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Kindergarten Enrollment Packet e g a e WELCOME TO !

REGISTRATION CHECKLIST

o Enrollment Form o Parent Input Form for Student Placement

o Child’s birth certificate ENROLLMENT (original and copy) REQUIREMENT

HEALTH CHECKLIST

o Immunization Form o Physical Exam/Health History Form o Make special arrangements with the health office as needed

Enclosed please find important information for all Edina Public Schools (EPS) KINDERGARTEN TIMELINE incoming kindergarten families pertaining to the upcoming school year. Included you will find information about: Program Preference Form Due Monday, January 13, 2014 at 4:00 p.m. • Kindergarten Enrollment – overview of enrollment options as well as a list of frequently asked questions; Applications Due for Open Enrollment • All-day Kindergarten – background information on free all-day Wednesday, January 15, 2014 kindergarten and frequently asked questions; Kindergarten Registration Day • Student Health Requirements – information on the health services Thursday, January 30, 2014 department and student immunization requirements; Concord 3:30 - 5:00 p.m. • Transitioning to Kindergarten – information and resources on how families can support their child to make a successful transition; Countryside 4:15 - 5:45 p.m. Cornelia 4:00 - 5:30 p.m. • Early Childhood Developmental Screening – information on student Creek Valley 4:00 - 5:30 p.m. screening requirements; and Highlands 4:15 - 5:45 p.m. • Community Education programming – information on before and after Normandale 3:30 - 5:00 p.m. school and non-school day care options through Edina KIDS Club and Edina Community Education Services. Teacher Assignments Information will be available in August Additional information about district programs and services can also be found online at www.edinaschools.org. Thank you for your partnership in making Elementary School Open Houses 2014-15 a great year! Held prior to the start of school

Concord Elementary Countryside Elementary Highlands Elementary First Day of School Rick Sansted, Principal Karen Bergman, Principal Peter Hodne, Principal Tuesday, August 26, 2014 952-848-4300 952-848-4700 952-848-4500 Cornelia Elementary Creek Valley Elementary Normandale Elementary Chris Holden, Principal Kari Dahlquist, Principal Gerry Lukaska, Principal 952-848-4600 952-848-3200 952-848-4100 3 ENROLLMENT INFORMATION

ENROLLMENT OPTIONS received notice that your child has been accepted into the French Kindergarten families have three educational options available: Immersion Program, please attend the Normandale Kindergarten Neighborhood Schools, French Immersion, and Continuous Registration event. Progress. Families who are interested in French Immersion or Continuous Progress must submit a Program Preference Form by CONTINUOUS PROGRESS PROGRAM Jan. 13, 2014. Continous Progress is an option for EPS families and is offered at Highlands and Countryside schools. Students work in multi-age FRENCH IMMERSION families and stay with a teacher for three to five years. Continuous French Immersion has been an educational option for EPS Progress (CP) begins in first grade, and students may enter families since 1991. The program is held at Normandale the program at any grade level. However, due to limited space, Elementary School (adjacent to the Edina Community Center). families are encouraged to enroll their child in kindergarten. The Normandale students receive the same curriculum as all program is located at both Countryside and Highlands Schools. Edina Public School students, but are instructed in the French If you received notice that your child has been accepted into language. Because of the advancing French proficiency level the CP program at Highlands or Countryside, please attend that of the curriculum and students, entrance to the program is respective school’s Kindergarten Registration event. most successful when children begin in kindergarten. If you

FREQUENTLY ASKED QUESTIONS (FAQ)

