2015-2016Kindergarten Enrollment Packet

Welcome CLASS OF 2028

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WELCOME TO KINDERGARTEN!

REGISTRATION CHECKLIST

oEnrollment FormoParent Input Form for

Student Placement oChild’s birth certificate

(original and copy)

HEALTH CHECKLIST

oImmunization Form oPhysical Exam/Health History FormoMake special arrangements with

the health office as needed

Concord Elementary Rick Sansted, Principal952-848-4300

Cornelia Elementary Lisa Masica, Principal952-848-4600

Countryside Elementary Karen Bergman, Principal952-848-4700

Creek Valley Elementary Kari Dahlquist, Principal952-848-3200

Highlands Elementary Peter Hodne, Principal 952-848-4500

Normandale Elementary Chris Holden, Principal952-848-4100

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:• 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; • 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.

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!

ENROLLMENTREQUIREMENT

KINDERGARTEN TIMELINE

Program Preference Form DueMonday, January 12, 2015 at 6 p.m.

Applications Due for Open EnrollmentThursday, January 15, 2015

Kindergarten Registration DayThursday, January 29, 2015Concord 3:30 - 5 p.m.Countryside 4:15 - 5:45 p.m.Cornelia 4 - 5:30 p.m.Creek Valley 4 - 5:30 p.m.Highlands 4:15 - 5:45 p.m.Normandale 3:30 - 5 p.m.

Teacher AssignmentsInformation will be available in August

Elementary School Open HousesHeld prior to the start of school

First Day of School for Kindergarten Tuesday, September 1 , 2015

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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 (952-848-4585) know if you are not planning to enroll your child in 2015-16.

WhenwillIfindoutwhomychild’steacherwillbe?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.

HowcanIlearnmoreaboutmychild’sschool?Specific questions about your child’s school can be answered during the orientation session or by contacting the school directly.

Whatarethebenefitsofall-daykindergarten?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.

Whatifmychildisnotreadyforafull-dayexperience?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.

ENROLLMENT INFORMATION

FREQUENTLY ASKED QUESTIONS (FAQ)

ENROLLMENT OPTIONSKindergarten 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 IMMERSIONFrench 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 PROGRAMContinous 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.

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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.” Screeningsareconductedthroughouttheschoolyearonanappointmentbasisandtakeapproximatelyonehour.• 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 HawthorneEarly Childhood Developmental Screening, Room 163

Edina Public Schools5701 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.

EARLY CHILDHOOD DEVELOPMENTAL SCREENING

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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.

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 ecc.kidsclub@edinaschools.org.

ProgramFees(subjecttochange):• 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)

1.BEFORESCHOOLKIDSCLUB 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.AFTERSCHOOLKIDSCLUB 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-SCHOOLDAY 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.

• Located at each elementary school

• Program operates before school, after school and on non-school days

• Visit our website to learn more: edinacommunityed.org

REGISTRATION

PROGRAM OPTIONS

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 | ecc.kidsclub@edinaschools.org

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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.

WHAT TIME DOES SCHOOL START/END?

• 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

WILLTHEREBEBUSINGONTHESEDAYS?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.

ENRICHMENT OPPORTUNITIESEdina 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.

• 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.

• 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.

LATE START/EARLY RELEASE INFORMATION

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.

EDINA FAMILY CENTER

YOUTH PROGRAMSYouth 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.

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.

ADULT EDUCATION

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 EdinaResourceCenter. All services are free and confidential.edinaresourcecenter.com

RESOURCELINE: (952)848-3936

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HEALTH SERVICES STAFFINGEach 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 SCHOOLWhenever 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.

IMMUNIZATION REQUIREMENTSIt 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 CONDITIONSParents 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.

FIRSTAID/EMERGENCYIf a student requires more than basic first aid, 911 will be called and the parent/guardian will be contacted.

STAY-INREQUESTSFORRECESSThe 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.

SCREENINGVision 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.

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 INFORMATION

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The enclosed forms need to be filled out and returned to the school your child will be attending in 2015-16.

