January Dear Kindergarten Family,

Transcription

1 January 2017 Dear Kindergarten Family, I am delighted to welcome you to the Wayzata Public Schools at the beginning of your child s educational journey! There has never been a more exciting time to be starting school. In today s world, teaching and learning is filled possibilities we couldn t have imagined even a few years ago. In Wayzata, we understand how individualized learning, technological advances and great teaching can converge to create a dynamic learning environment. We believe this positions us to provide each and every student we serve with an excellent educational experience that will prepare your child to thrive and excel not only in school, but in life. We look forward to being your partner on your child s unique and wonderful educational journey. If I can be of assistance along the way, please don t hesitate to contact me. Sincerely, Dr. Chace B. Anderson Superintendent

2 Kindergarten Enrollment Procedures Located at Wayzata Early Learning School 1461 County Road 101 N., Plymouth, MN Hours 7:30am - 4:00pm welcome@wayzata.k12.mn.us (fax) Student Information Form Please complete one form per family. Proof of Residency Families are required to provide proof of residency. Renting Current signed lease agreement with the name(s) of the parent/guardian on the document. Homeowner Copy of the closing papers (warranty deed). Long-time residents may provide copy of Hennepin County tax statement. New Home Under Construction Copy of builder s agreement and then follow-up with closing papers (warranty deed) after closing. All families are required to provide proof of birth date and spelling of legal name. Please bring along a photocopy for the school to retain. The original is not retained by the District. Race/Language Form Please complete one form per student. Families of Kindergarteners may be contacted after March 15 to assess eligibility and support in the English Learner program. Proof of Current Immunizations Form You may attach immunization forms from your doctor or complete the forms in this packet. State law requires that parents show written proof of immunization. Wayzata Public Schools enforces the NO SHOTS, NO SCHOOL policy. Children will not be allowed to attend school until the record of required immunizations has been provided. Families who object to the immunizations must provide a notarized declination form. Early Childhood Screening Form State law requires all children entering kindergarten to have an early childhood screening completed. The tests include: vision, hearing, cognitive motor skills, speech and language. Call to schedule an appointment that lasts about 60 minutes. Health and Physical Examination Form Although not required, it is highly recommended to have this form completed prior to beginning kindergarten. Proof of Current Immunization Form is required. Data Privacy Form (optional) The optional Data Privacy form is available online under Student Enrollment at or by calling the Welcome Center at Daycare Transportation Form (optional) Your child may be transported to and/or from a daycare with the following requirements: 1) the daycare location must be within the attendance area of your child s school, 2) the child must always be picked-up or dropped-off at the same daycare location and 3) arrangements for busing must be made in writing. The Daycare Transportation form is available online under Student Enrollment at or by calling the Welcome Center at

3 Student Information Form List all children in your household Last Name (legal) First Name (legal) Middle Name Birthdate Grade Gender Previous District Wayzata School of Attendance 1. / / M F / / 2. / / M F / / 3. / / M F / / 4. / / M F / / Wayzata Start Date Parent / Guardian Information: Does student receive special education services (have an IEP or IFSP)? Has student(s) ever received English as a Second Language? Last Name First Name Initial Birthdate Gender Cell Phone Work Phone Employer 1. / / M F ( ) - ( ) - Address: Has student(s) ever been screened, assessed, or attended a public school in Minnesota? Student 1 Yes No Yes No Yes No Student 2 Yes No Yes No Yes No Student 3 Yes No Yes No Yes No Student 4 Yes No Yes No Yes No 2. / / M F ( ) - ( ) - Address: Home & Address Information: House Number Street Name Dir. Bldg. # Apt. # City State ZIP Primary Phone Do you live in the Wayzata School District? Yes No Date moved into district: If not, in what district do you live?: ( ) - Guardian Info / Second Mailing: The Family Education Rights and Privacy Act provides that educational records are available to parents of a student. List other parent/guardian for additional mailings and information. Mother Father Last Name First Name Initial House Number Street Name Dir. Bldg. # Apt. # City State ZIP Home Phone ( ) - Child(ren) lives in home with: Parent/Guardian Step-parent Foster Family Grandparents Other Status of Parents: Married & living together Separated Divorced Mother remarried Mother deceased Father remarried Father deceased Other welcome@wayzata.k12.mn.us Rev. 12/14

