2023-2024 GSRP

Livonia Public Schools Registration - Great Start Readiness Program

Livonia Public Schools Registration - Great Start Readiness Program

Thank you for registering your child in Livonia Public Schools! We look forward to working with you and your family.
Student Information
Please select the year you are registering your student for. *
Student Name (As it appears on birth certificate)*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Place of Birth (City/State/Country)*
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Phone Type*

CellularResidence
I agree to allow the Michigan Department of Health view my student's immunization records.*

YesNo
Is the student Hispanic/Latino?*

YesNo

Please select the student's primary and secondary ethnic groups.*

Permission for Service

While your child is enrolled in GSRP, (s)he will be involved in a number of special activities, for which we need your permission. You have the option of withdrawing permission at any time.
Child's Name*

First NameLast Name

Please indicate your responses.*

	Yes	No
I give permission for my child to be screened for speech and language.
I give permission for my child to be screened for hearing and vision.
I give permission for my child to be screened for specific educational needs.

Permission and Release of Liability

At times we may take walks and use the playgrounds surrounding the school as part of our daily learning process. The children discuss what they hear, see, and smell. In addition, they develop their large muscle coordination.
I grant permission for my child to take neighborhood walks to the playgrounds surrounding the school as part of the daily programming.

Clear
I understand that attendance at this activity is not required by the school district, and attendance by the student is on a strictly voluntary basis. In consideration for the student to participate in and attend this activity, I agree to hold harmless and release Livonia Public Schools, its Board of Education, its elected officials, employees, agents, representatives, and the activity chaperones from all claims, damages, suits, actions, causes of action, and all liabilities whatsoever, in law or in equity, which may arise out of, or be related to, the student attending this activity, including, but not limited to, all liabilities and/or claims resulting from the negligence of the released parties from all injuries to the student, and all liabilities and/or claims from injuries to the student arising out of, or related to , his/her transportation to and from the activity.
Signature

Clear

Transportation Request Form
Child's Name

First NameLast Name
Parent's Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Other Phone Number

Area CodePhone Number
If your child will be dropped off after school at a location other than your home, please provide the following information:
By signing below, I am acknowledging that I understand that the full-day Great Start Readiness Program at Garfield Center provides transportation AFTER SCHOOL only.

Clear

Safety Support Device Responsibility
Child's Name

First NameLast Name
Birthdate

MonthDayYear
Date
If your child utilizes LPS transportation, he/she will be issued a safety support device in order to provide a safer ride to and from school. He/she is required to wear it while ridiing the bus, and will NOT be transported if he/she is not wearing it.

You are responsible for the return of this device at the end of the school year, or if your child leaves the program during the school term. The cost of the device ($125) will be billed to you if it is not returned at that time.
I agree to take responsibility for the return of the safety support device.

Clear

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
Should be Empty:

	Name	Case Number
Custodial Guardian 1
Custodial Guardian 2

American Indian/Alaskan Native

Black/African American

Hispanic/Latino

Native Hawaiian/Other Pacific Islander

White/Caucasian