What is the age requirement to enter kindergarten? What if my child is not attending EPS kindergarten in the fall? Children who are five years old on or before Sept. 1, 2014 are eligible to It is very helpful to the district’s future planning if we know of your begin kindergarten. Please bring your child’s official birth certificate with decision to not enroll your child. Please let your neighborhood school embossed seal to Kindergarten Registration. or the Student Registration Office (952-848-4585) know if you are not planning to enroll your child in 2014-15. If you wish to enroll in the When is registration? Edina Public Schools at a later time, stop by the Welcome Center at the Kindergarten registration will be held on Thursday, Jan. 30, 2014. Please Edina Community Center to complete your registration. bring your completed registration materials to this event. You are also encouraged to bring your child so they can see the classroom and meet When will I find out who my child’s teacher will be? school staff. The whole process will last about 20 minutes. Because of staffing and enrollment changes made throughout the summer, class lists are not finalized until early to mid-August. Specific What immunizations are required? teacher assignments are shared with families at that time. Statute 121.15 requires that all children must be immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, How can I get involved at my school? hepatitis B series and varicella (or a record of chicken pox.). Additional Edina Public Schools celebrates the partnership between home and information, including specified exemptions and the immunization form, school. Each class and school have several opportunities for families are located later in this packet. to be involved. You will begin to receive some of this information at Kindergarten Registration, throughout the spring, and again in the fall. Do I need to have my child screened prior to kindergarten? State law requires completion of a developmental screening (i.e. Early How can I learn more about my child’s school? Childhood Screening) prior to entrance into kindergarten. Please refer Specific questions about your child’s school can be answered during the to additional information later this packet for details on screening orientation session or by contacting the school directly. requirements and processes.

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ALL-DAY KINDERGARTEN

BACKGROUND INFORMATION At its meeting on Nov. 18, the Edina School Board approved offering all-day kindergarten for free to district families next year. The Board action means that all-day kindergarten will serve as the district’s primary kindergarten offering starting with the 2014-15 school year.

For several years, Edina Public School has offered families a fee-based option for a full-day kindergarten program along with the traditional, free, half-day kindergarten option. As the result of recent changes to the state student funding formula, Minnesota school districts are able to access ALL-DAY KINDERGARTEN FAQs funding in 2014-15 that allows for them to provide all-day kindergarten for free to families. What are the benefits of all-day kindergarten? Having a full day of instruction means students will experience an enhanced kindergarten experience that prepares them for As part of its strategic plan, the district has been working future education. Of particular note is the availability of more to expand access to the all-day kindergarten program to all time for both core academic learning, enrichment and social families, with the goal of providing free, all-day kindergarten development, as well as specialized instruction in physical to families by 2015. With the availability of new state education, music and art. resources, free all-day kindergarten is realized starting with the 2014-15 school year. How is this different from what EPS currently offers? Nearly 75 percent of current kindergarten families opt for the district’s fee-based, full-day option. For the past several years, The district is committed to ensuring a successful transition there has been a wait list for families wanting to enroll in the to kindergarten for all students. In an effort to meet the full-day program. Beginning in 2014-15, the switch to free all- needs of all families in the district, administration researched day kindergarten will eliminate the need for families to pay for the feasibility of continuing to offer a half-day kindergarten the K Plus program ($370/month) and will allow all families to program given the expansion of all-day offerings at all participate in full-day kindergarten at no charge. elementary schools. A variety of data were collected, How does this impact the district’s budget? including current program enrollment, survey responses Changes to the state funding formula provides resources for from prospective kindergarten families, program proposals all-day kindergarten starting in 2014-15. In addition, offering from neighboring school districts, educational best practices, all-day kindergarten as the primary program option will provide and availability of district financial and facility resources. It transportation savings and consistent programming across the was the conclusion of district administration that continuing district. a half-day option was neither financially or programmatically What if I want my child to attend half day? viable, and therefore recommended offering all-day Since the district will only be offering a full-day program option, kindergarten as the primary program option starting in families who wish to have their child attend for half the day can 2014-15. do so under current law. However, midday transportation would be the responsibility of the parent/guardian, and curriculum and The district is now moving ahead with plans to expand activities will be based on a full-day program model. classroom space at Concord and Cornelia elementary What if my child is not ready for a full-day experience? schools to accommodate the expanded kindergarten EPS is committed to working with families on individual bases program. The School Board included funding for the to help their child transition to school. Our principals have and construction as part of its preliminary levy certification earlier will continue to work hard in partnership with families during this this fall dependent upon the program decision made on time to ensure all students can be successful. Nov. 18. The Board will vote on the final 2013 Payable 2014 tax levy in December. Classroom construction should be completed by the start of school next August.

