1. Healthcare

Welcome
CLASS OF
2028
Kindergarten Enrollment Packet
2015-2016
g a
e
e
WELCOME TO KINDERGARTEN!
REGISTRATION CHECKLIST
oEnrollment Form
oParent Input Form for
Student Placement
oChild’s birth certificate
(original and copy)
ENROLLMENT
REQUIREMENT
HEALTH CHECKLIST
o
Immunization Form
o
Physical Exam/Health History Form
o
Make special arrangements with
the health office as needed
KINDERGARTEN TIMELINE
Enclosed please find important information for all Edina Public Schools (EPS)
incoming kindergarten families pertaining to the upcoming school year. Included
you will find information about:
Program Preference Form Due
Monday, January 12, 2015 at 6 p.m.
Applications Due for Open Enrollment
Thursday, January 15, 2015
•
Kindergarten Enrollment – overview of enrollment options as well as a list
of frequently asked questions;
•
Student Health Requirements – information on the health services
department and student immunization requirements;
Kindergarten Registration Day
Thursday, January 29, 2015
•
Transitioning to Kindergarten – information and resources on how
families can support their child to make a successful transition;
•
Early Childhood Developmental Screening – information on student
screening requirements; and
•
Community Education programming – information on before and after
school and non-school day care options through Edina KIDS Club and
Edina Community Education Services.
Concord
Countryside
Cornelia
Creek Valley
Highlands
Normandale
Additional information about district programs and services can also be found
online at edinaschools.org. Thank you for your partnership in making 2015-16 a
great year!
Concord Elementary
Rick Sansted, Principal
952-848-4300
Countryside Elementary
Karen Bergman, Principal
952-848-4700
Highlands Elementary
Peter Hodne, Principal
952-848-4500
Cornelia Elementary
Lisa Masica, Principal
952-848-4600
Creek Valley Elementary
Kari Dahlquist, Principal
952-848-3200
Normandale Elementary
Chris Holden, Principal
952-848-4100
3:30 - 5 p.m.
4:15 - 5:45 p.m.
4 - 5:30 p.m.
4 - 5:30 p.m.
4:15 - 5:45 p.m.
3:30 - 5 p.m.
Teacher Assignments
Information will be available in August
Elementary School Open Houses
Held prior to the start of school
First Day of School for Kindergarten
Tuesday, September 1 , 2015
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ENROLLMENT INFORMATION
ENROLLMENT OPTIONS
Kindergarten families have three educational options available:
Neighborhood Schools, French Immersion, and Continuous
Progress. Families who are interested in French Immersion or
Continuous Progress must submit a Program Preference Form by
Jan. 12, 2015.
FRENCH IMMERSION
French Immersion has been an educational option for EPS families
since 1991. The program is held at Normandale Elementary School
(adjacent to the Edina Community Center). Normandale students
receive the same curriculum as all Edina Public School students, but
are instructed in the French language. Because of the advancing
French proficiency level of the curriculum and students, entrance to
the program is most successful when children begin in kindergarten.
If you received notice that your child has been accepted into
the French Immersion Program, please attend the Normandale
Kindergarten Registration event.
CONTINUOUS PROGRESS PROGRAM
Continous Progress is offered at Highlands and Countryside schools.
Students work in multi-age families and stay with a teacher for
three to five years. Continuous Progress (CP) begins in first grade,
and students may enter the program at any grade level. However,
due to limited space, families are encouraged to enroll their child
in kindergarten. The program is located at both Countryside and
Highlands Schools. If you received notice that your child has been
accepted into the CP program at Highlands or Countryside, please
attend that respective school’s Kindergarten Registration event.
FREQUENTLY ASKED QUESTIONS (FAQ)
What is the age requirement to enter kindergarten?
Children who are five years old on or before Sept. 1, 2015 are eligible to
begin kindergarten. Please bring your child’s official birth certificate with
embossed seal to Kindergarten Registration.
When is registration?
Kindergarten registration will be held on Thursday, Jan. 29, 2015. Please
bring your completed registration materials to this event.
What immunizations are required?
