7-12 Enrollment Form 2020-2021
Please fill out the enrollment form with the information requested.
Student Last Name (must be LEGAL name) *
Student First Name (must be LEGAL name) *
Student Middle Name (must be LEGAL name) *
Previous School (list city, state) *
Student Social Security Number (xxx-xx-xxxx) *
Grade *
Gender *
Age *
Birthdate *
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Birthplace (City, State) *
With whom do you reside? *
Ethnicity *
Race *
Required
Is any language other than English spoken in the home? *
If yes, what is the primary language spoken?
Is the student a member of an Indian tribe? *
Medical Information (allergies, medication, health concerns, etc) *
Physical Address (list street, city, state, zip) *
Mailing Address (list street or PO, city, state, zip) *
Student cell phone number (xxx-xxx-xxxx) *
Parent/Guardian (mother) First Name, Last Name *
Parent/Guardian (mother) Cell xxx-xxx-xxxx *
Parent/Guardian(mother) Employer *
Parent/Guardian (mother) Email
Parent/Guardian (father) First Name, Last Name *
Parent/Guardian (father) Cell xxx-xxx-xxxx *
Parent/Guardian (father) Employer *
Parent/Guardian (father) Email
Name of Emergency Contact Other Than Parent/Guardian *
Phone Number of Emergency Contact Other Than Parent/Guardian *
Does the child reside 1.5 miles from the school? *
Bus Route (if applicable) *
Handbook Policy Acknowledgement- A copy of the Fargo-Gage School’s Handbook can be found on the school’s website at www.fargo.k12.ok.us located under the Administration tab, by clicking on the Forms & Handbook link. The handbook is available for viewing. Please sign below(by using your initials) acknowledging you received the location of the handbook information. *
Please identify below whether you give your permission for this student being enrolled to be included in pictures and/or videos taken while attending Fargo-Gage Public Schools. The pictures and/or videos may be released via various forms of media *
Student Internet Access Conduct Agreement- Every student, regardless of age, must read or have this read to them, and sign below. I have read, understand, and agree to the terms of the Internet Policy in the student handbook. Should I commit any violation or in any way misuse my access to the school district's computer network and the internet, I understand and agree that my access privileges may be revoked and school disciplinary action may be taken against me. Initial below. *
Parent/Guardian- If student applicant is under 18 years of age, a parent or guardian must also read and sign this agreement. As the parent or legal guardian of the above student, I have read, understand, and agree that my child or ward shall comply with the terms of the school district's acceptable Use and Internet Safety Policy for the student's access to the school district's computer network and the internet. I understand that access is being provided to the students for educational purposes only. However, I also understand that it is impossible for the school to restrict access to all offensive and controversial materials, and I understand that my child's or ward's responsibility for abiding by the policy. I am therefore, signing this policy and agree to indemnify and hold harmless the school, the school district, and the Data Acquisition Site that provides the opportunity to the school district for computer network and internet access, against all claims, damages, losses, and costs of whatever kind that may result from my child's or ward's use of his/her access account if and when such access is not in the school setting. I hereby give permission for my child or ward to use the building approved account to access the school district's computer network and internet. Place initials below to acknowledge statement. *
Administer Medication: The school may administer a non-prescription medication which I am hereby supplying to you, or will supply when required. This is to be given in accordance with the written, signed and dated instructions that will accompany the medication in a sealed bag. List non-prescription medication name:
Administer Medication: The school may administer a filled prescription medication which I am hereby supplying to you, or will supply when required. This is to be given in accordance with the directions for administering the medication as listed on the label on the bottle or vial, or in accordance with any written, signed and dated instructions of the prescribing Physician. Any prescribed medication must be supplied to the school in the original container with the prescription label attached. List prescription medication name:
Carry and Self-Administer Medication: A filled prescription which I am hereby supplying to you, or will supply when required. This is approved for carrying and self-administration by the student by the laws of the State of Oklahoma, and is used in accordance with the directions for administering the medication as listed on the bottle or vial, or in accordance with any written, signed and dated instructions of the prescribing Physician. List prescription medicine name to carry & self-administer:
I understand that under state law, the Board of Education, the School District, or employees of the School District, shall not be liable to the student, or the student's result, or the student's parent(s) or guardian(s), from acts of omissions of personal injuries to the student, which result from acts or omissions of school employees administering the medication I have hereby authorized. Parent Initials (Acknowledging read and understood as outlined above) *
I hereby authorize the Oklahoma Immunization Information System to release my child's Immunization records and information located within the Oklahoma State Immunization Information System ("OSISS") Fargo-Gage Public Schools. *
I acknowledge that the information contained in this enrollment packet is accurate *
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I acknowledge that the information in this enrollment packet is accurate. Signature *
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