ENROLLMENTREQUIREMENT

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)

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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Welcome CLASS OF 2028

ENROLLMENT FORMENROLLMENT

REQUIREMENT

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015 9

I certify that the registration information in this packet is correct.

OFFICE USE ONLY

Student ID#

EDINA Public School District #273 — Registration Form5701 Normandale Road, Edina, MN 55424Phone: 952.848.4585 FAX: 952.848.3937

Student’s Last Name (Legal only) Student’s First Name (Legal only) Middle Name

Gender

Birth Date M F Resident District if not Edina

SCHOOL # Start Date: __________________ GRADE ENTERING - Kindergarten

Last Location Does your child receive Special Services or have an Individual Education Plan(IEP)? YES NO

Has your child been through the Early ChildhoodDevelopmental Screening? YES NO

Dwelling #

If yes, where was your child screened?

Res Dist

State Aid Cat

Family #

If YOUR CHILD WAS NOT SCREENED IN EDINA,PLEASE ATTACH A COPY OF THE SCREENING

REPORT SUMMARY

In the definition used for this research, a homeless per-son 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 pri-vately-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?

YES NO

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.

Trans Code

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 NO

What language do the student’s parents speak?

Signature of Legal Parent/Guardian Date

Has your child attended a nursery school, day care center, Montessori or other Pre-Koption? YES NO

Name of School or Center:

Number of years:__________

Days per week:____________

Hours per day:____________

Proof of legal guardianship is needed ifstudent is living with someone other than the parent.

Is this student in foster care? YES NO

HOME LANGUAGE INFORMATION

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ENROLLMENT FORM (PAGE 2)ENROLLMENT

REQUIREMENT

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015 11

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ENROLLMENT FORM (PAGE 3)ENROLLMENT

REQUIREMENT

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015 13

ONKINDERGARTENREGISTRATIONDAY:

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.

Achildisnotpermittedtoenterschooluntilanofficialbirthcertificateispresented.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.

BIRTH CERTIFICATE INFORMATIONENROLLMENT

REQUIREMENT

ForallchildrenborninMinnesota,contact:

MINNESOTA DEPARTMENT OF HEALTHCentral Cashiering – Vital RecordsP.O. Box 64499St. 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

ForchildrenborninMinneapolisHospitalsor SuburbanHennepinCountyHospitals,contact:

VITAL RECORDSHennepin County Government Center300 South 6th Street, Suite A025Minneapolis, MN 55487-0026

Phone: 612-348-8240 (use prompts)Fax: 612-348-2010Website: www.hennepin.us

Cost: $26 per certificateMake 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).

WHERE TO REQUEST YOUR CHILD’S BIRTH CERTIFICATE

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 201514

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’sName: _____________________________________________________ BirthDate: _______________________

Parent(s)Name:___________________________________________________ PhoneNumber:___________________

Hasyourchildattendedanurseryschool,daycarecenter,MontessoriorotherPre-Koption? ¨Yes ¨No

NameofSchool/Center: _____________________________________________________________________________

NumberofYears:__________________________ Daysperweek:____________________ Hoursperday:_________

PARENT INPUT FORM FOR STUDENT PLACEMENTENROLLMENT

REQUIREMENT

CONTINUES ON NEXT PAGE

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 2015 15

Child’sName:_____________________________________________________

PHYSICALANDHEALTHFACTORSConsider: vision and hearing, speech, previous major illnesses, etc.

ACADEMICINTERESTSANDABILITIESConsider: reading, writing, math, and science

EMOTIONALANDBEHAVIORALDEVELOPMENTConsider: social awareness or interpersonal skills, cooperation, leadership, dependability, stability and respect for others.

SPECIALAND/ORUNIQUEINFORMATIONWHICHYOUTHINKWOULDHELPUSPLANFORYOURCHILD Consider: What does a teacher really need to understand about your child?

Parent Signature: ____________________________________

PARENT INPUT FORM FOR STUDENT PLACEMENT (PAGE 2)

Bring this completed form to Kindergarten Registration Day on Thursday, January 29, 201516

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Noidentifiedhealthconcerns

Identifiedhealthconcerns

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):

HEALTH HISTORY

ENROLLMENTREQUIREMENT

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.