Minnesota Statute 121.15 requires that all children must be immunized
against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella,
hepatitis B series and varicella (or a record of chicken pox.). Additional
information is located later in this packet.
Do I need to have my child screened prior to kindergarten?
State law requires completion of a developmental screening (i.e. Early
Childhood Screening) prior to entrance into kindergarten. Please refer to
additional information later this packet for details on screening requirements
and processes.
What if my child is not attending EPS kindergarten in the fall?
Please let your neighborhood school or the Student Enrollment Office (952848-4585) know if you are not planning to enroll your child in 2015-16.
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When will I find out who my child’s teacher will be?
Because of staffing and enrollment changes made throughout
the summer, class lists are not finalized until early to mid-August.
How can I get involved at my school?
Edina Public Schools celebrates the partnership between home and
school. Each class and school have several opportunities for families to be
involved. You will begin to receive some of this information at Kindergarten
Registration, throughout the spring, and again in the fall.
How can I learn more about my child’s school?
Specific questions about your child’s school can be answered during the
orientation session or by contacting the school directly.
What are the benefits of all-day kindergarten?
Having a full day of instruction means students will experience an enhanced
kindergarten experience that prepares them for future education.
What if I want my child to attend half day?
Since the district will only be offering a full-day program option, families who
wish to have their child attend for half of the day can do so under current
law. However, midday transportation would be the responsibility of the
parent/guardian, and curriculum and activities will be based on a full-day
program model.
What if my child is not ready for a full-day experience?
EPS is committed to working with families on an individual basis to help their
child transition to school. Our principals have and will continue to work hard
in partnership with families during this time to ensure all students can be
successful.
EARLY CHILDHOOD DEVELOPMENTAL SCREENING
As you begin to prepare your child for enrollment in kindergarten, there are certain requirements that must be met according
to State law. Early Childhood Developmental Screening is one of the required components for entrance into kindergarten.
If your child has already completed Early Childhood Developmental Screening through the Edina Public Schools, no
further action is required. Your child’s screening record will be delivered to his/her elementary school at the start of the
kindergarten school year.
If your child has not been screened, you will need to schedule an appointment and complete the screening before your child
can start school. Information regarding screening can be found online at www.edinaschools.org/screening. From the main
screen, click the “Schools” section, then “Early Education,” then “Early Childhood Developmental Screening.”
Screenings are conducted throughout the school year on an appointment basis and take approximately one hour.
• Screening should be done when your child is three-and-a-half years old.
• Screening is a FREE check of your child’s development, including speech and language skills, motor skills and
concepts, height, weight, vision and hearing.
• The purpose is to help identify health or learning concerns that may require special attention before a child enters
kindergarten. It is not beneficial to wait until your child is older to complete this screening.
• Screening does not determine kindergarten readiness.
You may choose to not have your child participate in this screening. If you do not want your child screened, you must
provide us with a signed, dated statement noting that you are a conscientious objector to the Early Childhood Screening
program.
If your child has been screened in another school district, or if your medical doctor has completed a standardized
assessment, submit the records by Dec. 12, 2014 to:
Lisa Hawthorne
Early Childhood Developmental Screening, Room 163
Edina Public Schools
5701 Normandale Road
Edina, MN 55424
If you would like additional information or have any questions,
please contact the Early Childhood Screening office at 952-848-4299.
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For Kindergarten 2015-2016
Edina KIDS Club is a fun, stimulating learning
environment for your child that will complement and
enrich your child’s kindergarten experience in Edina
Public Schools. We provide quality enrichment
and care before and after school and on release
days. Children learn through a wide variety of
activities such as art, music, science projects,
cooking, games, writing, reading, crafts, outdoor
play, computers, practicing social skills, gym time,
dramatic play, and much more! There is a balance
of activity options that includes large group, small
group, and individual choices. KIDS Club is a great
place for children to develop friendships, and grow
their confidence, independence and respect for
themselves and others.
REGISTRATION
KIDS Club registration materials will be available on our
website in May. Please watch for an email reminder in the
spring. For questions, contact 952-848-3947 or
[email protected].
