A person who knowingly or willfully presents to any school district any false information regarding the residency of a pupil for the purpose of enabling that pupil to attend any school in that district without the payment of a non-resident tuition charge shall be guilty of a Class C misdemeanor. District 91 will prosecute to the fullest extent of the law.

STUDENT INFORMATION - 17-18 School Year

ex. 09/01/2015

A student is new if they did not finish the previous school year in our district.

Numbers only

"PK Speech Only" means the student will ONLY attend for speech services, not general PK classes.

In cases of divorce, separation, or changes in custody, you must provide the school with current legal documentation indicating custody arrangements. Please indicate ANY parent that has custody of the child (whether full, partial, or joint). In cases of joint custody, indicate who has primary residential custody.


PARENT/GUARDIAN INFORMATION

Parent/Guardian phone numbers and emails will be used for calling to notify you of each child we show as absent that day if the child was not called in absent and our weekly messages.

-- Parent/Guardian 1 --

Enter none if not applicable
Enter none if not applicable
Must choose

If Parent/Guardian does not reside with the student, please provide information below

-- Parent/Guardian 2 --

Enter none if not applicable
Enter none if not applicable
Must choose

If Parent/Guardian does not reside with the student, please provide information below


​ADDITIONAL CONTACT INFORMATION

You may designate 1 additional number, 1 additional email and 3 Cell Numbers for Text Messages for Attendance and General calls. This is the number(s) we will call to notify you of each child we show as absent that day if the child was not called in absent and our weekly messages

The Parent/Guardian contact info entered in the above section will be used for Emergency calls, you may specify 2 additional emergency contact numbers.

Please note: In emergency situations (inclement weather, and unscheduled delayed start or early dismissals) ALL NUMBERS AND EMAILS LISTED ABOVE WILL BE CONTACTED.


OTHER ADULTS LIVING WITH STUDENT: (Step-Parents, Adult siblings, etc...)


OTHER EMERGENCY CONTACTS


SIBLING INFORMATION

ex. 09/01/2015
If applicable
ex. 09/01/2015
If applicable
ex. 09/01/2015
If applicable
ex. 09/01/2015
If applicable
ex. 09/01/2015
If applicable

FEDERAL & STATE REPORTING REQUIREMENTS

District 91 has several Federal and State reports to complete each year. Please tell us how you would like us to report your child.

City and State
(if not USA)

FAMILY RESIDENCE

Please complete one of the choices below.


STUDENT HEALTH SURVEY

Please indicate whether or not your child has ever been diagnosed with any of the following conditions:

Allergies (Be specific)

If yes, an Emergency Action Plan may be needed for your child. Please discuss this information with the school nurse.

If yes, an Emergency Action Plan may be needed for your child. Please discuss this information with the school nurse.

If yes, an Emergency Action Plan may be needed for your child. Please discuss this information with the school nurse.

If yes, an Emergency Action Plan may be needed for your child. Please discuss this information with the school nurse.

If yes, an Emergency Action Plan may be needed for your child. Please discuss this information with the school nurse.

Is medication needed at school for Allergies (Epinephrine, Benadryl)? If yes, please complete the respective Emergency Action Plan

Is medication needed at school? If yes, please complete the Asthma Action Plan or provide the health office with a current Asthma Action Plan.

Is medication needed at school? If yes, please complete the Medication Authorization with the treating physician.

Is medication needed at school? If yes, please complete the Diabetes Medical Management Plan with the treating physician and complete the Parent Questionnaire.

If yes, please specify the date of last incident
If yes, please specify
If yes, are assistive devices used?

Is medication needed at school? If yes, please complete the Seizure Action Plan with the treating physician and complete the Parent Questionnaire.

If you answered YES to any of the previous questions, additional forms may need to be completed. Additional forms can be found Here, near the bottom of the page. If you have any questions on the requirements needed, please contact the school nurse, contact details can be found Here.


Please list all prescription, over-the-counter, and herbal medications your child takes regularly:

NOTE: All prescription medications given in school must be prescribed by a doctor. A written order from the prescribing doctor must be provided and name of the medicine, dosage, and time intervals that the medicine is to be administered should also be included. Medication must be brought to school in the original package. A parent/guardian requesting any medication to be administered during school hours must give consent by providing a completed and signed copy of a Medication Authorization Form. That form will then be placed on file in the respective health office.


No Publicity

If, for any reason, you DO NOT want your child's name/picture included as part of publicity on our Website, Newsletters and in local news paper articles, please check the following answer box.


Computer/Google Apps User Agreement

I agree with the details outlined in the STUDENT USE OF COMPUTERS AND THE INTERNET PERMISSION FORM, the 2014 Addendum to the Appropriate Use of Technology Policy (Updated 5/5/16) and give the student permission to access a District user account including internet and Google Apps.

Selecting "No" above will severely limit your student.
Technology is a key component in teaching in D91.


Pesticide Application Registry

I would like to be notified at least 48 hours prior to the use of pesticides on the school property. When we have no other choice but to use a pesticide on school grounds, the application will normally take place on a school; holiday or on the weekends. Notification is normally made via Friday's weekly Connect Ed message and/or through the District's monthly newsletter.