FLF: Registration Packet 2021-22

Primary Parent/Guardian Last Name

Select No. of students

Primary Parent/Guardian Email

example@example.com

Name of Student 1

First NameMiddle NameLast NameSuffix

Nick Name

If different from first name

Gender

Incoming Grade for 2021-2022

Date of Birth

Date

Student Lives With

Other

Home Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Format: (000) 000-0000.

Student 1 Personal Information

Are you a member of First Lutheran Church?

Ethnicity

Race

Birth Place

City, State, Country

Gender

Primary Language Spoken at home

What Language did your child first learn

What Language does your child use most frequently at home?

What Language do the adults at home speak most often?

What Language do you use most often when speaking to your child?

Number of Siblings

Sibling 1 Name

Birth Date

Date

Sibling 2 Name

Birth Date

Date

Sibling 3 Name

Birth Date

Date

Sibling 4 Name

Birth Date

Date

Religion

Authorize

Parents/guardians will be notified first in case of illness or injury for pick-up. Others picking up students must be at least 18 years old and bring a photo ID. Please indicate below who will be available to pick up your child in the order you wish them contacted. Please list their daytime phone numbers.

Student Emergency Contacts

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 2

Name

Relation with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 3

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 4

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Non-Emergency Student Release Permission

The following contacts listed below may pick up my child on any school day without additional notification to the school.

Name 1

Phone Number

Format: (000) 000-0000.

Name 2

Phone Number

Format: (000) 000-0000.

Name 3

Phone Number

Format: (000) 000-0000.

Name 4

Phone Number

Format: (000) 000-0000.

Never Release To Information

My child may never be released to the following:

Contact 1

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Contact 2

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Out-of-state Contact

Name

Relation with child

Phone Number

Format: (000) 000-0000.

What State?

Street Address

Street Address Line 2

State

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form. Complete the attached form and submit to the School Office by email (robertsonm@flchurch.org) or in person.

Medications child takes

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?

Parent/Guardian Signature

Physician's Name

Phone Number

Format: (000) 000-0000.

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?

Parent/Guardian Signature

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

Click here for the COVID-19 Public Health Emergency School Attendance Acknowledgement and Disclosure. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the attached disclosure. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

H.U.G. Fee, Family Commitment Fee (FCF)

Every FLS family is required to contribute each year in two ways:

1, An annual $200 contribution per family to the Help Us Grow (HUG) building fund, AND

2. A yearly $150 Family Commitment Fee for the general maintenance costs, which can be satisfied in cash, or 10 hours of volunteer time to authorized service projects.

By selecting "I Agree", you agree to satisfy the requirements for the HUG and FCF.

Do you agree?

Parent/Guardian Signature

LIBRARY PERMISSION

Click here for Library Permission and use information

I give permission for my child listed in this profile to check out books from the library this school year.
I have read and understand the procedures and fees for lost, missing, or damaged library materials.

Do you agree?

Parent/Guardian Signature

MILK ORDERS

Are you ordering milk for this child?

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?

Parent/Guardian Signature

TECHNOLOGY INFORMATION AND PERMISSIONS

Click here for Student Acceptable Use Policy. I agree as part of my contractual] agreement with First Lutheran to abide by all the policies and procedures set forth in the Student Acceptable Use Policy and that | will be invoiced $100 for tech fee (grades 5-8) on my August Smart Tuition Account. I also acknowledge that the First Lutheran School Administration May amend any and all policies as deemed necessary for the Safety and education of Our students.

Do you agree?

Parent/Guardian Signature

Click here for information regarding our G Suite for Education Privacy and Security Information and here for our G Suite for Education Parent Permission Form. If you decide to deny your child permission to access G Suite for Education, please submit a written request to Mrs. Tammy Kirkpatrick for your child to opt-out of G Suite for Education. You will need to discuss with your child’s teachers any necessary accommodations that must be made in order for your child to complete assignments and receive communication from teacher and fellow students.

Do you agree?

Parent/Guardian Signature

Name of Student 2

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022

Birth Date

Date

Student Lives With

Other

Home Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Format: (000) 000-0000.

Second Address if parents have separate households

Student 2 Personal Information

Are you a member of First Lutheran Church?

Ethnicity

Race

Birth Place

City, State, Country

Gender

Primary Language Spoken at home

What Language did your child first learn

What Language does your child use most frequently at home?

What Language do the adults at home speak most often?

What Language do you use most often when speaking to your child?

