below.I hereby state that my child's health is sound and has my permission to participate in all physical education activities.
Please use the space below to indicate any additional health information that should be given for the benefit and welfare of the pupil. Be as specific as possible, please.
We request that when a lengthy illness (colds, flu, etc) or accident (sprains, broken bones, etc) occurs, a note from a doctor be sent with the student telling us when the student may resume normal physical activity.

Yes, I have read the above statement and agree to the terms.
Media Release Form

In accordance with School Board Policies 8330 and 8350, and with the Federal Educational Right to Privacy Act (FERPA), Imlay City Schools releases only directory information for any of its students.Often our students will be involved in interviews by the local media, reporting on positive instructional programs, events and activities sponsored by Imlay City Schools. These interviews may include, but are not limited to, discussions of classroom events, musical concerts and other extracurricular or co-curricular activities. On occasion, Imlay City Schools will submit articles and/or information to local media outlets as well in the form of press releases. In completing this form, you will be giving your student's school (Imlay City Schools) permission to interview, name, or use the image of yor student in connection with activities associated with Imlay City Schools, as long as your child is a student of this district. If you select "no"on this form, no information regarding your student, including his/her photograph, will be released at any time. If you have questions regarding this release, please contact the Executive Director of Curriculum and Instruction, Dr. Dina Tallis, at (810) 724-2765 for additional information.
Interview, identify, photograph, video or capture an audio recording of my child in connection with school events. I agree that my child's participation in such interviews, etc ... is voluntary and without compensation.*

YesNo
Interview, identify, photograph, video or capture an audio recording of my child in connection with school events. I agree that my child's participation in such interviews, etc ... is voluntary and without compensation. This includes posting my child's image and/or name on the school district's website.*

YesNo
Immunization Release Form

The Family Educational Rights and Privacy Act (FERPA) requires written parental consent before personally identifiable information from your child's education records is disclosed to the health department.
By selecting below, you are authorizing Imlay City Schools to release your child's immunization record to the Michigan Department of Health and Human Services, and Local Health Department. By selecting below, you understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally indentifiable information from the school.*

YesNo
Previous School Information

If your child attended a previous school before enrolling in Weston Elementary, please provide that information below.
Previous School Name
Previous School City and State
Last grade attended

PreschoolDevelopmental KindergartenKindergarten1st Grade2nd Grade
I understand that there may be online courses offered to my child and I give my consent for my student to take any course assigned.
Please sign and date the Registration Form below:
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Weston Elementary Begindergarten - 2nd Grade Enrollment Form

Transportation

Residency

Parent and/or Guardian Information

Non-Custodial Parent Information

Emergency Contacts (other than parents/guardians)

Family Information

Other Student Information

Parent Statement of Child's Health Condition

Media Release Form

Immunization Release Form

Previous School Information

Please sign and date the Registration Form below: