Ocean Beach Primary School

Ocean Park Elementary School TEACHER: ______P. O. Box 1220 PK: Ocean Park, WA 98640 BUS INFO: (360) 665-4815 (360) 665-1275 FAX For Office Use Only

Kindergarten & PK Pre-Registration and Request for Student Records

Student’s Name: ______Last Name First Name Middle Name Legal Name, if different : ______BirthDate______M or F Ethnic:  White  Black  Hispanic  Asian /Pacific Islander  Indian/Alaska Native  Of more than one race

Student lives with: _____ Father/Mother _____Stepfather/Stepmother _____ Grandparent/Guardian Name: ______Home Phone: ______Employer: ______Cell #______Wk Phone: ______

Name: ______Home Phone: ______Employer: ______Cell #______Wk Phone: ______

Street Address: ______City: ______

Mailing Address: ______City: ______e-mail address______

Emergency Contact ______phone ______Siblings (names and ages): ______Day Care Name: ______Phone: ______After School Plan:  Bus Home  Day Care  Other: ______Health Concerns: ______

Please send all Permanent Records, Health Records, Withdrawal Grades, Attendance and Behavior Records, and, if applicable, Special Education Records. As provided under the Family Rights and Privacy Act of 1974, I understand that I may obtain a copy of my child’s records. I am aware that I may challenge the content of these records. I also understand that the school will treat these records confidentially. Finally, no one will send these records to a non-public school agency without my written consent.

Parent/Guardian Signature: ______Date: ______

Prior Schools Attended: ______

Has this child been receiving special services? Yes ______No ______If yes, please specify: ______

BC Immunization Registration Meals Permission Language Health s

For Office Use Only