5 HEALTH SERVICES INFORMATION

IMMUNIZATION REQUIREMENTS The Edina Public Schools Health Services It is important for parents to understand the immunization requirements department is pleased to welcome your for enrollment in Edina Public Schools. Minnesota Statute 121A.15 states “...no person over two months old may be allowed to enroll or kindergartener and you! remain enrolled in any elementary or …” without proof that he/she has received the immunizations appropriate for age or that The mission of Edina Schools Health Services is to the student should not have shots for medical reasons or because of promote optimal health for optimal learning. parent beliefs. For your reference, please see the “Are Your Kids Ready for School?” fact sheet (right) on the Minnesota School Immunization Law. HEALTH SERVICES STAFFING Each elementary school has a health office that is staffed during the CHILDREN WITH CHRONIC HEALTH CONDITIONS day when students are in school. A team of Licensed School Nurses Parents should consult with the LSN if they have a child with a and Health Services Associates work closely with one another and diagnosed chronic health condition such as asthma, diabetes, seizures, other school staff to support all district students, prevent communicable or severe allergies. The nurse, student and family work with the child’s diseases, and promote healthy learning environments. health care provider to establish a health plan that will assist school staff in understanding and accommodating the student’s health needs. • The Health Services Associate (HSA) is trained in first aid and CPR. The HSA provides basic medical attention, gives medications ILLNESS under the direction of the Licensed School Nurse, assists with Sick children can spread illness to other students and staff. Your child vision and hearing screening, and helps track student immunization should not come to school if he/she has had: records. • a fever of 100 degrees F or more in the past 24 hours; • A Licensed School Nurse (LSN) is a Registered Nurse with a • vomiting or diarrhea in the past 24 hours; or Bachelor’s Degree in nursing and certification as a public health • a skin rash that has not been diagnosed by a health care provider. nurse. The LSN works with parents, students and teachers to help students participate fully in the school program. Examples of the Call the Absence Line at your child’s school when your child is absent LSN’s work include setting up health plans for students with chronic due to illness. Please notify your school health office if your child has a health or disabling conditions, performing prescribed medical condition that can be spread to others such as strep throat, chickenpox treatments, and teaching students about healthy behaviors. and head lice.

As some sites have special programs that require additional health When students become ill or are injured during the school day, parents/ services staff, the following are the staffing assignments for EPS guardians are contacted first. If a parent/guardian cannot be reached, a elementary schools: 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 • Concord, Creek Valley, Highlands and Normandale expectation that students will be picked up within one hour of the call to Each of these elementary schools has a Health Services Associate the parent/guardian. who provides care during student hours. One LSN serves all four of these schools and consults regularly with the HSAs. FIRST AID/EMERGENCY • Cornelia and Countryside If a student requires more than basic first aid, 911 will be called and the Cornelia school has a full time LSN and a part-time HSA; parent/guardian will be contacted. Countryside has a full time LSN. STAY-IN REQUESTS FOR RECESS MEDICATIONS AT SCHOOL The district’s position is that children who are well enough to attend Whenever possible, medications should be given during non-school school are well enough to take part in gym and outdoor recess. A hours. When it is necessary for a student to receive medication during request to stay inside will be honored if made by the child’s physician in the school day, the student must bring the following for each medication: writing and filed with the school health office. • medication in the original container with directions; • written permission from the parent/guardian; and SCREENING • a written order from the physician for all medications including Vision and hearing are important to a student’s ability to learn. Health over the counter medications for pain relief. services staff screen students in select grade levels to identify potential vision and hearing difficulties. All kindergarten students are screened for All medications must be kept in the Health Office unless special hearing difficulties. arrangements (e.g. emergency epipens or inhalers ) are made with the LSN. Please contact your school health office to obtain medication authorization forms.

6 7 EARLY CHILDHOOD DEVELOPMENTAL SCREENING

As you begin to prepare your child for enrollment in kindergarten, there are certain requirements that must be met according to State law. Early Childhood Developmental Screening is one of the required components for entrance into kindergarten.

If your child has already completed the 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.

Screenings are conducted throughout the school year on an appointment basis and take approximately one hour. • Screening should be done when your child is 3-1/2 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. 20, 2013 to:

Lisa Hawthorne Early Childhood Developmental Screening, Room 163 Edina Public Schools 5701 Normandale Road Edina, MN 55424

If you would like additional information or have any questions, please contact the Early Childhood Screening office at 952-848-4299.