Program Fees (subject to change):
• KIDS Club 5 days/week schedule:
$11.50/morning and $11.50/afternoon
• KIDS Club 4 days/week or less schedule:
$12.50/morning and $12.50/afternoon
• KIDS Club Extra Time: $15/morning or afternoon
• Non-School Days: $42/day
($39/day if added by 15th of preceeding month)
• Located at each elementary school
• Program operates before school,
after school and on non-school days
• Visit our website to learn more:
edinacommunityed.org
PROGRAM OPTIONS
1. BEFORE SCHOOL KIDS CLUB
KIDS Club programming is available for all students in
grades K-3 and is offered at your elementary school
before school from 6:45 a.m. to the start of school.
2. AFTER SCHOOL KIDS CLUB
KIDS Club programming is available for all students in
grades K-3 and is offered at your elementary school
after school from school dismissal to 6:00 p.m.
3. NON-SCHOOL DAY
Non-school day programming is available on days
when school is not in session. It is located at your
child’s school and is available all day, from 6:45 a.m.
to 6:00 p.m. The program often includes a field trip and
additional enrichment opportunities.
KIDS Club is a program of Edina Community Education Services of Edina Public Schools
5701 Normandale Road | Edina, MN 55424 | edinacommunityed.org | 952-848-3947 | [email protected]
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EDINA FAMILY CENTER
The Edina Family Center offers high-quality early education programs for
families with children from birth through age five. Programs include New
Baby and Me classes, Early Childhood Family Education (ECFE), preschool,
childcare and more.
YOUTH PROGRAMS
Youth programs offer a variety of fun and educational activities for ages
3-18. KIDS Club (gr. K-3), WISE Guys (gr. 4-5), and SURGE (gr. 6-9) provide
high-quality out-of-school time care. Classes and camps offer new and
favorite enrichment subjects. Youth Serving Youth (YSY) at Edina High School
provides student leadership and service activities.
ADULT EDUCATION
Edina Center for Adult Education engages adults of all ages with extensive
learning opportunities, ranging from cooking, fitness and world language
courses, 21st century technology and career exploration, and metro-area field
trips and world travel.
VOLUNTEER
Edina’s Community Volunteer Program invites community members to share
their time, talents, and passion for learning with Edina students. Volunteers
work across all schools and programs to offer assistance with basic skills help,
homework help, and serve as speakers and resources.
Enriching Lives to
Strengthen Community
For more information on resources
and services in Edina, contact
the Edina Resource Center. All
services are free and confidential.
edinaresourcecenter.com
RESOURCE LINE:
(952) 848-3936
LATE START/EARLY RELEASE INFORMATION
Late Starts and Early Releases were introduced during the 2013-14
school year to provide critical collaboration time allowing teachers to
better customize the learning experience for each student. Having
this additional planning time periodically during the school year allows
teachers to provide timely modifications or change instruction in ways
that best meet the needs of their students.
ENRICHMENT OPPORTUNITIES
Edina Community Education Services (CES) invites students to
join its welcoming enrichment programs before and after school
on the scheduled late start/early release days. Edina Community
Education collaborates with EPS teachers to offer activities that
complement what students are learning during the school day.
WHAT TIME DOES SCHOOL START/END?
• Elementary Program - Elementary students can enroll in
enrichment programs at their home elementary school for one,
two, three or all four of the late start and early release days.
• Late Start means that the student school day begins two hours
later than usual
• Early Release means the student day will end two hours earlier
than usual
WILL THERE BE BUSING ON THESE DAYS?
District transportation will be adjusted for the two hour late start or early
release. That is, on late start days, the bus will arrive two hours after
their usual pickup time; on early release days, students will be dropped
off two hours earlier than their usual time. After school activity buses will
operate as usual.
• Middle School Program - Middle School students can enroll
in the CES enrichment program on early release days only.
(NOTE: There will be no middle school enrichment program
program offered on late start days.) The Middle School
program will be held at South View Middle School. Valley
View students interested in participating in the program will be
bused to South View for the afternoon program.
• Cost - The cost per student for each two-hour time block is
$20. To learn more about scholarships for the CES enrichment
program, please call 952-848-3952.
• Registration - Interested families can register for enrichment
programs at http://edina.thatscommunityed.com.
