<p>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</p><p>Kindergarten & PK Pre-Registration and Request for Student Records</p><p>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</p><p>Student lives with: _____ Father/Mother _____Stepfather/Stepmother _____ Grandparent/Guardian Name: ______Home Phone: ______Employer: ______Cell #______Wk Phone: ______</p><p>Name: ______Home Phone: ______Employer: ______Cell #______Wk Phone: ______</p><p>Street Address: ______City: ______</p><p>Mailing Address: ______City: ______e-mail address______</p><p>Emergency Contact ______phone ______Siblings (names and ages): ______Day Care Name: ______Phone: ______After School Plan:  Bus Home  Day Care  Other: ______Health Concerns: ______</p><p>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.</p><p>Parent/Guardian Signature: ______Date: ______</p><p>Prior Schools Attended: ______</p><p>Has this child been receiving special services? Yes ______No ______If yes, please specify: ______</p><p>BC Immunization Registration Meals Permission Language Health s</p><p>For Office Use Only </p>