8 TRANSITIONING TO KINDERGARTEN

“Is my child ready for kindergarten?” Does “ready” mean being able to count to ten, say the alphabet, sit for storytime, or identify colors?” Perhaps! These things could mean that your child is “ready” for kindergarten, but the real question is: Is your child excited, curious and eager to keep learning in a kindergarten classroom? To help you prepare your child to make the transition into kindergarten, we’ve provided some information and resources that could be helpful.

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 September 1st are encouraged to attend kindergarten.

If you have concerns or needs for your family or young children and are not eligible for services from other local programs, the Edina Family Center School Readiness program may be for you. School Readiness helps families with children, 3-1/2 to 5 years-old, prepare for a successful school experience. For more information, please contact Mary Streier, School Readiness Coordinator at 952-848-3985 or [email protected].

9 EDINA KIDS CLUB

For Kindergarten 2014-2015

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 • Located at each elementary school days. Children learn through a wide variety of activities such as art, music, science projects, • Program operates before school, cooking, games, writing, reading, crafts, outdoor after school and on non-school days play, computers, practicing social skills, gym time, dramatic play, and much more! There is a balance • Visit our website to learn more: of activity options that includes large group, small www.edinacommunityed.org 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. PROGRAM OPTIONS

1. BEFORE SCHOOL KIDS CLUB KIDS Club programming is available for all students in REGISTRATION grades K-3 and is offered at your elementary school before school from 6:45 a.m. to the start of school. KIDS Club registration materials will be available on our website in May. Please watch for a postcard reminder in 2. AFTER SCHOOL KIDS CLUB the spring. For questions, contact 952-848-3947 or KIDS Club programming is available for all students in [email protected]. grades K-3 and is offered at your elementary school Program Fees (subject to change): after school from school dismissal to 6:00 p.m. • KIDS Club 5 days/week schedule: $11/morning and $11/afternoon 3. NON-SCHOOL DAY • KIDS Club 4 days/week or less schedule: Non-school day programming is available on days $12/morning and $12/afternoon when school is not in session. It is located at your • KIDS Club Extra Time: $14.50/morning or afternoon 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 • Non-School Days: $42/day additional enrichment opportunities.

KIDS Club is a program of Edina Community Education Services of Edina Public Schools 5701 Normandale Road | Edina, MN 55424 | www.edinacommunityed.org | 952-848-3947 | [email protected]

10 COMMUNITY EDUCATION

EDINA FAMILY CENTER The Edina Family Center offers high-quality early education programs for families with children from birth through age five. Programs include New Baby and Me classes, Early Childhood Family Education (ECFE), preschool, childcare and more.

YOUTH PROGRAMS Youth programs offer a variety of fun and educational activities for ages Enriching Lives to 3-18. KIDS Club (gr. K-3), WISE Guys (gr. 4-5), and SURGE (gr. 6-9) provide Strengthen Community high-quality out-of-school time care. Classes and camps offer new and favorite enrichment subjects. Youth Serving Youth (YSY) at provides student leadership and service activities. ADULT EDUCATION For more information on resources Edina Center for Adult Education engages adults of all ages with extensive and services in Edina, contact learning opportunities, ranging from cooking, fitness and world language the Edina Resource Center. All courses, 21st century technology and career exploration, and metro-area field services are free and confidential. trips and world travel. www.edinaresourcecenter.com

VOLUNTEER RESOURCE LINE: Edina’s Community Volunteer Program invites community members to share (952) 848-3936 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.

LATE START/EARLY RELEASE INFORMATION

Late Starts and Early Releases were introduced during the 2013-14 ENRICHMENT OPPORTUNITIES school year to provide critical collaboration time allowing teachers to Edina Community Education Services (CES) invites students to better customize the learning experience for each student. Having join its welcoming enrichment programs before and after school this additional planning time periodically during the school year allows on the scheduled late start/early release days. Edina Community teachers to provide timely modifications or change instruction in ways Education collaborates with EPS teachers to offer activities that that best meet the needs of their students. complement what students are learning during the school day.