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HEALTH SERVICES INFORMATION
The Edina Public Schools Health Services
department is pleased to welcome your
kindergartener and you! The mission of Edina
Schools Health Services is to promote optimal
health for optimal learning.
HEALTH SERVICES STAFFING
Each elementary school has a health office that is staffed during the
day when students are in school. A team of Licensed School Nurses
and Health Services Associates work closely with one another and
other school staff to support all district students, prevent communicable
diseases, and promote healthy learning environments.
•
•
The Health Services Associate (HSA) is trained in first aid and
CPR. The HSA provides basic medical attention, gives medications
under the direction of the Licensed School Nurse, assists with
vision and hearing screening, and helps track student immunization
records.
A Licensed School Nurse (LSN) is a Registered Nurse with a
Bachelor’s Degree in nursing and certification as a public health
nurse. The LSN works with parents, students and teachers to help
students participate fully in the school program. Examples of the
LSN’s work include setting up health plans for students with chronic
health or disabling conditions, performing prescribed medical
treatments, and teaching students about healthy behaviors.
As some sites have special programs that require additional health
services staff, the following are the staffing assignments for EPS
elementary schools:
•
Concord, Creek Valley, Highlands and Normandale
Each of these elementary schools has a Health Services Associate
who provides care during student hours. One LSN serves all four of
these schools and consults regularly with the HSAs.
•
Cornelia and Countryside
Cornelia school has a full time LSN and a part-time HSA;
Countryside has a full time LSN.
MEDICATIONS AT SCHOOL
Whenever possible, medications should be given during non-school
hours. When it is necessary for a student to receive medication during
the school day, the student must bring the following for each medication:
• medication in the original container with directions;
• written permission from the parent/guardian; and
• a written order from the physician for all medications including
over the counter medications for pain relief.
All medications must be kept in the Health Office unless special
arrangements (e.g. emergency epipens or inhalers ) are made with
the LSN. Please contact your school health office to obtain medication
authorization forms.
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IMMUNIZATION REQUIREMENTS
It is important for parents to understand the immunization requirements
for enrollment in Edina Public Schools. Minnesota Statute 121A.15
states “...no person over two months old may be allowed to enroll or
remain enrolled in any elementary or secondary school…” without proof
that he/she has received the immunizations appropriate for age or that
the student should not have shots for medical reasons or because of
parent beliefs. For your reference, please see the “Are Your Kids Ready
for School?” fact sheet (right) on the Minnesota School Immunization
Law.
CHILDREN WITH CHRONIC HEALTH CONDITIONS
Parents should consult with the LSN if they have a child with a
diagnosed chronic health condition such as asthma, diabetes, seizures,
or severe allergies. The nurse, student and family work with the child’s
health care provider to establish a health plan that will assist school staff
in understanding and accommodating the student’s health needs.
ILLNESS
Sick children can spread illness to other students and staff. Your child
should not come to school if he/she has had:
• a fever of 100 degrees F or more in the past 24 hours;
• vomiting or diarrhea in the past 24 hours; or
• a skin rash that has not been diagnosed by a health care provider.
Call the Absence Line at your child’s school when your child is absent
due to illness. Please notify your school health office if your child has a
condition that can be spread to others such as strep throat, chickenpox
or head lice.
When students become ill or are injured during the school day, parents/
guardians are contacted first. If a parent/guardian cannot be reached, a
call is made to other individuals listed on the emergency card. Students
will not be released unless accompanied by a responsible adult. It is an
expectation that students will be picked up within one hour of the call to
the parent/guardian.
FIRST AID/EMERGENCY
If a student requires more than basic first aid, 911 will be called and the
parent/guardian will be contacted.
STAY-IN REQUESTS FOR RECESS
The district’s position is that children who are well enough to attend
school are well enough to take part in gym and outdoor recess. A
request to stay inside will be honored if made by the child’s physician in
writing and filed with the school health office.
SCREENING
Vision and hearing are important to a student’s ability to learn. Health
services staff screen students in select grade levels to identify potential
vision and hearing difficulties. All kindergarten students are screened for
hearing difficulties.