4 Race/Ethnicity Form Student Information Last Name (legal) First Name (legal) M.I. Date of Birth Country of Birth If country of birth is not USA, date of first enrollment in USA school Race/Ethnicity Background Information Please complete all sections, A, B, and C. If any of the following sections are left unmarked, the district is mandated by federal law to choose for you. A. For state reporting purposes, please check the ONE response that best describes your child s primary racial background: American Indian or Alaska Native (persons having origins in any of the original peoples of North America and maintain cultural identification through tribal affiliation or community recognition.) Asian or Pacific Islander (persons having origins in any of the original peoples of the Far East, Southeast Asia, the Pacific Islands or the Indian subcontinent. This area includes China, India, Japan, Korea, Philippine Islands and Samoa.) Hispanic (persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race.) Black, not of Hispanic origin (persons having origins in any of the Black racial groups of Africa.) White, not of Hispanic origin (persons having origins in any of the original peoples of Europe, North Africa or the Middle East.) B. For federal reporting purposes, check ONE answer Child s Ethnicity Yes Mexican, Puerto Rican, South or Central American and other Spanish culture or origin, regardless of race No Not Hispanic or Latino C. For federal reporting purposes, check ALL that apply: American Indian or Alaska Native (persons having origins in any of the original peoples of North America or South America, including Central America and maintains a tribal affiliation or community attachment.) Asian (persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian sub continent. Including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, Philippine Islands, Thailand, Vietnam.) Black, not of Hispanic origin (persons having origins in any of the black racial groups of Africa.) Native Hawaiian or other Pacific Islander (a person having origins in any of the original people of Hawaii, Guam, Samoa or other Pacific Islands.) White (a person having origins in any of the original peoples of Europe, North Africa or Middle East.) Rev. /1

5 Student Language Form Student Information Last Name (legal) First Name (legal) M.I. Date of Birth Student Language Information 1. What language did your child learn first? 2. Which language is most often spoken in your home? 3. Which language does your child usually speak? 4. What is the student s home language? 5. Can the student read and write in the home language? 6. Does the student speak another language other than his or her home language? If yes, list the language(s). 7. If yes, can the student read and write in that language? List Language(s) Office Use Only 8. Please list what years the student attend school in his or her home country? Do not include any years the child missed school. 9. If applicable, please list what years the student attended school in the USA. Include what state as well. Do not include any years the child missed school. School Year Age US State 10. Military Connection Data Collection: Does this student have an immediate family member, including a parent or sibling, who is currently in the armed forces either as a reservist or an active duty or has recently retired from the armed forces? Parent / Guardian Signature Yes Date No Rev. 06/15