WHEN ARE THE 2014-15 LATE START/EARLY RELEASES DAYS? • Elementary Program - Elementary students can enroll in enrichment programs at their home elementary school for one, On the following dates, school will either start two hours late or dismiss two, three or all four of the late start and early release days. two hours early: (NOTE: There will be no early or late day release offerings for • Wednesday, Oct. 29, 2014 - Late Start the CES half-day kindergarten programs.) • Wednesday, Dec. 10, 2014 - Early Release • Program - Middle School students can enroll • Wednesday, Feb. 4, 2015 - Late Start in the CES enrichment program on the two early release • Friday, Mar. 27, 2015 - Early Release days only. (NOTE: There will be no middle school enrichment program program offered on late start days.) The Middle WHAT TIME DOES SCHOOL START/END? School program will be held at South View Middle School. • Late Start means that the student school day begins two hours Valley View students interested in participating in the program later than usual will be bused to South View for the afternoon program. • Early Release means the student day will end two hours earlier than usual • Cost - The cost per student for each two-hour time block is $20. To learn more about scholarships for the CES enrichment WILL THERE BE BUSING ON THESE DAYS? program, please call 952-848-3952. District transportation will be adjusted for the two hour late start or early • Registration - Interested families can register for enrichment release. That is, on late start days, the bus will arrive two hours after programs at http://edina.thatscommunityed.com. 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.

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The enclosed forms need to be filled out and returned to the school your child will be attending in 2014-15.

ENROLLMENT CHECKLIST: Please bring completed forms and materials to Kindergarten Registration Day on Thursday, January 30, 2014.

¨ Enrollment Form (3 pages) ENROLLMENT ¨ Birth Certificate (orginal and copy) REQUIREMENT ¨ Parent Input Form (2 pages)

HEALTH REQUIREMENT CHECKLIST: All health forms must be submitted prior to the start of school.

¨ Immuninization 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/Health History Form ¨ Special Arrangemenets (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.

12 ENROLLMENT FORM

ENROLLMENT REQUIREMENT

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14 ENROLLMENT FORM (PAGE 2)

ENROLLMENT REQUIREMENT

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16 ENROLLMENT FORM (PAGE 3)

ENROLLMENT REQUIREMENT

17 Bring this completed form to Kindergarten Registration Day on Thursday, January 30, 2014 BIRTH CERTIFICATE INFORMATION

ENROLLMENT REQUIREMENT ON KINDERGARTEN REGISTRATION DAY: 1. Please present an original birth certificate with embossed seal to the school that your child will be attending. It will be returned upon presentation. 2. We request that you also bring a copy of the original birth certificate with for the school to keep on file.

A child is not permitted to enter school until an official birth certificate is presented. A hospital certificate cannot be accepted. The following information will help you obtain a certified birth certificate:. • A written request is preferred and all requests must be made by mail, fax or online. • List father’s name, mother’s maiden name, the child’s name, date, and place of birth. • Enclose $26 per certificate and a self-addressed, stamped envelope.

WHERE TO REQUEST YOUR CHILD’S BIRTH CERTIFICATE

For all children born in Minnesota, contact: For children born in Minneapolis Hospitals or Suburban Hennepin County Hospitals, contact: MINNESOTA DEPARTMENT OF HEALTH Central Cashiering – Vital Records VITAL RECORDS P.O. Box 64499 Hennepin County Government Center St. Paul, MN 55164-0499 300 South 6th Street, Suite A025 Minneapolis, MN 55487-0026 Fax: 651-201-5740 or 651-201-5750 Phone: 612-348-8240 (use prompts) Website: www.health.state.mn.us Fax: 612-348-2010 Website: www.hennepin.us Make checks payable to: Minnesota Department of Health Cost: $26 per certificate Make checks payable to: Hennepin County Treasurer

You may also request a birth certificate in person at the Southdale Hennepin County Service Center in Edina (7009 York Avenue South).

18 Bring this completed form to Kindergarten Registration Day on Thursday, January 30, 2014 PARENT INPUT FORM FOR STUDENT PLACEMENT

ENROLLMENT REQUIREMENT We welcome you and your child to our school! There will be many different kinds of things for our students to do and we hope your child will be interested in the activities from the very first day. Because children have so many different interests, it takes a few weeks for us to get to know each child. This information will help your child’s teacher become better acquainted with your child.

