2024-2025 Student Paperwork
Form needs to be completed individually for each student attending Glenn.
Student Full Name
*
First Name
Middle Name
Last Name
Student Nickname
*
What does your child preferred to be called?
Student Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Please Select
Male
Female
N/A
Students Birthday
*
-
Month
-
Day
Year
Date
Primary Language at Home
*
Parent #1 Name
*
First Name
Last Name
Parent #1 Phone Number
*
Please enter a valid phone number.
Parent #1 Email
*
example@example.com
Parent #1 Occupation
*
Parent #2 Name
First Name
Last Name
Parent #2 Phone Number
Please enter a valid phone number.
Parent #2 Email
example@example.com
Parent #2 Occupation
Do parent #1 and parent #2 live at the same address?
*
Yes
No
N/A
If parents live at separate addresses, please provide secondary address below.
Who lives in the house with the child?
*
Parents, grandparents, siblings, etc.
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Emergency Contact Information
Please provide names of two emergency contacts that are not the student's parents to contact in case of an emergency.
Primary Emergency Contact
*
First Name
Last Name
Primary Emergency Contact's Relationship to Student
*
Primary Contact (1) Phone Number
*
Please enter a valid phone number.
Secondary Emergency Contact
*
First Name
Last Name
Secondary Emergency Contact's Relationship to Student
*
Primary Contact (2) Phone Number
*
Please enter a valid phone number.
Please provide names of up to three (3) persons approved to pick your child up from school. In addition to their names, please provide each person's phone number and relationship to your child.
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Student Information
Child's Assigned Class (this can be found in "Class Assignment" email from Kerry Bresee)
Toddlers
Bears - Polar or Brown (2s)
Honeybees (2s)
Dolphins (3s)
Whales (3s)
Elephants (PreK)
Pandas (PreK)
Owls (K)
Unsure
Is your child potty trained? *Children entering the Three’s classes should be actively potty training before school begins.
*
Yes
In progress
No
Does your child have any known medical conditions that we need to be aware of?
*
Yes
No
Please provide details on your child's known medical conditions.
Does your child have any allergies?
*
Yes
No
Is an Epipen required for your child if exposed to allergen?
Yes
No
Please list your child's allergens and how they are managed.
Does your child currently receive support or services outside of school (OT, PT, Speech, etc)?
*
Yes
No
What service(s) is your child currently receiving?
What is the reason/diagnosis for the service(s)?
List three strengths that you see in your child.
*
What are some areas of growth you would like to see in your child this school year?
*
Has your child been in a school setting before?
*
Yes
No
Please describe the setting and your child’s experience
Student Immunization Record
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Choose a file
Please upload the most current immunization record for your child provided by your pediatrician.
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Glenn School Authorizations and Releases
MEDICAL TREATMENT AUTHORIZATION: I grant permission to the Glenn School for Young Children, teachers, and staff, during any emergency or accident involving my child to obtain the services of a physician and/or to transport my child to a hospital if I cannot be reached.
*
Please Select
Agree
Disagree
Medical Insurance Company
*
Policy/Group Number
*
Participant ID Number
*
Medical Insurance Phone Number
*
TUITION PAYMENT AGREEMENT: I understand that tuition payments are made in three installments. Advanced tuition that was paid in April 2023. The next two payments are due October 6, 2023 and January 19, 2024. The tuition payment chart for tuition is on the tuition page on the Glenn School website. If you need to make other arrangements for tuition payments, you will need to contact Beth Smith atbsmith@glennumc.org.
*
Please Select
Agree
Disagree
ILLNESS POLICY AGREEMENT: I understand I should not send my child to school if they are showing any signs of Illness. The Glenn School illness policy is provided in the Parent Handbook.
*
Please Select
Agree
Disagree
IMMUNIZATION AGREEMENT: I understand that an updated immunization form from my child’s pediatrician is required, before your child can start school. All immunization forms should be emailed to Kerry Bresee at kbresee@glennumc.org.
*
Please Select
Agree
Disagree
CARPOOL POLICY AGREEMENT: I understand that carpool runs during the following times and arriving late for pickup could result in a late fee after two warnings: (Morning Drop Off: 8:50 am – 9:10 am; Afternoon Pickup: 11:50 am – 12:10 pm; Lunch Bunch Pickup: 12:50 pm – 1:10 pm)
*
Please Select
Agree
Disagree
NUT FREE POLICY AGREEMENT: I understand that Glenn School is a nut-free facility no food products containing nuts will be allowed in the school for snack or Lunch Bunch.
*
Please Select
Agree
Disagree
FAMILY DIRECTORY AGREEMENT: I understand that the Glenn School Directory will be available to all Glenn parents (the directory is password protected on the website) and will contain child’s name, parents’ names, phone numbers and email addresses. If I wish to opt out of the Glenn Directory, I will send an email to Alison LaGree at alagree@glennumc.org requesting to opt out. (Please put DirectoryOpt Out in subject line of email.)
*
Please Select
Agree
Disagree
PHOTO RELEASE AGREEMENT: I understand that the Glenn School publishes photos and videos on Glenn School platforms that include: (1) This Week at Glenn, our weekly newsletter that is sent to current Glenn families. (2) Class Dojo, where pictures are shared only with the class and school-wide for the weekly newsletter post. (3) The Glenn School Facebook page and The Glenn School Instagram page. (No identifying information will be shared on social media pages). (4) Glenn Gala Art projects. (5) The Glenn School Annual Yearbook (6) Bulletin Boards throughout Glenn School. If I wish to opt out, I will send an email to Alison LaGree at alagree@glennumc.org requesting to opt out. (Please put Photo Release Opt Out in subject line of email.)
*
Please Select
Agree
Disagree
ENRICHMENT PROGRAMS AGREEMENT: I understand that Enrichment Programs are offered through Glenn United Methodist Church and these programs are supervised by the individual program. All providers are background checked through Glenn UMC and follow all Glenn School guidelines.
*
Please Select
Agree
Disagree
LIABILITY WAIVER: I understand that Glenn School for Young Children operates under an exemption from licensing, granted by Bright from the Start. We do carry liability insurance and comply with criteria and requirements for exemptions in Rule 591-1-1-.46(1)(a) Exemption Requirements and Rule 581-1-1-.46(1)(b) Exemption Categories.
*
Please Select
Agree
Disagree
My signature below confirms my choices listed above align with my preferences and the information provided in this entire document is accurate and up to date.
*
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