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Prairie School District

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Regular Enrollment

73 Questions

Welcome to Prairie School District RE-11J located in New Raymer, Colorado! 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 (even if you are a child of a staff member), please also fill out this form for Enrollment: CHOICE Enrollment

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

Student Demographic Form

1) Student's Full Legal Name Required*

2) Date of Birth (MM/DD/YYYY) Required*

3) Grade Level (Preschool - 12th) Required*

Please specify the grade. IE: Preschool, 1st, Freshman, etc.

4) Previous School Required*

Please specify the school student previously attended. If Prairie School District, please type "PSD RE-11J"

5) Gender Assigned at Birth Required*

Male

Female

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

African American / Black

Hispanic / Latino

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)

15) Shirt Size Required*

Primary Household

16) Residence Address Required*

17) Mailing Address (optional)

(If different from Residence Address)

18) Parent/Guardian Name Required*

19) Relationship to student Required*

20) Cell Phone Required*

21) Home Phone (optional)

22) Work Phone (optional)

23) Email Required*

24) Parent/Guardian Name (optional)

25) Relationship to student (optional)

26) Cell Phone (optional)

27) Home Phone (optional)

28) Work Phone (optional)

29) Email (optional)

Secondary Household

30) Residence Address (optional)

31) Mailing Address (optional)

(If different from residence address)

32) Parent/Guardian Name (optional)

33) Relationship to Student (optional)

34) Cell Phone (optional)

35) Home Phone (optional)

36) Work Phone (optional)

37) Email (optional)

38) Parent/Guardian Name (optional)

39) Relationship (optional)

40) Cell Phone (optional)

41) Home Phone (optional)

42) Work Phone (optional)

43) Email (optional)

Emergency Contacts (Other Than Primary Contacts)

44) Contact Name Required*

45) Relationship to student Required*

46) Phone Required*

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

Yes

Other

48) If you answered "Other" in the last question, please explain below: (optional)

49) Contact 2 Name (optional)

50) Relationship to student (optional)

51) Phone (optional)

52) Is this person authorized to pick up your child from school? (optional)

Yes

53) If you answered "Other" in the last question, please explain below: (optional)

54) Authorized Pick-Up Additional Comments (optional)

Please note any additional information you'd like to include about authorized pick-up contacts (i.e. contact for non-emergency situation, alternate contact information, date restrictions, etc.)

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

55) Upload Birth Certificate (optional)

Max 10 files | 200 MB limit

56) Upload Immunization Records (optional)

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.

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

School Nurse: Tarri McDaniel | Phone: 970-978-1590

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

If your student is not a new or transfer student OR if there has been no change, please proceed to question #68. If yes, please explain below:

58) Health Concerns (optional)

Please select one or more below as applicable:

59) 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.)

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

Please indicate below if applicable

61) Activity restrictions in school? (optional)

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

63) Name of Health Care Provider (optional)

64) 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. **Note: the "Permission to Administer Medication" form MUST be filled out and include a guardian's signature AND the signature of a healthcare provider. We cannot disburse ANY medication without this form, including cough drops, sunscreen, acetaminophen, ibuprofen, prescription medication, etc.

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

ASTHMA SELF-CARRY FORM
ASTHMA CARE PLAN
ALLERGY SELF-CARRY (EPI)
ALLERGY/ANAPHYLAXIS CARE PLAN
MEDICAL MEAL MODIFICATION
PERMISSION TO ADMINISTER MEDICATION

Colorado Department of Education Asthma Resources

65) Upload Asthma Self-Carry Form (optional)

Max 10 files | 200 MB limit

66) Upload Asthma Care Plan (optional)

Max 10 files | 200 MB limit

67) Upload Allergy Form (optional)

Max 10 files | 200 MB limit

68) Upload Medical Meal Modification Form (optional)

Max 10 files | 200 MB limit

69) 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*Required

Please 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

70) 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

71) 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.

72) 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.

73) 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

2024 Mileage Reimbursement Form

Activity or Substitute Bus Driver Time Sheet

Bus Driver Report of Absence

Out-of-District CHOICE Enrollment

Prairie/CHSAA Athletic Handbook & Contract

Prairie RE-11J School District Document in Lieu of Receipt

Regular Enrollment

Request for Item Reimbursement

Request Form for Bus/Suburban/Car

School Employee Report of Absence

Substitute Sign-In Sheet

Supply Order Request

Transcript Request Form

13 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

Stay Connected

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