6 Student Immunization Form Student Name Birthdate Student Number Minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or conscientious exemption. FOR SCHOOL USE ONLY ( ) Complete; booster required in ( ) In process; 8 mos. expires ( ) Medical exemption for ( ) Conscientious objection for ( ) Parental/guardian consent Parent/Guardian: You may attach a copy of the child s immunization history to this form OR enter the MONTH, DAY, and YEAR for all vaccines your child received. Enter MED to indicate vaccines that are medically contraindicated including a history of disease, or laboratory evidence of immunity and CO for vaccines that are contrary to parent or guardian s conscientiously held beliefs. Sign or obtain appropriate signatures on reverse. Complete section 1A or 1B to certify immunization status and section 2A to document medical exemptions (including a history of varicella disease) and 2B to document a conscientious exemption. Additionally, if a parent or guardian would like to give permission to the school to share their child s immunization record with Minnesota s immunization information system, they may sign section 3 (optional). For updated copies of your child s vaccination history, talk to your doctor or call the Minnesota Immunization Information Connection (MIIC) at or School Personnel: Be sure to initial and date any new information that you add to this form after the parent/guardian submits it. Also, record combination vaccines (e.g., DTaP+HepB+IPV, Hib+HepB) in each applicable space. Type of Vaccine DO NOT USE ( ) or ( ) 1st Dose Mo/Day/Yr 2nd Dose Mo/Day/Yr 3rd Dose Mo/Day/Yr 4th Dose Mo/Day/Yr 5th Dose Mo/Day/Yr Required (The shaded boxes indicate doses that are not routinely given; however, if your child has received them, please write the date in the shaded box.) Diphtheria, Tetanus, and Pertussis (DTaP, DTP, DT) for children age 6 years and younger final dose on or after age 4 years Tetanus and Diphtheria (Td) for children age 7 years and older 3 doses of Td required for children not up to date with DTaP, DTP, or DT series above Tetanus, Diphtheria and Pertussis (Tdap) for children in 7th - 12th grade Polio (IPV, OPV) final dose on or after age 4 years Measles, Mumps, and Rubella (MMR) minimum age: on or after 1st birthday Hepatitis B (hep B) Varicella (chickenpox) minimum age: on or after 1st birthday vaccine or disease history required Meningococcal (MCV, MPSV) for children in 7th - 12th grade booster given at age 16 years Recommended Human Papillomavirus (HPV) Hepatitis A (hep A) Influenza (annually for children 6 months and older) 4th dose not required if 3rd dose was given on or after the 4th birthday 5th dose not required if 4rd dose was given on or after the 4th birthday Additional exemptions: Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum requirements of the law. Students in grades 7-12: A Tdap at age 11 years or later is required for students in grades If a child received Tdap at age 7-10 years another dose is not needed at age years. However, if it was only a Td, a Tdap dose at age years is required. Students years of age: A 3rd dose of hepatitis B vaccine is not required for students who provide documentation of the alternative 2-dose schedule. Students 18 years of age or older: Do not need polio vaccine. Developed by the Minnesota Department of Health - Immunization Program (12/13) #

7 Student Name Instructions, please complete: Box 1 to certify the child s immunization status Box 2 to file an exemption (medical or concientious) Box 3 to provide consent to share immunization information (optional) 1. Certify Immunization Status. Complete A or B to indicate child s immunization status. A. Received all required immunizations: I certify that this student has received all immunizations required by law. Signature of Parent / Guardian OR Physician / Public Clinic Date B. Will complete required immunizations within the next 8 months: I certify that this student has received at least one dose of vaccine for diphtheria, tetanus, and pertussis (if age-appropriate), polio, hepatitis B, varicella, measles, mumps, and rubella and will complete his/her diphtheria, tetanus, pertussis, hepatitis B, and/or polio vaccine series within the next 8 months. The dates on which the remaining doses are to be given are: Signature of Physician / Public Clinic Date 2. Exemptions to School Immunization Law. Complete A and/or B to indicate type of exemption. A. Medical exemption: No student is required to receive an immunization if they have a medical contraindication, history of disease, or laboratory evidence of immunity. For a student to receive a medical exemption, a physician, nurse practitioner, or physician assistant must sign this statement: I certify the immunization(s) listed below are contraindicated for medical reasons, laboratory evidence of immunity, or that adequate immunity exists due to a history of disease that was laboratory confirmed (for varicella disease see * below). List exempted immunization(s): B. Conscientious exemption: No student is required to have an immunization that is contrary to the conscientiously held beliefs of his/ her parent or guardian. However, not following vaccine recommendations may endanger the health or life of the student or others they come in contact with. In a disease outbreak schools may exclude children who are not vaccinated in order to protect them and others. To receive an exemption to vaccination, a parent or legal guardian must complete and sign the following statement and have it notarized: I certify by notarization that it is contrary to my conscientiously held beliefs for my child to receive the following vaccine(s): Signature of physician/nurse practitioner/physician assistant Date *History of varicella disease only. In the case of varicella disease, it was medically diagnosed or adequately described to me by the parent to indicate past varicella infection in (year) Signature of physician/nurse practitioner/physician assistant (If disease occured before September 2010, a parent can sign.) Signature of parent or legal guardian Date Subscribed and sworn to before me this: day of 20 Signature of notary 3. Parental/Guardian Consent to Share Immunization Information (optional): Your child s school is asking your permission to share your child s immunization documentation with MIIC, Minnesota s immunization information system, to help better protect students from disease and allow easier access for you to retrieve your child s immunization record. You are not required to sign this consent; it is voluntary. In addition, all the information you provide is legally classified as private data and can only be released to those legally authorized to receive it under Minnesota law. I agree to allow school personnel to share my student s immunization documentation with Minnesota s immunization information system: Signature of parent or legal guardian Date Developed by the Minnesota Department of Health - Immunization Program (12/13) #