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Welcome
CLASS OF
2028
The enclosed forms need to be filled out and returned to the school your
child will be attending in 2015-16.
ENROLLMENT CHECKLIST:
Please bring completed forms and materials to Kindergarten
Registration Day on Thursday, January 29, 2015.
¨ Enrollment Form (3 pages)
¨ Birth Certificate (orginal and copy)
¨ Parent Input Form (2-sided)
ENROLLMENT
REQUIREMENT
HEALTH REQUIREMENT CHECKLIST:
All health forms must be submitted prior to the start of school.
¨ Immunization Records (one of the following)
• Completed Pupil Immunization Record (see form) that includes the month, day and year of each
immunization; or
• Copy of immunization records from physician or clinic; or
• Pupil Immunization Record signed by a physician that the child should not receive the vaccine OR signed by
the parent and notarized that the child has not been immunized as prescribed because of the conscientiously
held beliefs of the parents.
¨ Physical Exam (provided and signed by primary care provider)
¨ Health History Form (see page 17)
¨ Special Arrangements (if applicable)
• Parents of students with chronic health conditions and special health needs should contact the Health Office
staff this spring before school is out to ensure adequate planning and care for fall. This includes students with
diabetes, asthma, seizures and severe allergies.
• Any student requiring medications at school should contact the Health Services staff this spring to discuss
medication policy/procedure requirements.
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ENROLLMENT FORM
OFFICE USE
ONLY
Student ID#
SCHOOL #
Last Location
Dwelling #
EDINA Public School District #273 — Registration Form
5701 Normandale Road, Edina, MN 55424 ENROLLMENT
Phone: 952.848.4585 FAX: 952.848.3937 REQUIREMENT
Student’s Last Name (Legal only)
Student’s First Name (Legal only)
Gender
M
Birth Date
Start Date:
F
GRADE ENTERING - Kindergarten
Has your child been through the Early Childhood
Developmental Screening?
Does your child receive Special Services
or have an Individual Education Plan
(IEP)? YES
NO
YES
Has your child attended a nursery school,
day care center, Montessori or other Pre-K
option? YES
NO
NO
If yes, where was your
child screened?
If YOUR CHILD WAS NOT SCREENED IN EDINA,
PLEASE ATTACH A COPY OF THE SCREENING
REPORT SUMMARY
Res Dist
Number of years:__________
Days per week:____________
Hours per day:____________
Proof of legal guardianship is needed if
student is living with someone other than the
parent.
Family #
Resident District if not Edina
__________________
Name of School or Center:
State Aid Cat
Middle Name
Is this student in foster care? YES
In the definition used for this research, a homeless person is anyone who (1) lacks a fixed, regular, and
adequate nighttime residence; and (2) has a primary
nighttime residence that is a supervised, publicly- or privately-operated temporary living accommodation,
including emergency shelters, transitional housing, and
battered women’s shelters; or 3) has a nighttime
residence in any place not meant for human habitation,
such as under bridges or in cars. This is based on the
definition established by the U.S. Congress.
Is this student homeless?
NO
YES
NO
HOME LANGUAGE INFORMATION
Family #
This information is used to determine if your student is eligible for the English Language Learner (ELL)
program. In order to help your student learn, your student’s teachers need to determine which language your
student uses most.
1. Which language did your child learn first?
2. Which language is most often spoken in your home?
3. Which language does your child usually speak?
Do you need an interpreter for conferences, etc.? YES
Trans Code
NO
What language do the student’s parents speak?
I certify that the registration
information in this packet is correct.
Signature of Legal Parent/Guardian
Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
Date
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ENROLLMENT FORM (PAGE 2)
ENROLLMENT
REQUIREMENT
Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
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ENROLLMENT FORM (PAGE 3)
ENROLLMENT
REQUIREMENT
Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
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BIRTH CERTIFICATE INFORMATION
ENROLLMENT
REQUIREMENT
ON KINDERGARTEN REGISTRATION DAY:
1. Please present an original birth certificate with embossed seal to the school that your child will be
attending. It will be returned upon presentation.
