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Prairie School District

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Enrollment

81 Questions

Welcome to Prairie School! We are thrilled to have you as a part of our close-knit community where small class sizes, dedicated teachers, and a supportive environment are at the heart of everything we do.

Welcome to Prairie School

At Prairie School, we believe every child deserves a quality education that empowers them to reach their full potential. Our passionate and experienced educators are committed to providing the best learning experience for each and every student. They bring creativity, expertise, and a deep love for teaching to the classroom, ensuring that your child receives personalized attention and guidance along their educational journey.

If you are an out of District Student, please refer to this form for Enrollment: Choice Enrollment

PLEASE NOTE:
A BIRTH CERTIFICATE & IMMUNIZATION RECORDS ARE REQUIRED FOR NEW STUDENTS BEFORE BEGINNING ENROLLMENT. EXISTING STUDENTS SHOULD SUBMIT A BIRTH CERTIFICATE & IMMUNIZATION RECORDS ONLY IF (1) THERE HAVE BEEN CHANGES OR (2) YOU HAVE BEEN INSTRUCTED BY ADMINISTRATION TO DO SO.

Student Demographic Form

1) Student Name Required*

2) Date of Birth Required*

3) Grade Level Required*

Kindergarten

4) Gender Required*

Male

Female

5) Shirt Size Required*

6) Has this child ever attended school in another country? Required*

Yes

7) Is student's ethnic background Hispanic/Latino? Required*

Yes

8) Race (select one or more): Required*

Asian

Caucasian/White

Native American

Pacific Island / Native Hawaiian

Black/African American

9) Student's Primary Language Required*

Select One

English

Spanish

Other

10) If you selected "other" for primary language, please indicate the language below (optional)

11) Will this student require (ESL) English as a Second Language service? Required*

Yes

12) Does the student have: Required*

Section 504 Plan (ensure a qualified child with a disability has equal access to education

Active IEP (Individualized Education Plan)

None of the above

13) Are there any medical conditions that Prairie School should be aware of? Required*

If Yes, please explain on next question

Yes

14) If you answered yes to the previous question about Medical conditions, please explain below: (optional)

Primary Household

15) Residence Address Required*

16) Mailing Address Required*

(If different from Residence Address)

17) Parent/Guardian Name Required*

18) Relationship to student Required*

19) Cell Phone Required*

20) Home Phone Required*

21) Work Phone (optional)

22) Email Required*

23) Parent/Guardian Name Required*

24) Relationship to student (optional)

25) Cell Phone Required*

26) Home Phone (optional)

27) Work Phone (optional)

28) Email Required*

Secondary Household

29) Residence Address (optional)

30) Mailing Address (optional)

(If different from residence address)

31) Parent/Guardian Name (optional)

32) Relationship to Student (optional)

33) Cell Phone (optional)

34) Home Phone (optional)

35) Work Phone (optional)

36) Email (optional)

37) Parent/Guardian Name (optional)

38) Relationship (optional)

39) Cell Phone (optional)

40) Home Phone (optional)

41) Work Phone (optional)

42) Email (optional)

Emergency Contacts

43) Contact Name Required*

44) Relationship to student Required*

45) Phone Required*

46) Is this person authorized to pick up your child from school? Required*

Yes

47) Contact 2 Name (optional)

48) Relationship to student (optional)

49) Phone (optional)

50) Is this person authorized to pick up your child from school? Required*

Yes

Birth Certificate & Records

Please follow the instructions to upload birth certificate and immunization records.

Immunization Records:
To obtain records, please visit: https://cdphe.colorado.gov/immunization/for-the-public/get-a-copy-of-your-records
You may fill out an Online Exemption form here: https://cdphe.colorado.gov/school-required-vaccine-exemptions

51) Upload Birth Certificate Required*

Max 10 files | 200 MB limit

52) Upload Immunization Records Required*

OR fill out Online Exemption form here: https://cdphe.colorado.gov/school-required-vaccine-exemptions

Max 10 files | 200 MB limit

Student Health Information

The Student Health Form is required for all new and transfer students.

Existing students should only submit this form if there have been health changes within the last three months.

Name of School Nurse: Tarri McDaniel

Phone: 970-978-1590

Please contact the School Nurse if you would like to discuss any of the information in this form.

53) Health Concerns (optional)

Please select one or more below as applicable:

54) Please indicate any required medication or equipment related to a condition noted above (optional)

Type name and dosage of all medications, and indicate any required equipment (hearing aids, preferential seating, etc.)

55) Routine or daily medications, treatments, or therapies not listed above? (optional)

Please indicate below if applicable

56) Activity restrictions in school? (optional)

57) Have there been any changes to your child's health over the last year? (optional)

If yes, please explain:

58) Please list any illnesses, hospitalizations, accidents/injuries, and dates: (optional)

59) Name of Health Care Provider (optional)

60) Health Care Provider Phone: (optional)

Optional Student Health Forms

Please download and complete the forms on this page if they are applicable to your student. A guardian's signature and the signature of a healthcare provider are required.

Please upload these completed forms with this enrollment packet in the designated file upload areas.

ASTHMA SELF-CARRY FORM
ASTHMA CARE PLAN
ALLERGY/ANAPHYLAXIS
PERMISSION TO ADMINISTER MEDICATION

Colorado Department of Education Asthma Resources

61) Upload Asthma Self-Carry Form (optional)

Max 10 files | 200 MB limit

62) Upload Asthma Care Plan (optional)

Max 10 files | 200 MB limit

63) Upload Allergy Form (optional)

Max 10 files | 200 MB limit

64) Upload "Permission to Administer Medication" Form (optional)

Max 10 files | 200 MB limit

Salud Family Health Free Dental Enrollment

Prairie School District RE-11J has once again partnered with Salud Family Health to offer free dental services for our students. All children are eligible to enroll in Salud's dental program, regardless of insurance coverage. Families are NOT billed for these services. Please visit www.saludschools.org to enroll your student in these FREE services today!

More Information can be found HERE: SALUD DENTAL ENROLLMENT FLYER

Free & Reduced Lunch Application

You can download and complete the Free and Reduced Lunch application by clicking the link below:

FREE & REDUCED LUNCH APPLICATION

Please upload the application on the following question

More information about applying can be found here: FNS.USDA.GOV

65) Upload Free & Reduced Lunch application (optional)

Max 10 files | 200 MB limit

Student Use of Internet and Electronic Communications

Please click on the document link to review the policy on Student Use of Internet and Electronics. Your signature verifying that you have read this policy will be required on the next screen.

Student Use of Internet and Electronic Communications

66) Your signature on this Agreement is binding and indicates you have read the school district's policy on Student Use of the Internet and Electronic Communications and understand its significance. Required*

Please initial below

Student Photo/Video Release Form

We request permission for your child to have their picture taken or to be videotaped by school staff or local news organizations during the 2024-2025 school year. If permission is granted, a photograph or video recording of your child may be used in publications and promotional pieces for print and electronic media, including the school website.

67) Student Photo/Video Release Required*

Yes I give permission

No I do not give permission

Signature

I do hereby attest that this information is true, accurate, and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of information may subject me to administrative liability.

68) Parent / Guardian Signature Required*

Please follow instructions to sign and submit below

Signature

I understand that my typed signature is the legal equivalent of my handwritten signature on this document.

Prairie School District
Forms

Forms

CHSAA Athletics Agreement

Enrollment

Out-of-District CHOICE Enrollment

Transcript Request Form

4 forms were found.

Find Us

Prairie School District RE-11J42315 County Road 133 | PO Box 68New Raymer, Colorado 80742Phone: 970-437-5351Fax: 970-437-5732

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