8 Early Childhood Screening Form Early Childhood Developmental Screening is a required component of the getting ready for kindergarten process. Screening is not a school entrance exam or test, but is a fun set of standardized games that screen for age appropriate development. Early Childhood Developmental Screening is recommended when a child is three to four years of age, but must have been completed prior to starting kindergarten in any Minnesota public school. Screening is a free, quick and simple check of your child s development, hearing and vision, growth, health and immunization history, fine and gross motor skills, speech and language, and social and emotional development. Early Childhood Developmental Screening helps a school district identify children who may benefit from district and community resources available to help in their development. Early Childhood Developmental Screening includes a vision screening that helps detect potential eye problems but is not a substitute for a comprehensive eye exam. Student Information (please print): Last Name First Name Date of Birth Address City / ZIP Gender Male Female Guardian Information (please print): Name Name Contact Phone Contact Phone Please indicate your child s screening status: My child has been previously screened through Wayzata Public School District Early Childhood Screening program. Your child s screening summary will automatically be forwarded to your child s school. My child has been previously screened through the following Minnesota School District:. Select one: A copy of students screening summary is attached. I authorize the release of screening results from School District. My child has not completed an Early Childhood Developmental Screening. Call to schedule a screening appointment. Screening appointments are available during the school year. Request an appointment via at screening@wayzata.k12.mn.us. My child has a scheduled appointment date: / /

9 History and Physical Form Parent or Guardian: please complete the top half of this form prior to seeing medical provider. Student Last Name Student First Name Middle Birth Date / / Wayzata School of Attendance Grade Age Parent / Guardian Gender Past History: please x if your child has had any of the following conditions or health concerns: Allergies Hearing Concerns Asthma Vision Concerns Cancer Dizziness/Fainting Heart Disease Persistent Cough or Breathing Problem Orthopedic Concerns Abdominal Complaints Neurological Concerns Recurrent Strep Throat Infections Seizures Recurrent Ear Infections Physical Disability Bleeds Easily Other: Bladder or Bowel Problem Developmental or Learning Concerns (i.e. speech, motor, social skills, etc.): HEENT Lungs Heart Abdomen Medical Provider: Please complete below including comment for any abnormal findings: N Ab N Ab Musculoskeletal Neurological Skin Lymphatic Genito-urinary Other: Vaccines Administered Today: Height inches Weight lbs. Blood Pressure / Vision: Right 20/ Left 20/ Corrected: Yes No Hearing: Normal Abnormal Health Classification for School Program Is in excellent health and able to participate in the entire school program. There is a condition which may limit participation. Check any or all that apply: Classroom Activities Physical Education Competitive Sports Add Explanation: Is the above classification temporary? Yes No If yes, expected time for restriction from activity: Provider Signature Print Name Exam Date Clinic Name Address Phone ( ) Fax ( ) / /