Number of Siblings

Sibling 1 Name

Birth Date

Date

Sibling 2 Name

Birth Date

Date

Sibling 3 Name

Birth Date

Date

Sibling 4 Name

Birth Date

Date

Religion

Authorize

Parents/guardians will be notified first in case of illness or injury for pick-up. Others picking up students must be at least 18 years old and bring a photo ID. Please indicate below who will be available to pick up your child in the order you wish them contacted. Please list their daytime phone numbers.

Student Emergency Contacts

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 2

Name

Relation with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 3

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 4

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Non-Emergency Student Release Permission

The following contacts listed below may pick up my child on any school day without additional notification to the school.

Name 1

Phone Number

Format: (000) 000-0000.

Name 2

Phone Number

Format: (000) 000-0000.

Name 3

Phone Number

Format: (000) 000-0000.

Name 4

Phone Number

Format: (000) 000-0000.

Never Release To Information

My child may never be released to the following:

Contact 1

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Contact 2

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Out-of-state Contact

Name

Relation with child

Phone Number

Format: (000) 000-0000.

What State?

Street Address

Street Address Line 2

State

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?

Parent/Guardian Signature

Physician's Name

Phone Number

Format: (000) 000-0000.

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?

Parent/Guardian Signature

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

Click here for the COVID-19 Public Health Emergency School Attendance Acknowledgement and Disclosure. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the attached disclosure. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

H.U.G. Fee, Family Commitment Fee (FCF)

Every FLS family is required to contribute each year in two ways:

1, An annual $200 contribution per family to the Help Us Grow (HUG) building fund, AND

2. A yearly $150 Family Commitment Fee for the general maintenance costs, which can be satisfied in cash, or 10 hours of volunteer time to authorized service projects.

By selecting "I Agree", you agree to satisfy the requirements for the HUG and FCF.

Do you agree?

Parent/Guardian Signature

LIBRARY PERMISSION

Click here for Library Permission and use information

I give permission for my child listed in this profile to check out books from the library this school year.
I have read and understand the procedures and fees for lost, missing, or damaged library materials.

Do you agree?

Parent/Guardian Signature

MILK ORDERS

Are you ordering milk for this child?

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?

Parent/Guardian Signature

TECHNOLOGY INFORMATION AND PERMISSIONS

Click here for Student Acceptable Use Policy. I agree as part of my contractual] agreement with First Lutheran to abide by all the policies and procedures set forth in the Student Acceptable Use Policy and that | will be invoiced $100 for tech fee (grades 5-8) on my August Smart Tuition Account. I also acknowledge that the First Lutheran School Administration May amend any and all policies as deemed necessary for the Safety and education of Our students.

Do you agree?

Parent/Guardian Signature

Click here for information regarding our G Suite for Education Privacy and Security Information and here for our G Suite for Education Parent Permission Form. If you decide to deny your child permission to access G Suite for Education, please submit a written request to Mrs. Tammy Kirkpatrick for your child to opt-out of G Suite for Education. You will need to discuss with your child’s teachers any necessary accommodations that must be made in order for your child to complete assignments and receive communication from teacher and fellow students.

Do you agree?

Parent/Guardian Signature

Name of Student 3

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022

Birth Date

Date

Student Lives With

Other

Home Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Format: (000) 000-0000.

Second Address if parents have separate households

Student 3 Personal Information

Are you a member of First Lutheran Church?

Ethnicity

Race

Birth Place

City, State, Country

Gender

Primary Language Spoken at home

What Language did your child first learn

What Language does your child use most frequently at home?

What Language do the adults at home speak most often?

What Language do you use most often when speaking to your child?

Number of Siblings

Sibling 1 Name

Birth Date

Date

Sibling 2 Name

Birth Date

Date

Sibling 3 Name

Birth Date

Date

Sibling 4 Name

Birth Date

Date

Religion

Authorize

Parents/guardians will be notified first in case of illness or injury for pick-up. Others picking up students must be at least 18 years old and bring a photo ID. Please indicate below who will be available to pick up your child in the order you wish them contacted. Please list their daytime phone numbers.

Student Emergency Contacts

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 2

Name

Relation with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 3

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 4

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Non-Emergency Student Release Permission

The following contacts listed below may pick up my child on any school day without additional notification to the school.

Name 1

Phone Number

Format: (000) 000-0000.

Name 2

Phone Number

Format: (000) 000-0000.

