K-5 Students:                $1.05           $5.25             $21.00

Reduced Breakfast        $0.30           $1.50             $  6.00

Adult                             $1.65           $8.25             $33.00

K-5 Students:                $1.60           $8.00             $32.00

Reduced Breakfast        $0.40           $2.00             $  8.00

Adult                             $2.05           $10.25           $41.00

Milk with Sack lunch     $0.30           $1.50             $  6.00

Yearly amount with sack lunch: $52.50

Recess Milk/Yearly amount:     $52.50

Special Education Enrollees: must pay the fees as charged by the school

Insurance: School Time Cost provided by District

A claim form and instructions can be picked up at the school office. It is the parents responsibility to submit the form along with copies of itemized bills to the school insurance company within 90 days of an accident (not to the school!) Students must be treated by a licensed physician within 30 days from the date of injuy. **Submit copies of all bills to your family and/or groupinsurance, even if you have a large deductible. This plan is in excess to all other valid coverage.

24 hour coverage is offered. Please ask for a brochure if interested.

Forms you will need to fill out:

All students

Student Enrollment Form

Student Health Information Form

Bus Registration

School Medication Authorization Form

Electronic/Technology Release Form

Pesticide Application Registry Notice

Forms you will need to have completed:

Physical Form Page 1    Page 2  (You need both pages of this form!) Grades Kdg, 6th, and 9th

Dental Form Grades Kdg & 6th

Eye Examination Form Grades Kdg, 2nd, & 6th

Physician Medication Release Form  All students receiving medication at school

Miscellaneous Items:

Supply List

Copy of Birth Certificate Pre-K, Kdg, and New students

School Physicals and Updated Immunization Records