• Household

    A household is a grouping of people who live together in one location.  A household name is typically a last name or a hyphenated name that represents the students in the family.  Please provide the address and primary phone number associated with this household.  Proof of residency will be required.

  • Household Members

    Please list all students in your household that will attend Glenpool Public Schools and any adults living in this household who will be a contact for students.

  • Relationships

    Let's establish the relationship between the adults in the household and the students in this household.  We will start with adut 1.

  • Relationships

    Let's establish the relationship between adult 2 and the students in this household.

  • Relationships

    Let's establish the relationship between adult 3 and the students in this household.

  • Relationships

    Let's establish the relationship between adult 4 and the students in the household.

  • Additional information about the adults in this household.

  • Student Information

    Let's get some detailed information about each student living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Student Information

    Let's get some detailed information about student 2 living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Student Information

    Let's get some detailed information about student 3 living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Student Information

    Let's get some detailed information about student 4 living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Student Information

    Let's get some detailed information about student 5 living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Student Information

    Let's get some detailed information about student 6 living in this household.

  •  /  / Pick a Date

  • Enrollment History

  • Transportation

    Provide information about how each student in this household will get to school and arrive home.

  • Health Information

    Let's collect some health information for each student in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Let's collect some health information for student 2 in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Let's collect some health information for student 3 in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Let's collect some health information for student 4 in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Health Information

    Let's collect some health information for student 5 in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Health Information

    Let's collect some health information for student 6 in this household.

     

  • I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical facility to administer any emergency treatment, procedure, or medication necessary and advisable. I also authorize the use of an ambulance, if necessary, to transport my child. I further agree to pay for all services provided for my child.

  • OSIIS - Authorization to Use or Share Protected Health Information to School.

    I hearby authorize the Oklahoma Immunization Service to release my Immunization records and information located within the Oklahoma State Immunization Information System (OSIIS) to Glenpool Public Schools.

    The informaion may be disclosed to to ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. §
    1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

    This authorization will be in effect for one year from the date of signature.

  •  -  -
    Pick a Date
  • Clear
  •  -  -
    Pick a Date

  • Emergency Contacts

    Please list adults who do not live in your home that you want contacted in case of an emergency if you can not be reached.  Also, list any biological parent who has custodial rights to these students but is not living in the student's household.   

  • Since adult 1 is a biological parent, additional information is requested.