10 Immunization Requirements Birth through 4 years Early childhood programs & Child care Hepatitis A Hepatitis B DTaP/DT Polio MMR Hib Haemophilus influenzae type b Pneumococcal At age 2-24 months Are Your Kids Ready? Minnesota s Immunization Law The following immunizations are required beginning Sept. 1, To enter into child care, early childhood programs, and elementary or secondary schools (public or private), children need to have certain immunizations. Use this chart as a quick reference to determine which vaccines are required for enrollment. See below for exemption information. Age: 5 through 6 years 2 For Kindergarten Hepatitis B 3 doses MMR 2 doses Varicella 1 Varicella 1 2 doses Age: 7 through 11 years For 1st through 6 th grade Hepatitis B 3 doses MMR 2 doses Varicella 1 2 doses Immunizations recommended but not required by the Immunization Law: Influenza Recommended annually for all children age 6 months and older Rotavirus Recommended for infants DTaP 5 doses 5 th shot not needed if 4 th was after age 4 Final dose on or after age 4 years Polio 4 doses 4 th polio not needed if 3 rd was after age 4 Final dose on or after age 4 years At least 3 tetanus and diphtheria containing doses Polio At least 3 doses Age: 12 years and older For 7 th through 12 th grade Hepatitis B 3 3 doses Tdap 4 At age years Polio At least 3 doses MMR 2 doses Meningococcal 5 At age years Varicella 1 2 doses Human papillomavirus Recommended at age 11 years 1 If the child has already had chickenpox disease, varicella shots are not required. If the disease occurred after 2010, the child s doctor must sign a form. 2 First graders who are 6 years old and younger must follow the polio and DTaP/DT schedules for kindergarten. 3 An alternate 2-shot schedule of hepatitis B may also be used for kids from age 11 through 15 years. 4 Proof of at least three doses of diphtheria and tetanus vaccination needed. If a child received Tdap at age 7-10 years another dose is not needed at age years. However, if it was only a Td, a Tdap dose at age years is needed. 5 A booster dose is required at age 16 years or three years later if the first dose was given between age years. Exemptions Looking for Vaccination Records? To go to school in Minnesota, students must show they ve had these immunizations or file a legal exemption with the school. Parents may file a medical exemption signed by a health care provider or a conscientious objection signed by a parent/guardian and notarized. For copies of your child s vaccination records, talk to your doctor or call the Minnesota Immunization Information Connection (MIIC) at or Immunization Program For a parent-friendly chart of immunizations needed for kids from PO Box birth to age 16 see, When to Get Vaccines available to download from St. Paul, MN or IC# (MDH, 10/2013)

