2023-24 Young Fives - Livonia Public Schools Registration

Livonia Public Schools Registration - Young Fives 2023-2024

Livonia Public Schools Registration - Young Fives 2023-2024

Thank you for registering your child in Livonia Public Schools! We look forward to working with you and your family.
Please complete all required fields of this form. Arrangements to present the REQUIRED DOCUMENTATION will be communicated with families at a later time.

Other Forms
- Medication Authorization Form (if your child requires medication during the school day, to be completed by the student's doctor)
Does the student reside within the Livonia Public Schools district? (Please note that priority is given to residents of LPS.)*

YesNo
If you do not reside within the LPS district, which district do you reside in?
How did you find information about registering your student?*

Child's schoolLPS WebsiteDirect MailE-mailSocial MediaPrint Ad

Student Website/Media Authorization OPT OUT

You DO NOT need to complete this section if there are no restrictions.
Dear Parents and Guardians,

Livonia Public Schools uses all available media to showcase our school district and the achievements of our students. We do this through a variety of means, including web, print marketing materials, newsletters, press releases, local cable TV, and coverage in local print and broadcast media.

Recognizing that some families may wish to restrict their student(s) names and/or images from being used in school district information, we respectfully offer this opt-out form. By signing this form, you are requesting that your student NOT be included in the aforementioned forms of publication.

You DO NOT need to complete this form if there are no restrictions.
Student's Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date Signed

MonthDayYear
Date

Emergency Contact Information

Please complete this form in case we are unable to reach you in the case of emergency.
Emergency Contact 1 - Name*

First NameLast Name
Emergency Contact 1 - Relationship*
Emergency Contact 1 - Phone 1*

Area CodePhone Number
Emergency Contact 1 - Phone 2

Area CodePhone Number
Emergency Contact 2 - Name

First NameLast Name
Emergency Contact 2 - Relationship
Emergency Contact 2 - Phone 1

Area CodePhone Number
Emergency Contact 2 - Phone 2

Area CodePhone Number
Emergency Contact 3 - Name

First NameLast Name
Emergency Contact 3 - Relationship
Emergency Contact 3 - Phone 1

Area CodePhone Number
Emergency Contact 3 - Phone 2

Area CodePhone Number
Emergency Contact 4 - Name

First NameLast Name
Emergency Contact 4 - Relationship
Emergency Contact 4 - Phone 1

Area CodePhone Number
Emergency Contact 4 - Phone 2

Area CodePhone Number

Early Entry Waiver

In accordance with Michigan Law, a child residing in the Livonia Public Schools’ attendance area who is not five years old by September 1st, but will be five years of age not later than December 1st, the parent or legal guardian of that child may enroll the child in Young Fives for the current school year.
Student's Name

First NameLast Name
Student's Birth Date

MonthDayYear
Date
Please give evidence of your student's school readiness.
Name of Parent

First NameLast Name
Parent Signature

Clear
Should be Empty:

American Indian/Alaskan Native

Black/African American

Hispanic/Latino

Native Hawaiian/Other Pacific Islander

White/Caucasian