21-22 ECE Reg Form | Omaha Public Schools Foundation

ECE Available at 6 OPS Elementary Schools

Select First, Second and Third Choice. ECE Locations

First Choice ECE Location *

Second Choice ECE Location *

Third Choice ECE Location *

Child/Student Information

Student's Legal Name *

First

Middle

Last

Date of Birth *//

Date of birth must be on or before July 31st, 2017.

Gender *

Female
Male

Ethnicity *

Hispanic/Latino
Not Hispanic/Latino
Choose Not to Answer

Race *

Siblings *

Sibling Name *

Sibling Age *

Sibling OPS School Attending *

Add Sibling *

Yes
No

Sibling2 Name *

Sibling2 Age *

Sibling2 OPS School Attending *

Official Birth Certificate Required - Please select your preferred method to provide documentation *

Upload Document File Now
*Email Document to OPSF
*Fax Document to OPSF
*Mail Document to OPSF

*If you choose to email, fax or mail document, information and instructions will be emailed once registration is submitted.

Upload Birth Certificate Document *

Click or drag files to this area to upload. You can upload up to 2 files.

Primary Parent/Guardian Information (Primary Account Guarantor)

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Proof of Residency is Required to Complete Registration

Proof of Residency Required - Please select your preferred method to provide documentation *

Upload Document File Now
*Email Document to OPSF
*Fax Document to OPSF
*Mail Document to OPSF

*If you choose to email, fax or mail document, information and instructions will be emailed once registration is submitted.

Upload Proof of Residency *

Click or drag files to this area to upload. You can upload up to 3 files.

Relationship to Student *

Employer *

Email *

Email

Confirm Email

Email will be used for future account access, billing and other communications from OPSF ECE .

Cell Phone

Home Phone

Work Phone

Would you like to add a secondary parent/guardian? *

Yes
No

Secondary Parent/Guardian Information (Secondary Account Guarantor)

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Relationship to Student *

Employer *

Email *

Email

Confirm Email

Email will be used for future account access, billing and other communications from OPSF ECE .

Mobile Phone

Home Phone

Work Phone

Emergency Contact Information

Minimum of two emergency contacts are required. We will first contact primary and/or secondary guardian(s) before emergency contacts. If authorization for pick up is granted, a photo identification will be required at pick up.

Primary Emergency Contact *

First

Last

Best Contact Number *

Relationship to Student *

Pick Up Authorization *

Secondary Emergency Contact *

First

Last

Best Contact Number *

Relationship to Student *

Pick Up Authorization *

Add Additional Emergency Contact *

Yes
No

3rd Emergency Contact *

First

Last

Best Contact Number *

Relationship to Child *

Pick Up Authorization *

Add Additional Emergency Contact *

Yes
No

4th Emergency Contact *

First

Last

Best Contact Number *

Relationship to Child *

Pick Up Authorization *

Child's Medical History

Any LIFE THREATENING Conditions or Allergies *

No Life Threatening Conditions or Allergies Known
YES! My Child has a LIFE THREAENING Condition or Allergy - Provide Details Below

ALERT !!- LIFE THREATENING CONDITION OR ALLERGY DETAILS *

Physician's Name *

Physician's Phone *

Immunization Records are Required - Please select your preferred method to provide documentation *

Upload Document File Now
*Email Document to OPSF
*Fax Document to OPSF
*Mail Document to OPSF

*If you choose to email, fax or mail document, information and instructions will be emailed once registration is submitted.

Upload Immunization Doucment(s) *

Click or drag files to this area to upload. You can upload up to 3 files.

Does you child need to take any medication while in school? *

No
Yes - *OPS Medication Permission Form Required

*OPS Medication Policy & Permission Form Required & Available for Download

Health Conditions *

Please Provide Details Relating to Allergies *

Please Provide Details of Other Health Conditions or Concerns *

Any Special Concerns Not Listed Above? *

Yes
No

Please Provide Details of Special Concerns *

Any Activity Restrictions? *

Yes
No

Please Provide Details of Activity Restrictions *

Consent & Permission

Photographs, Videos and Broadcast Permission & Consent *

Yes, Permission and consent is given to use any photographs, videos, and/or broadcasts of my child.
No, Please do NOT use any photographs, videos and/or broadcasts of my child.

Signature: I give my permission and consent for the Omaha Public Schools Foundation and/or Omaha Public Schools to include my child in photographs, videos, and/or broadcasts used for the publicity and promotion of the Omaha Public Schools Foundation. *

Acknowledgments & Authorizations

I understand that my child must be 4 years old on or before July 31st, 2017 to be considered for acceptance to ECE Parent Pay Program. *

Yes

No exceptions to the ECE age requirement.

I understand that my child must be toilet trained, must have age appropriate hygiene skills. *

Yes

I understand there is a $75 non-refundable registration fee to process registration application. *

Yes

Registration fee is required to complete application process. Non-refundable registration application is processed regardless of acceptance.

I understand this program is operated by Omaha Public Schools Foundation as a parent pay program. Weekly tuition is $195 per student. Lack of payment can result in suspension from ECE parent pay program. *

Yes

Once OPS has 21-22 calendar we provide all accepted families detail fee schedule of annual financial responsibility.

I agree to provide all required documents to OPSF ECE and/or OPS to complete registration and acceptance to ECE. *

Yes

Birth Certificate, Current Immunization Records & Proof of Residency.

Signature: Primary Parent/Guardian *

Signature: Secondary Parent/Guardian *

2021-2022

OPSF Early Childhood Education

Parent Pay Program

Registration Form

ECE Available at 6 OPS Elementary Schools

Child/Student Information

Primary Parent/Guardian Information (Primary Account Guarantor)

Secondary Parent/Guardian Information (Secondary Account Guarantor)

Emergency Contact Information

Child's Medical History

Consent & Permission

Acknowledgments & Authorizations