Each spring, Edina Public Schools staff work to develop class lists for the coming year, striving to create classes where optimum learning for all students can take place. We value a strong family-school partnership. It is our goal to have balanced classes across each grade level. If you have specific information about your child that should be taken into consideration, please complete this form. We consider many factors as we try to stabilize our classes and accommodate individual needs:

• Gender balance • Emotional/social combinations • Balance of performance levels • Special learning needs • Teaching/learning styles • Behavior factors

Families will receive information on their classroom placement during school open house nights in August.

STUDENT PLACEMENT INFORMATION (Please Print):

Child’s Name: ______Birth Date: ______

Parent(s) Name: ______Phone Number: ______

Has your child attended a nursery school, day care center, Montessori or other Pre-K option? ¨Yes ¨No

Name of School/Center: ______

Number of Years: ______Days per week: ______Hours per day: ______

CONTINUES ON NEXT PAGE

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20 PARENT INPUT FORM FOR STUDENT PLACEMENT (PAGE 2)

ENROLLMENT Child’s Name: ______REQUIREMENT

PHYSICAL AND HEALTH FACTORS Consider: vision and hearing, speech, previous major illnesses, etc.

ACADEMIC INTERESTS AND ABILITIES Consider: reading, writing, math, and science

EMOTIONAL AND BEHAVIORAL DEVELOPMENT Consider: social awareness or interpersonal skills, cooperation, leadership, dependability, stability and respect for others.

SPECIAL AND/OR UNIQUE INFORMATION WHICH YOU THINK WOULD HELP US PLAN FOR YOUR CHILD Consider: What does a teacher really need to understand about your child?

Parent Signature: ______

21 Bring this completed form to Kindergarten Registration Day on Thursday, January 30, 2014 IMMUNIZATION CLINIC Bloomington Public Health Department

Immunizations that are required for entrance into Minnesota schools are available at the Bloomington Health Department. Parents must bring previous immunization records. No immunization will be given without the signature of the parent or guardian. If you have questions in advance of your visit, you may call the clinic at the number below.

1900 West Old Shakopee Road Bloomington, MN 55431 952-563-8900

Clinics are held on the first and third Tuesday of each month from 3:00 – 5:30 p.m.

Cost: $10.00 donation per immunization (for those without insurance coverage for immunizations)

22 FOR SCHOOL USE ONLY Pupil Immunization Record ( ) Complete; booster required in ______( ) In process; 8 mos. expires ______( ) Medical exemption for ______Student Name ______( ) Conscientious objection for ______Birthdate ______Student Number ______( ) 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.

1st Dose 2nd Dose 3rd Dose 4th Dose 5th Dose Type of Vaccine DO NOT USE () or () Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Mo/Day/Yr Required (The shaded boxes indicate doses that are not routinely given; however, if your child has received them, please write the date in the shaded box.)

Diphtheria, Tetanus, and Pertussis (DTap, DTP)

Diphtheria and Tetanus (DT) • for 6-year-olds and younger

Tetanus and Diphtheria (Tdap, Td) • for 7-year-olds and older

Polio (IPV, OPV)

Measles, Mumps, and Rubella (MMR) • minimum age: on or after 1st birthday • required for kindergarten and 7th grade

Hepatitis B (hep B) • required for kindergarten and 7th grade

Varicella (chickenpox) • minimum age: on or after 1st birthday • vaccine or disease history required for kindergarten and 7th grade

Recommended

Meningococcal (MCV, MPSV)

Human Papillomavirus (HPV)

Hepatitis A (hep A)

Additional exemptions: • Children less than 7 years of age: The 5th dose of DTaP/DTP/DT (similarly, the 4th dose of polio vaccine) is not necessary if the 4th DTaP/DTP/DT (3rd dose of polio) was administered after the 4th birthday. • Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum requirements of the law. • Students in grades 7-12: A Td or Tdap booster at age 11 years or later is not required for students in grades 7-12 whose most recent Td was given after their 7th birthday but before their 11th birthday. Instead, it will be required 10 years after the date of the most recent dose. • Students 11-15 years of age: A 3rd dose of hepatitis B vaccine is not required for students who provide documentation of the alternative 2-dose schedule. • Students 10 years or older: May receive Tdap to fulfill the Td requirement for students in grades 7-12. • Students 18 years of age or older: Do not need polio vaccine.