Name 3

Phone Number

Format: (000) 000-0000.

Name 4

Phone Number

Format: (000) 000-0000.

Never Release To Information

My child may never be released to the following:

Contact 1

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Contact 2

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Out-of-state Contact

Name

Relation with child

Phone Number

Format: (000) 000-0000.

What State?

Street Address

Street Address Line 2

State

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?

Parent/Guardian Signature

Physician's Name

Phone Number

Format: (000) 000-0000.

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?

Parent/Guardian Signature

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

Click here for the COVID-19 Public Health Emergency School Attendance Acknowledgement and Disclosure. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the attached disclosure. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

H.U.G. Fee, Family Commitment Fee (FCF)

Every FLS family is required to contribute each year in two ways:

1, An annual $200 contribution per family to the Help Us Grow (HUG) building fund, AND

2. A yearly $150 Family Commitment Fee for the general maintenance costs, which can be satisfied in cash, or 10 hours of volunteer time to authorized service projects.

By selecting "I Agree", you agree to satisfy the requirements for the HUG and FCF.

Do you agree?

Parent/Guardian Signature

LIBRARY PERMISSION

Click here for Library Permission and use information

I give permission for my child listed in this profile to check out books from the library this school year.
I have read and understand the procedures and fees for lost, missing, or damaged library materials.

Do you agree?

Parent/Guardian Signature

MILK ORDERS

Are you ordering milk for this child?

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?

Parent/Guardian Signature

TECHNOLOGY INFORMATION AND PERMISSIONS

Click here for Student Acceptable Use Policy. I agree as part of my contractual] agreement with First Lutheran to abide by all the policies and procedures set forth in the Student Acceptable Use Policy and that | will be invoiced $100 for tech fee (grades 5-8) on my August Smart Tuition Account. I also acknowledge that the First Lutheran School Administration May amend any and all policies as deemed necessary for the Safety and education of Our students.

Do you agree?

Parent/Guardian Signature

Click here for information regarding our G Suite for Education Privacy and Security Information and here for our G Suite for Education Parent Permission Form. If you decide to deny your child permission to access G Suite for Education, please submit a written request to Mrs. Tammy Kirkpatrick for your child to opt-out of G Suite for Education. You will need to discuss with your child’s teachers any necessary accommodations that must be made in order for your child to complete assignments and receive communication from teacher and fellow students.

Do you agree?

Parent/Guardian Signature

Name of Student 4

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022

Birth Date

Date

Student Lives With

Other

Home Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Format: (000) 000-0000.

Second Address if parents have separate households

Student 4 Personal Information

Are you a member of First Lutheran Church?

Ethnicity

Race

Birth Place

City, State, Country

Gender

Primary Language Spoken at home

What Language did your child first learn

What Language does your child use most frequently at home?

What Language do the adults at home speak most often?

What Language do you use most often when speaking to your child?

Number of Siblings

Sibling 1 Name

Birth Date

Date

Sibling 2 Name

Birth Date

Date

Sibling 3 Name

Birth Date

Date

Sibling 4 Name

Birth Date

Date

Religion

Authorize

Parents/guardians will be notified first in case of illness or injury for pick-up. Others picking up students must be at least 18 years old and bring a photo ID. Please indicate below who will be available to pick up your child in the order you wish them contacted. Please list their daytime phone numbers.

Student Emergency Contacts

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 2

Name

Relation with Child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 3

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 4

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Emergency contact 5

Name

Relation with child

Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Address

Non-Emergency Student Release Permission

The following contacts listed below may pick up my child on any school day without additional notification to the school.

Name 1

Phone Number

Format: (000) 000-0000.

Name 2

Phone Number

Format: (000) 000-0000.

Name 3

Phone Number

Format: (000) 000-0000.

Name 4

Phone Number

Format: (000) 000-0000.

Never Release To Information

My child may never be released to the following:

Contact 1

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Contact 2

Name

Relationship with Child

Phone Number

Format: (000) 000-0000.

Address

Out-of-state Contact

Name

Relation with child

Phone Number

Format: (000) 000-0000.

What State?

Street Address

Street Address Line 2

State

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?

Parent/Guardian Signature

Physician's Name

Phone Number

Format: (000) 000-0000.

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?

Parent/Guardian Signature

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

Click here for the COVID-19 Public Health Emergency School Attendance Acknowledgement and Disclosure. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the attached disclosure. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?