2. We request that you also bring a copy of the original birth certificate with for the school to keep on file.
A child is not permitted to enter school until an official birth certificate is presented. A hospital certificate cannot be
accepted. The following information will help you obtain a certified birth certificate:.
• A written request is preferred and all requests must be made by mail, fax or online.
• List father’s name, mother’s maiden name, the child’s name, date, and place of birth.
• Enclose $26 per certificate and a self-addressed, stamped envelope.
WHERE TO REQUEST YOUR CHILD’S BIRTH CERTIFICATE
For all children born in Minnesota, contact:
MINNESOTA DEPARTMENT OF HEALTH
Central Cashiering – Vital Records
P.O. Box 64499
St. Paul, MN 55164-0499
Fax: 651-201-5740 or 651-201-5750
Website: www.health.state.mn.us
Make checks payable to:
Minnesota Department of Health
For children born in Minneapolis Hospitals or
Suburban Hennepin County Hospitals, contact:
VITAL RECORDS
Hennepin County Government Center
300 South 6th Street, Suite A025
Minneapolis, MN 55487-0026
Phone: 612-348-8240 (use prompts)
Fax: 612-348-2010
Website: www.hennepin.us
Cost: $26 per certificate
Make checks payable to:
Hennepin County Treasurer
You may also request a birth certificate in person at
the Southdale Hennepin County Service Center in
Edina (7009 York Avenue South).
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Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
PARENT INPUT FORM FOR STUDENT PLACEMENT
ENROLLMENT
REQUIREMENT
We welcome you and your child to our school! There will be many different kinds of things for our students to do and
we hope your child will be interested in the activities from the very first day. Because children have so many different
interests, it takes a few weeks for us to get to know each child. This information will help your child’s teacher become better
acquainted with your child.
Each spring, Edina Public Schools staff work to develop class lists for the coming year, striving to create classes where
optimum learning for all students can take place. We value a strong family-school partnership. It is our goal to have
balanced classes across each grade level. If you have specific information about your child that should be taken into
consideration, please complete this form. We consider many factors as we try to stabilize our classes and accommodate
individual needs:
•
•
•
•
•
•
Gender balance
Emotional/social combinations
Balance of performance levels
Special learning needs
Teaching/learning styles
Behavior factors
Families will receive information on their classroom placement during school open house nights in August.
STUDENT PLACEMENT INFORMATION (Please Print):
Child’s Name: _____________________________________________________Birth Date: _______________________
Parent(s) Name: ___________________________________________________ Phone Number: ___________________
Has your child attended a nursery school, day care center, Montessori or other Pre-K option?
¨Yes
¨No
Name of School/Center: _____________________________________________________________________________
Number of Years: __________________________ Days per week: ____________________ Hours per day: _________
CONTINUES ON NEXT PAGE
Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
15
PARENT INPUT FORM FOR STUDENT PLACEMENT (PAGE 2)
Child’s Name: _____________________________________________________
PHYSICAL AND HEALTH FACTORS
Consider: vision and hearing, speech, previous major illnesses, etc.
ACADEMIC INTERESTS AND ABILITIES
Consider: reading, writing, math, and science
EMOTIONAL AND BEHAVIORAL DEVELOPMENT
Consider: social awareness or interpersonal skills, cooperation, leadership, dependability, stability and respect for others.
SPECIAL AND/OR UNIQUE INFORMATION WHICH YOU THINK WOULD HELP US PLAN FOR YOUR CHILD
Consider: What does a teacher really need to understand about your child?
Parent Signature: ____________________________________
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Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015
HEALTH HISTORY
This form is a quick overview of identified health conditions. Follow up will occur closer to the start of
kindergarten. Please remember to also include a physical examination form provided and signed by
your primary care provider.