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ENROLLMENTREQUIREMENT

IMMUNIZATION CLINICBloomington 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 55431952-563-8900

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)

Pupil Immunization Record 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 DoseMo/Day/Yr

2nd DoseMo/Day/Yr

3rd DoseMo/Day/Yr

4th DoseMo/Day/Yr

5th DoseMo/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)

Developed by the Minnesota Department of Health - Immunization Program (11/11) #140-0155 www.health.state.mn.us/immunize

Student Name _________________________________________________

Birthdate _____________________Student Number __________________

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.

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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

Developed by the Minnesota Department of Health - Immunization Program (11/11) #140-0155 www.health.state.mn.us/immunize

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 DateSubscribed and sworn to before me this _______ day of ______________________ 20______ ___________________________________________________________

Signature of notary

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 age- appropriate), 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

BOX 1: Certifying Immunization Status BOX 2: Consent to Share Immunization Information BOX 3A: Medical Exemptions BOX 3B: Conscientious Exemptions

“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 mary.streier@edinaschools.org.

TRANSITIONING TO KINDERGARTEN

2015-16 Start/End Times: ElementaryConcord 8:30 a.m.-3:05 p.m. Cornelia 9:15 a.m.-3:50 p.m Countryside 9:15 a.m.-3:50 p.m.Creek Valley 9:15 a.m.-3:50 p.m.Highlands 9:15 a.m.-3:50 p.m.Normandale 8:30 a.m.-3:05 p.m. Middle SchoolSouth View M.S. 7:40 a.m.-2:40 p.m.Valley View M.S. 7:40 a.m.-2:40 p.m.

High SchoolEdina H.S. 8:25 a.m.-3:10 p.m.Zero Hour 7:25 a.m.-8:20 a.m.

STAY CONNECTEDGreatstorieshappeneveryday. Sign up for the Edina In The Know weekly electronic newsletter at edinaschools.org/know and stay connected.

ISD 2735701 Normandale RoadEdina, MN 55424edinaschools.org

NON-PROFITORGANIZATIONUS POSTAGE

PAIDPERMIT NO. 91349TWIN CITIES MN

ConcordElementary(K-5)5900 Concord Avenue S.Edina, MN 55424952-848-4300edinaschools.org/concord

CorneliaElementary(K-5)7000 Cornelia DriveEdina, MN 55435952-848-4600edinaschools.org/cornelia

CountrysideElementary(K-5)5701 Benton Avenue S.Edina, MN 55436952-848-4700edinaschools.org/countryside

CreekValleyElementary(K-5)6401 Gleason RoadEdina, MN 55439952-848-3200edinaschools.org/creekvalley

HighlandsElementary(K-5)5505 Doncaster Way Edina, MN 55436952-848-4500edinaschools.org/highlands

NormandaleElementary(K-5)French Immersion School5701 Normandale RoadEdina, MN 55424952-848-4100edinaschools.org/normandale

SouthViewMiddleSchool(6-9)4725 South View LaneEdina, MN 55436952-848-3700edinaschools.org/southview

ValleyViewMiddleSchool(6-9)6750 Valley View RoadEdina, MN 55439952-848-3500edinaschools.org/valleyview

EdinaHighSchool(10-12)6754 Valley View RoadEdina, MN 55439952-848-3800edinaschools.org/edinahigh

ELEMENTARY SCHOOLS

SECONDARY SCHOOLS

WELCOME CENTER5701 Normandale RoadEdina, MN 55424 952-848-3900 info@edinaschools.org

STUDENT ENROLLMENT5701 Normandale Road Edina, MN 55424952-848-4585enrollment@edinaschools.org

EPS SCHOOL BOARDSchoolBoard@edinaschools.orgRandy Meyer, ChairCathy Cella, Vice ChairRegina Neville, Clerk

Leny Wallen-Friedman, TreasurerSarah Patzloff, Assistant TreasurerDavid Goldstein, Assistant ClerkLisa O’Brien, Assistant Clerk

CONTACT US