2021-2022 Pre K Enrollment
Child must be 4 yrs old by Sept. 1 and be able to tend to personal needs.
Students First Name *
Students Last Name *
Date of Birth *
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Social Security Number *
Gender *
Physical Address *
City *
Zip *
Ethnicity *
Race *
Required
Is any language other than English spoken in your home? *
If yes, the primary language spoken is
Is student a member of an Indian Tribe *
Student's place of birth(city) *
Student's place of birth(state) *
Student resides with *
Legal/Custody Papers? Please note, the school must have a copy of the court order on file declaring custody arrangement. *
Does the child reside 1.5 miles from school? *
If yes, will the child be riding on a bus route?
Clear selection
Mother's first name
Mother's last name
Mother's phone number(no dashes)
Mother's email address
Mother's Street Address
Mother's City, State, Zip Code
Mother's Place of Employment
Mother's Work Phone Number(no dashes)
Father's First Name
Father's Last Name
Father's Phone Number(no dashes)
Father's email address
Father's Address
Father's City, State, Zip code
Father's Place of Employment
Father's Work Phone Number(no dashes)
Guardian's First and Last Name
Guardian's Home Phone Number
Guardians Cell Number
Guardian's Street Address
Guardian's City, State, Zip Code
List individuals whom the student is allowed to leave with *
Emergency Contact Name(s) other than parent or guardian *
Emergency Contact phone number(s) *
Medical Information *
Fargo Public Schools is proud to offer a service that allows those interested to receive text messages notifications regarding district news, alerts and updates like weather-related closing/delays, games cancellations, etc. Do you want to subscribe to this service? *
10 digit number(no dashes)
Handbook Policy Acknowledgement- A copy of the Fargo-Gage School’s Handbook can be found @ https://s3.amazonaws.com/scschoolfiles/356/19-20_student_handbook_-_complete.pdf here or 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 immediate 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. * A Classroom Usage Agreement form must be signed and on file. *
Please identify below whether you give your permission for this student being enrolled to be transported by Fargo-Gage Public Schools personnel to and/or from school events/activities during the school day. * *
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 foregoing acceptable use and Internet Safety Policy. 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 listed below, 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. Non-Prescription Medication Name:
Administer medication listed below, 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. Prescription Medication Name:
Carry and Self-Administer medication listed below, 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. 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) *
OSIIS - Authorization to use or share protected health information to school or Day Care. I hereby authorize the Oklahoma Immunization Information System to Fargo-Gage School. *
Please note that upon the final process of enrolling students, actual parent signatures will be gathered acknowledging you have read and accepted the terms of these forms. You will complete this process during enrollment for the child's school. I acknowledge that the information contained in this enrollment packet is accurate. *
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Parent Initials-for Acceptance of above statement *
The following documents are required for enrollment. Email to tflanagan@fargo.k12.ok.us or mail copies to Fargo-Gage Elementary School, PO Box 200, Fargo, OK 73840
Enrollment for Fargo-Gage Pre K is limited to in district students and on a first come first served basis. Space is limited. Initial below for acknowledgement. *
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