ENROLLMENT
REQUIREMENT
No identified health concerns
Identified health concerns
ADHD/ADD/Other learning disabilities (describe):
Allergies, life threatening (describe):
Dairy
Nuts
Soy
Wheat, gluten
Food intolerance (describe):
Asthma or other breathing problems (describe):
Bladder problems/Bowel problems (describe):
Diabetes: __ Type 1 __ Type 2
Managed by: __ Diet only __Oral meds __ Insulin injections __ Insulin pump
Heart problems (describe):
Seizures: Type (describe):
Date of last seizure
Social/Emotional/Behavioral mental health concerns (describe):
Anxiety
Depression
Vision deficit that requires preferential seating (describe):
Hearing deficit that requires preferential seating (describe):
Other health concerns or restrictions (describe):
Surgeries or hospitalizations in the last year (describe):
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ENROLLMENT
REQUIREMENT
IMMUNIZATION CLINIC
Bloomington Public Health Department
Immunizations that are required for entrance into Minnesota schools
are available at the Bloomington Health Department. Parents must
bring previous immunization records. No immunization will be given
without the signature of the parent or guardian. If you have questions
in advance of your visit, you may call the clinic at the number below.
1900 West Old Shakopee Road
Bloomington, MN 55431
952-563-8900
Clinics are held on the first and third Tuesday of each month
from 3 – 5:30 p.m.
Cost: $10 donation per immunization (for those without insurance
coverage for immunizations)
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Pupil Immunization Record
Student Name _________________________________________________
Birthdate _____________________Student Number __________________
FOR SCHOOL USE ONLY
( ) Complete; booster required in ___________
( ) In process; 8 mos. expires _____________
( ) Medical exemption for _________________
( ) Conscientious objection for _____________
( ) Parental/guardian consent _____________
Minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or
conscientious exemption.
Parent: Enter the MONTH, DAY, and YEAR for all vaccines your child received, MED for vaccines that are medically
contraindicated, or CO for vaccines that are conscientiously opposed. Sign appropriate signature boxes on reverse.
MED: Medical contraindication to immunization, history of disease, or laboratory evidence of immunity.
CO: Immunizations are contrary to parent or guardian’s conscientiously held beliefs.
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)
Diphtheria and Tetanus (DT)
• for 6-year-olds and younger
Tetanus and Diphtheria (Tdap, Td)
• for 7-year-olds and older
Polio (IPV, OPV)
Measles, Mumps, and Rubella (MMR)
• minimum age: on or after 1st birthday
• required for kindergarten and 7th grade
Hepatitis B (hep B)
• required for kindergarten and 7th grade
Varicella (chickenpox)
• minimum age: on or after 1st birthday
• vaccine or disease history required for kindergarten and
7th grade
Recommended
Meningococcal (MCV, MPSV)
Human Papillomavirus (HPV)
Hepatitis A (hep A)
Additional exemptions:
• Children less than 7 years of age: The 5th dose of DTaP/DTP/DT (similarly, the 4th dose of polio vaccine) is not
necessary if the 4th DTaP/DTP/DT (3rd dose of polio) was administered after the 4th birthday.
• 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 Td or Tdap booster at age 11 years or later is not required for students in grades 7-12 whose
most recent Td was given after their 7th birthday but before their 11th birthday. Instead, it will be required 10 years after the
date of the most recent dose.
• Students 11-15 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 10 years or older: May receive Tdap to fulfill the Td requirement for students in grades 7-12.
• Students 18 years of age or older: Do not need polio vaccine.
Developed by the Minnesota Department of Health - Immunization Program
www.health.state.mn.us/immunize
(11/11) #140-0155
19
BOX 1: Certifying Immunization Status
BOX 3A: Medical Exemptions
BOX 2: Consent to Share Immunization Information
BOX 3B: Conscientious Exemptions
1. Choose one of the following to indicate student’s immunization status and the source of the information above:
A. I certify that this student has received all immunizations required by law.
____________________________________________________________________________________________
Signature of parent/guardian or physician/public clinic
Date
B. I certify that this student has received at least one dose of vaccine for diphtheria, tetanus, and pertussis (if ageappropriate), polio, hepatitis B (K and 7th), varicella (K and 7th), 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. Parental/Guardian Consent to Share Immunization Information:
Your child’s school is asking your permission to share your child’s immunization record with Minnesota’s immunization
registry to help us better protect students from disease. 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 record with Minnesota’s immunization registry:
______________________________________________________________________________________________
Signature of parent or legal guardian
Date
3. Exemptions to School Immunization Law
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.)