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

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

1. Choose one of the following to indicate student’s immunization status and the source of the information above: A. I certify that this student has received all immunizations required by law. ______Signature of parent/guardian or physician/public clinic Date B. I certify that this student has received at least one dose of vaccine for diphtheria, tetanus, and pertussis (if 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

2. Parental/Guardian Consent to Share Immunization Information: Your child’s school is asking your permission to share your child’s immunization record with Minnesota’s immunization registry to help us better protect students from disease. You are not required to sign this consent; it is voluntary. In addition, all the information you provide is legally classified as private data and can only be released to those legally authorized to receive it under Minnesota law. I agree to allow school personnel to share my student’s immunization record with Minnesota’s immunization registry: ______Signature of parent or legal guardian Date

3. Exemptions to School Immunization Law A. Medical exemption: No student is required to receive an immunization if they have a medical contraindication, history of disease, or laboratory evidence of immunity. For a student to receive a medical exemption, a physician, nurse practitioner, or physician assistant must sign this statement: I certify the immunization(s) listed below are contraindicated for medical reasons, laboratory evidence of immunity, or that adequate immunity exists due to a history of disease that was laboratory confirmed. (For varicella disease see * below.) Exempted immunization(s): ______Signature of physician/nurse practitioner/physician assistant Date *History of varicella disease only. In the case of varicella disease, it was medically diagnosed or adequately described to me by the parent to indicate past varicella infection in ______. Year ______Signature of physician/nurse practitioner/physician assistant B. Conscientious exemption: No student is required to have an immunization that is contrary to the conscientiously held beliefs of his/her parent or guardian. However, not following vaccine recommendations may endanger the health or life of the student or others they come in contact with. In a disease outbreak schools may exclude children who are not vaccinated in order to protect them and others. To receive an exemption to vaccination, a parent or legal guardian must complete and sign the following statement and have it notarized: I certify by notarization that it is contrary to my conscientiously held beliefs for my child to receive the following vaccine(s): ______Signature of parent or legal guardian Date Subscribed and sworn to before me this ______day of ______20______Signature of notary

Developed by the Minnesota Department of Health - Immunization Program (11/11) #140-0155 www.health.state.mn.us/immunize 24 Edina Health Services PHYSICAL EXAM/HEALTHKindergarten HISTORY– 5th Grade PHYSICAL EXAM / HEALTH HISTORY

Name Sex Birth Date Address Telephone Parent/Guardian Name Parent/Guardian Name

TYPE of VACCINE 1st DOSE 2nd DOSE 3rd DOSE 4th DOSE 5th DOSE MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY MM/DD/YY Diphtheria, Tetanus, Pertussis (DTaP, DTP) Diphtheria and Tetanus (DT)-for under 7 yrs Tetanus and Diphtheria (Td, Tdap)-for 7 yrs and older Polio (IPV, OPV) MMR (Measles, Mumps, Rubella) (minimum age: on or after 1st birthday) Hepatitis B (Hep B) Varicella (chickenpox) HIB (Haemophilus Influenza b) Other (specify)

HEALTH HISTORY

Communicable Diseases German Measles ______(month & year) Mumps ______(month & year) Red Measles______(month & year) Chickenpox ______(month & year)

Identified Health Concerns No Identified Health Concerns ADHD / ADD / other learning disability ______Allergies (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) ______No Identified Health Concerns

There is a condition that may result in an emergency: yes no (If yes, describe below.)

There is a condition that is being treated with medication: yes no (If yes, describe below.)

There is a condition that may interfere with learning: yes no (If yes, describe below.)

25 (over) PHYSICAL EXAM/HEALTH HISTORY (PAGE 2) HEALTH EXAMINATION

DATE RESULTS Normal Abnormal Hemoglobin/Hct Ears Urinalysis Mouth / Dental Tuberculin (PPD) mm Throat Chest x-ray Nose Lead Lymph Nodes Thyroid Height: ______ins. Heart Pulses Weight: ______lbs. Lungs Abdomen Blood Pressure ___ / ___ Musculoskeletal Spine Hearing: ___Normal ___Abnormal Extremities Skin Hearing aid(s): ___yes ___no Neurological Nutritional Vision: R 20 / __ L 20 / __ Status Emotional Status Corrected ___Yes ___ No Behavior Speech

Describe any abnormal findings / chronic conditions. Health Concerns Recommendations for School

Note: A separate medication form is required for all medications and treatments to be administered at school.

