Registration Update
Please review the information and complete the fields for information that needs to be updated from last year's records.  If there are no changes, please select "No Changes," enter the student's name, and select the student's grade they will be entering before going to the bottom and choosing "Submit."  If you are unsure about anything, please write your question in the last section at the end of the form.

If you have more than one student attending, please complete the form for each student individually.
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Student's Name (First, Middle, Last) *
If there are no changes to to the student's information from last year, please select no changes below.
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I grant permission for my child to participate in school field and study trips under the guidance and direction of employees and/or volunteers from the Glen Ullin Public School.  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by my student. *
Student-Parent Handbook agreements can be accessed online at https://www.glen-ullin.k12.nd.us/ under District Info at any time.  Physical copies may be obtained in the school office.  The Student-Parent Handbook contains essential information about the Glen Ullin Public School.  It is required that every parent/guardian and student read and discuss it.  Parents/guardians are encouraged to read the handbook to younger students.  

Please indicate below that you have read, discussed carefully, and agree to be governed by the philosophy and rules of the Glen Ullin Public School.  Selecting yes below acts as a signature for both the student and the parents/guardians.
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Glen Ullin Public School may photograph your child in the school and at school events/activities.  These photos may appear in our school, on our school webpage, and on our social media, such as Facebook or Twitter.  If you wish to opt out of your student's photograph being shared, please indicate so below. *
Student Information
Student's Preferred Name
What grade will be student be entering? *
Will the student be riding the bus?
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Is this student the youngest family member enrolled in this school?
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Student Home Phone
Gender
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Date of Birth
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Ethnicity
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Physical Address
Mailing Address (If Different from Physical Address)
Parent Information
Mother's Name (First, Last)
Mother's Home Phone
Mother's Cell Phone
Mother's Work Phone
Mother's Preferred Daytime Contact Method
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Mother's Address (if different)
Father's Name (First, Last)
Father's Home Phone
Father's Cell Phone
Father's Work Phone
Father's Preferred Daytime Contact Method
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Father's Address (if different)
Living Arrangements
Is the child's household a single-parent household?
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If yes, who does the student currently live with?
If the student currently has a Step-Parent, Guardian, Foster Parent, Custodian, Group Home, etc., please indicate the name, relationship, and contact information for any applicable individuals.
Emergency Contact Information - Local Individual that is Not a Parent
First Emergency Contact Name, Phone Number, Address, and Relationship to Student.   Please include first and last name.
Second Emergency Contact Name, Phone Number, Address, and Relationship to Student.   Please include first and last name.
Third Emergency Contact Name, Phone Number, Address, and Relationship to Student.   Please include first and last name.
Medical Information
Doctor's Name and Phone Number
Dentist's Name and Phone Number
Does the student have any allergies?  Please list all allergies and any medications (if applicable).
What is the severity of the allergic reaction?
Does the student use an Epi-Pen?
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If the student requires an Epi-Pen, when will school personnel need to administer the Epi-Pen in the instance it is needed?
Does the student use an Inhaler?
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Does the student have any health problems?  If so, please list them here.
Have any health concerns resulted in a prior emergency medical situation?  Please describe.
Does the student take any medications?
Please Note:  If the student will take any medications at school, including over-the-counter pain relievers, the student's parent must complete the Medication Authorization Form and return it to the office.  This form must be completed each year.  Most medications will be stored and administered in the office.  These medications must be given to the office when the form is turned in, and will be returned at the end of the school year.  Office personnel will notify parents when medication is running low, as necessary.  This form can be picked up from the office or can be found on the school website under the forms tab.
In case of a medical emergency where I cannot be reached, I give my child's doctor or any attending physician permission to administer medical treatment. *

At Glen Ullin Public School District, we use Google Workspace for Education, and we are seeking your permission to provide and manage a Google Workspace for Education account for your child. Google Workspace for Education is a set of education productivity tools from Google including Gmail, Calendar, Docs, Classroom, and more used by tens of millions of students and teachers around the world. Our students will use their Google Workspace for Education accounts to complete assignments, communicate with their teachers, sign into their Chromebooks, and learn 21st-century digital citizenship skills. 

The Google Consent Form Information link found under District Info on our website provides answers to common questions about what Google can and can’t do with your child’s personal information.

Please read it carefully, let us know of any questions, and then indicate that you’ve read the notice and give your consent. If you don’t provide your consent, we will not create/maintain a Google Workspace for Education account for your child.  This may cause a disruption in educational services for your child. 

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Additional Questions or Concerns
Please write any other questions or comments you may have concerning this form or information the school needs to be aware of regarding your student.
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