Exempted immunization(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
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 parent or legal guardian
Date
Subscribed and sworn to before me this _______ day of ______________________ 20______
___________________________________________________________
Signature of notary
Developed by the Minnesota Department of Health - Immunization Program
www.health.state.mn.us/immunize
20
(11/11) #140-0155
TRANSITIONING TO KINDERGARTEN
“Is my child ready for kindergarten?” Does “ready” mean being
able to count to ten, say the alphabet, sit for storytime, or identify
colors?” Perhaps! These things could mean that your child is
“ready” for kindergarten, but the real question is: Is your child
excited, curious and eager to keep learning in a kindergarten
classroom?
To help you prepare your child to make the transition into
kindergarten, we’ve provided some information and resources
that could be helpful. The district will also send out a Countdown
to Kindergarten eNewsletter starting in January 2015, with helpful
tips, advice and activities to help prepare your family for kindergarten. Parents are a child’s first teacher and every child
develops at a different pace. In Minnesota, all children who are five years of age on or before Sept. 1 are encouraged to
attend kindergarten.
If you have concerns or needs for your family or young children and are not eligible for services from other local programs,
the Edina Family Center School Readiness program may be for you. School Readiness helps families with children, 3-1/2
to 5 years old, prepare for a successful school experience. For more information, please contact Mary Streier, school
readiness coordinator at 952-848-3985 or [email protected].
NON-PROFIT
ORGANIZATION
US POSTAGE
PAID
PERMIT NO. 91349
TWIN CITIES MN
ISD 273
5701 Normandale Road
Edina, MN 55424
edinaschools.org
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CONTACT US
WELCOME CENTER
5701 Normandale Road
Edina, MN 55424
952-848-3900
[email protected]
STUDENT ENROLLMENT
5701 Normandale Road
Edina, MN 55424
952-848-4585
[email protected]
EPS SCHOOL BOARD
[email protected]
Randy Meyer, Chair
Cathy Cella, Vice Chair
Regina Neville, Clerk
ELEMENTARY SCHOOLS
Concord Elementary (K-5)
5900 Concord Avenue S.
Edina, MN 55424
952-848-4300
edinaschools.org/concord
Countryside Elementary (K-5)
5701 Benton Avenue S.
Edina, MN 55436
952-848-4700
edinaschools.org/countryside
Highlands Elementary (K-5)
5505 Doncaster Way
Edina, MN 55436
952-848-4500
edinaschools.org/highlands
Cornelia Elementary (K-5)
7000 Cornelia Drive
Edina, MN 55435
952-848-4600
edinaschools.org/cornelia
Creek Valley Elementary (K-5)
6401 Gleason Road
Edina, MN 55439
952-848-3200
edinaschools.org/creekvalley
Normandale Elementary (K-5)
French Immersion School
5701 Normandale Road
Edina, MN 55424
952-848-4100
edinaschools.org/normandale
SECONDARY SCHOOLS
South View Middle School (6-9)
4725 South View Lane
Edina, MN 55436
952-848-3700
edinaschools.org/southview
Valley View Middle School (6-9)
6750 Valley View Road
Edina, MN 55439
952-848-3500
edinaschools.org/valleyview
Edina High School (10-12)
6754 Valley View Road
Edina, MN 55439
952-848-3800
edinaschools.org/edinahigh
Leny Wallen-Friedman, Treasurer
Sarah Patzloff, Assistant Treasurer
David Goldstein, Assistant Clerk
Lisa O’Brien, Assistant Clerk
2015-16 Start/End Times:
Elementary
Concord8:30 a.m.-3:05 p.m.
Cornelia9:15 a.m.-3:50 p.m Countryside9:15 a.m.-3:50 p.m.
Creek Valley9:15 a.m.-3:50 p.m.
Highlands9:15 a.m.-3:50 p.m.
Normandale8:30 a.m.-3:05 p.m. Middle School
South View M.S.7:40 a.m.-2:40 p.m.
Valley View M.S.7:40 a.m.-2:40 p.m.
High School
Edina H.S.8:25 a.m.-3:10 p.m.
Zero Hour7:25 a.m.-8:20 a.m.