______Signature and title of health care provider Print name Date of physical exam

______Clinic name Phone FAX

Please return this form to your school nurse. The school district intends to use the requested information to provide for your child’s health and safety needs while at school. You may refuse to supply the requested personal information. There will be no consequence for not providing the information. It may result in an incomplete health and safety plan for your child. The information you provide will be shared only with staff in the school district whose jobs require access to this information to ensure your child’s safety and school success. (MS Section 13.04, Subdivision2) 11/04/08 26 SCHOOL YEAR 2014-15 CALENDAR

AUGUST 2014 S M T W Th F Sa SEPTEMBER 2014 OCTOBER 2014 S M T W Th F Sa S M T W Th F Sa 1 2 1 2 3 4 5 6 1 2 3 4 3 4 5 6 7 8 9 5 6 7 8 9 10 11 10 11 12 13 14 15 16 7 8 9 10 11 12 13 14 15 16 17 18 19 20 12 13 14 15 16 17 18 17 18 19 20 21 22 23 24 21 22 23 24 25 26 27 19 20 21 22 23 24 25 31 25 26 27 28 29 30 28 29 30 26 27 28 29 30 31 August 25: First Day of School for Grades 1-12 August 26: First Day of School for Kindergarten

NOVEMBER 2014 DECEMBER 2014 JANUARY 2015 S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa 1 1 2 3 4 5 6 1 2 3 2 3 4 5 6 7 8 7 8 9 10 11 12 13 4 5 6 7 8 9 10 9 10 11 12 13 14 15 14 15 16 17 18 19 20 11 12 13 14 15 16 17 16 17 18 19 20 21 22 21 22 23 24 25 26 27 18 19 20 21 22 23 24 23 30 24 25 26 27 28 29 28 29 30 31 25 26 27 28 29 30 31

FEBRUARY 2015 MARCH 2015 APRIL 2015 S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 8 9 10 11 12 13 14 8 9 10 11 12 13 14 5 6 7 8 9 10 11 15 16 17 18 19 20 21 15 16 17 18 19 20 21 12 13 14 15 16 17 18 22 23 24 25 26 27 28 22 23 24 25 26 27 28 19 20 21 22 23 24 25 29 30 31 26 27 28 29 30

KEY MAY 2015 S M T W Th F Sa No School 1 2 Late Start 3 4 5 6 7 8 9 School starts two hours late 10 11 12 13 14 15 16 Early Release 17 18 19 20 21 22 23 School ends two hours early 24 31 25 26 27 28 29 30 First Day/Last Day of School

Wel come

2027

CONTACT US DISTRICT OFFICE STUDENT REGISTRATION COMMUNITY EDUCATION Edina Community Center Edina Community Center Edina Community Center 5701 Normandale Road Welcome Center, Room 171 Suite 100 Edina, MN 55424 Open Monday through Friday 952-848-3952 952-848-3900 8:00 a.m. - 4:00 p.m. www.edinacommunityed.org www.edinaschools.org 952-848-4585 [email protected] [email protected]

ELEMENTARY SCHOOLS Concord Elementary (K-5) Countryside Elementary (K-5) Highlands Elementary (K-5) 5900 Concord Avenue S. 5701 Benton Avenue S. 5505 Doncaster Way Edina, MN 55424 Edina, MN 55436 Edina, MN 55436 952-848-4300 952-848-4700 952-848-4500 edinaschools.org/concord edinaschools.org/countryside edinaschools.org/highlands

Cornelia Elementary (K-5) Creek Valley Elementary (K-5) Normandale Elementary (K-5) 7000 Cornelia Drive 6401 Gleason Road French Immersion School Edina, MN 55435 Edina, MN 55439 5701 Normandale Road 952-848-4600 952-848-3200 Edina, MN 55424 edinaschools.org/cornelia edinaschools.org/creekvalley 952-848-4100 edinaschools.org/normandale