New Student Registration

New Student Registration

WWG Schools #2898
Superintendent: Mr. Loy Woelber

Elementary Principal: Mr. Derrick Jenniges ----- High School Principal: Mr. Sam Woitalewicz
Today's Date*

MonthDayYear
Date
Grade Entering*
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Home Phone Number*
Please enter a valid phone number.
Student's Cell Number
Please enter a valid phone number.
Are you staying in temporary housing?*

YesNo
Military Connected Youth (immediate family members, including a parent or sibling, who is currently in the armed forces either as a reservist or on active duty or has retired from the armed forces)*

YesNo
Student's Ethnicity- Dual reporting required by federal law *
Student Race (select all that apply)*

Hispanic or LatinoAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhite
Student's Language:
Language student first learned
Language student uses at home
Language(s) student understands
Language student uses with friends
Language parent uses with student
I hereby verify that the above information is true and correct to the best of my knowledge and belief. Signature of Parent/Guardian*

Clear
Parent/Guardian Information
**Mother

First NameLast Name
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer/Occupation
Work Phone
Email
example@example.com
**Father

First NameLast Name
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer/Occupation
Work Phone
Email
example@example.com
Educational History
School District where child received Early Childhood Screening
Does the student have any special needs? (i.e. special ed, ELL, health, etc)*

YesNo
Please identify:
Has the student ever attended a Minnesota Public School?*

YesNo
What school(s)?
School most recently attended (School Name/Address/Phone Number)*
Family Information
Please list other children who live in the same household
Illness or Injury
If we cannot reach you in case of illness or emergency, please list alternate contact person*
Transportation Consent
I give permission for   First Name   Last Name   Relationship to Student
to drive my children to any appointments as deemed necessary during school hours. I realize I must notify the school of the upcoming appointment and who will be picking my child up from the school. Without this notification, my child should not be released to anyone who is not included on this list provided. Please list any additional individuals below.

First Name   Last Name   Relationship to Student
First Name   Last Name   Relationship to Student

   Signature   Date
Custody
Are there custody restrictions the school needs to be aware of?

Yes, if yes, please furnish the school with a copy of the restriction.No
Discipline
Are there any current school discipline situations we need to be are of?

YesNo
Please note:
Please note: This information will be used for the administration and management of this student’s educational program. You are encouraged, but not legally required, to complete all items on this form.

Kindergarten: Any child is eligible for kindergarten who is or will be 5 years old on or before September 1 or any child who transfers into this system during the school year who has attended a regular kindergarten class in another school district.

Birth Certificate: A legal birth certificate or other similar legal identification form must be brought to the school district at the time of registration if entering WWG School District #2898 for the first time.

Immunizations Certificate: Minnesota State Law (Statute 121A.15) requires all children at the time of initial entry to a public school to submit a signed statement from a physician or public immunization clinic stating that the child has been immunized against Diphtheria, Tetanus, Pertussis, Mumps, Rubeola (hard, red) Measles, Rubella (German) Measles, Polio, Varicella, and Hepatitis B. Exemptions to the law are available to anyone who has a medical concern or a conscientious objection to receiving the vaccine. A notarized form must be on file for those choosing exemption.
Signature of person completing this registration

Clear
Printed Name*

First NameLast Name
Relationship to Student*
Should be Empty:

New Student Registration

Superintendent: Mr. Loy Woelber

Parent/Guardian Information

Educational History

Family Information

Illness or Injury

Transportation Consent

Custody

Discipline