11 Vaccine-Preventable Diseases and the Vaccines that Prevent Them Vaccines required to enter into child care, early childhood programs, and elementary or secondary schools (public or private). Vaccine/Disease Disease spread by Disease symptoms Disease complications DTaP or Tdap vaccine protects against diphtheria, pertussis, and tetanus Hib vaccine protects against Haemophilus influenzae type b Hep A vaccine protects against hepatitis A Hep B vaccine protects against hepatitis B Diphtheria: Air, direct contact Pertussis: Air, direct contact Tetanus: Exposure through cuts in skin Direct contact, air Direct contact, contaminated food or water Contact with blood or body fluids Diphtheria: Sore throat, mild fever, weakness, swollen glands in neck Pertussis: Severe cough, runny nose, apnea (a pause in breathing in infants) Tetanus: Stiffness in neck and abdominal muscles, difficulty swallowing, muscle spasms, fever May be no symptoms unless bacteria enters the blood; generalized weakness and fever, stiff neck, confusion, irritability, local infections, joint pain Fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice (yellowing of skin and eyes), joint pain, dark urine or no symptoms Fever, headache, weakness, vomiting, jaundice, joint pain, or no symptoms Measles: High fever, cough, runny nose, red watery eyes, rash Diphtheria: Swelling of the heart muscle, heart failure, coma, paralysis, death Pertussis: Pneumonia (infection in the lungs), brain damage, death Tetanus: Broken bones, breathing difficulty, severe muscle spasms, death, Meningitis (infection of the covering around the brain and spinal cord), shock due to blood infection, swelling of the throat that can lead to serious breathing problems, hearing loss, pneumonia, bone and heart infections, death Liver failure Chronic liver infection, cirrhosis, liver failure, liver cancer Measles: Brain swelling, seizures, ear infection, pneumonia, death MMR vaccine protects against measles, mumps, and rubella Air, direct contact Mumps: Swollen salivary glands (under the jaw), testicle or ovary swelling, fever, headache, tiredness, muscle pain Rubella: Rash, fever, swollen lymph nodes Mumps: Meningitis, brain swelling, deafness, sterility Rubella: Very serious in pregnant women can lead to miscarriage, stillbirth, premature delivery, birth defects MCV vaccine protects against meningococcal Air, direct contact Severe headache, fever, nausea, vomiting, bruising rash, confusion, extreme sleepiness Blood infections, amputation, deafness, nervous system problems, developmental disabilities, seizures, death PCV vaccine protects against pneumococcal Air, direct contact Fever, cough or difficulty breathing, weakness, severe headache or irritability, or no symptoms Blood infections, meningitis, pneumonia, death Polio vaccine protects against polio Direct contact, through the mouth, air Sore throat, fever, nausea, headache, leg weakness, or no symptoms Paralysis, chronic muscle weakness, death Varicella vaccine protects against chickenpox Air, direct contact Itchy rash, fever, tiredness, headache Vaccines recommended but not required by the Immunization Law Skin infection, bleeding disorders, brain swelling, pneumonia Vaccine/Disease Disease spread by Disease symptoms Disease complications HPV vaccine protects against human papillomavirus Flu vaccine protects against influenza Rotavirus vaccine protects against rotavirus Sex, intimate contact Air, direct contact Warts on genitals, or no symptoms Fever, muscle pain, sore throat, cough, extreme fatigue Through the mouth Diarrhea, fever, vomiting Dehydration, collapse Cervical, vaginal, or vulvar cancer in females; penile cancer in males; anal or oral cancer and genital warts in males and females. Chronic infections requiring ongoing treatment. Pneumonia, Guillain-Barré syndrome, death IC# (MDH, 10/2013)

12 Online Family Access Information amily Access is a web based online informational application designed to provide parents guardians and students with communication on a range of school topics. he system is available hours a day seven days a wee. Family ccess arents stay connected and involved with their student s academic progress in an online application that is easy to understand and navigate. Parents uardians ay ie Address Information Attendance Report Cards Parents uardians Student Information erification (update annually) rint Report Cards mail School ersonnel Retrieve forgotten login and password rade Parents uardians may also vie Class Schedules Calendar aily Assignments rade oo Messages from Staff etting Started e Families 1. In your web browser address bar type ata. 1.mn.us. Under uic in s clic on amily Access. Clic on Sign up for amily Access arents and egal uardians. ill out the form. Your e mail address must be provided to receive a return e mail with your username login and password information. ach parent/guardian must have their own unique address for security purposes. 5. Clic the Sumbit button to process the request. ithin five ( ) business days you will receive a user login and password sing Family ccess 1. In your web browser address bar type ata. 1.mn.us. Under uic in s clic on amily Access. Clic on User I og in here button and enter your login and password r you can type in your browser and save to your favorites: ywardfamilyaccess.iscorp.com/way ata nter your login and password. Clic Sign In to enter the site Report Card pt in Student report cards are available online through amily Access and can be printed from any home computer. In an effort to reduce costs and save paper hard copies of the report card I be sent home. If computer/internet access is not available to a family call the amily Access phone at 1 to request a printed report card.