Parent/Guardian Signature

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

H.U.G. Fee, Family Commitment Fee (FCF)

Every FLS family is required to contribute each year in two ways:

1, An annual $200 contribution per family to the Help Us Grow (HUG) building fund, AND

2. A yearly $150 Family Commitment Fee for the general maintenance costs, which can be satisfied in cash, or 10 hours of volunteer time to authorized service projects.

By selecting "I Agree", you agree to satisfy the requirements for the HUG and FCF.

Do you agree?

Parent/Guardian Signature

LIBRARY PERMISSION

Click here for Library Permission and use information

I give permission for my child listed in this profile to check out books from the library this school year.
I have read and understand the procedures and fees for lost, missing, or damaged library materials.

Do you agree?

Parent/Guardian Signature

MILK ORDERS

Are you ordering milk for this child?

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?

Parent/Guardian Signature

TECHNOLOGY INFORMATION AND PERMISSIONS

Click here for Student Acceptable Use Policy. I agree as part of my contractual] agreement with First Lutheran to abide by all the policies and procedures set forth in the Student Acceptable Use Policy and that | will be invoiced $100 for tech fee (grades 5-8) on my August Smart Tuition Account. I also acknowledge that the First Lutheran School Administration May amend any and all policies as deemed necessary for the Safety and education of Our students.

Do you agree?

Parent/Guardian Signature

I give permission for First Lutheran School to create/maintain a Google Workspace for Education account for my child and for Google to collect, use, and disclose information about my child only for the purposes described in the
Google
Workspace for Education Privacy and Security Notice 2021-2022.

Do you agree?

Parent/Guardian Signature

Select Number of Parents/guardians

Parent 1 Information

Name of Parent 1

First NameMiddle NameLast Name

Email

example@example.com

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Marital Status

Employer

Employer City

Occupation

Work Phone Number

Format: (000) 000-0000.

Employer City

Highest Level of education attained:

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Occupation

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 2 Information

Name of Parent 2

PrefixFirst NameMiddle NameLast NameSuffix

Email

example@example.com

Marital Status

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Employer

Employer City

Occupation

Work Phone Number

Format: (000) 000-0000.

Highest Level of education attained:

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 3 Information

Name of Parent 3

PrefixFirst NameMiddle NameLast NameSuffix

Email

example@example.com

Marital Status

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Employer

Employer City

Occupation

Work Phone Number

Format: (000) 000-0000.

Highest Level of education attained:

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 4 Information

Name of Parent 4

PrefixFirst NameMiddle NameLast NameSuffix

Email

example@example.com

Marital Status

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Employer

Employer City

Occupation

Work Phone Number

Format: (000) 000-0000.

Highest Level of education attained:

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Submitter's Email

example@example.com

Registration Packet

Student 1

Student 1 Emergency Contacts

Never Release To Information

Student 1 Medical Information/Contacts

MEDICAL AUTHORIZATION

FLS Parent Handbook

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

FLASH (DAY CARE) EXPECTED NEEDS

H.U.G. Fee, Family Commitment Fee (FCF)

LIBRARY PERMISSION

MILK ORDERS

TECHNOLOGY INFORMATION AND PERMISSIONS

Student 2

Student 2 Emergency Contacts

Never Release To Information

Student 2 Medical Information/Contacts

MEDICAL AUTHORIZATION

FLS Parent Handbook

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

FLASH (DAY CARE) EXPECTED NEEDS

H.U.G. Fee, Family Commitment Fee (FCF)

LIBRARY PERMISSION

MILK ORDERS

TECHNOLOGY INFORMATION AND PERMISSIONS

Student 3

Student 3 Emergency Contacts

Never Release To Information

Student 3 Medical Information/Contacts

MEDICAL AUTHORIZATION

FLS Parent Handbook

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

FLASH (DAY CARE) EXPECTED NEEDS

H.U.G. Fee, Family Commitment Fee (FCF)

LIBRARY PERMISSION

MILK ORDERS

TECHNOLOGY INFORMATION AND PERMISSIONS

Student 4

Student 4 Emergency Contacts

Never Release To Information

Student 4 Medical Information/Contacts

MEDICAL AUTHORIZATION

FLS Parent Handbook

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

FLASH (DAY CARE) EXPECTED NEEDS

H.U.G. Fee, Family Commitment Fee (FCF)

LIBRARY PERMISSION

MILK ORDERS

TECHNOLOGY INFORMATION AND PERMISSIONS

Parent Contact Information