Christina Hall

Experienced professional with 15 years of teaching experience in a preschool setting and 9 years of seasonal work at UPS. Known for loyalty and commitment to delivering high-quality service. Adept at fostering a positive learning environment for young children and ensuring efficient operations in a fast-paced logistics environment. Passionate about making a meaningful impact in the workplace through dedication and hard work.

• This completed application is required only upon entry into GUSD. Each year, however, annual registration paperwork will be sent out electronically through the SchoolWise Parent Portal.
• All Grade Levels:
• Completed Student Application Form
• Copy of Student’s Birth Certificate
• Proof of Complete Required Immunizations for School Entry - more information is available on the next page.
• Proof of Residency (Utility Bill or other acceptable document)
• Copy of IEP or 504 (If Applicable)
• TK and Kindergarten Only: (Must also include)
• Report of Health Exam for School Entry
• Oral Health Assessment for School Readiness
• 7th Grade Only: (Must also include)
• 7th Grade Immunization Requirement – 1 Tdap booster, 2 chickenpox/Varicella vaccines
• FOR OFFICE USE ONLY:
• Student SSID
• Special Programs
• Direct Cert
• Date Application & All Forms Received
• Acceptance Sent
• Parent Confirmed
• Entered in SchoolWise
• ELD

• Parents/Guardians – Are Your Kids Ready for School?
• Please bring your child’s immunization records with you at the time of registration. You may view and print a digital copy of your child’s California vaccine record at: MyVaccineRecord.CDPH.CA.gov
• Students Entering Transitional Kindergarten or Kindergarten Need:
• Diphtheria, Tetanus, and Pertussis (DTaP, DTP, Tdap or Td) — 5 doses
• 4 doses OK if one was given on or after 4th birthday; 3 doses OK if one was given on or after 7th birthday.
• Polio (IPV or OPV) — 4 doses
• 3 doses OK if one was given on or after 4th birthday.
• Hepatitis B — 3 doses
• Measles, Mumps, and Rubella (MMR) — 2 doses
• Both doses must be given on or after 1st birthday.
• Varicella (Chickenpox) — 2 doses
• New and Transfer Students Entering TK/K-12th Grade Need:
• All immunizations listed above
• For 7th-12th graders: at least 1 dose of pertussis-containing vaccine is required on or after 7th birthday. Hepatitis B vaccine is required for any grade, except for entry into 7th grade.
• Students Starting 7th Grade Need:
• Tetanus, Diphtheria, Pertussis (Tdap) —1 dose
• What other immunizations should I ask my health care provider about?
• When you visit your health care provider for back-to-school immunizations, make sure to also ask about other vaccines that help keep your child healthy, including hepatitis A, COVID-19, and the annual flu vaccine. Preteens and teens should also get the human papillomavirus (HPV) vaccine to protect against certain cancers and meningococcal vaccines.
• Learn more about vaccines your child needs according to their age (bit.ly/CDCVaccinesByAge) and where you can get your child immunized (bit.ly/Where2BVaxed).
• IMM-222 School (8/22) (Reviewed 8/23)
• California Department of Public Health
• Immunization Branch
• ShotsForSchool.org

• Option 1 - Physical Delivery
• Once you have filled out the application, click on the print button (on the last page of the application) and print out the application. Attach the other required documents and you can hand deliver, mail, or fax them to the appropriate school.
• Gravenstein Elementary School
• 3840 Twig Ave
• Sebastopol, CA 95472
• Fax (707) 823-0478
• Hillcrest Middle School
• 725 Bloomfield Rd
• Fax (707) 823-4630
• Option 2 - Digital Delivery
• Save the document to your computer and email the application. To do this, you will click the print button (on the last page of the application), but instead of selecting a printer, you will click “save as pdf”. This will save the document to your computer. You can then send it as an attachment to the appropriate school.
• O Gravenstein email: gravapplications@gusdschools.org
• O Hillcrest email: hmsapplications@gusdschools.org

• Gravenstein Union School District
• 725 Bloomfield Rd
• Sebastopol, California 95472
• Student Registration Form
• School Year 2024/2025
• Grade Level ___________
• (Grade level in 2024/2025)
• Date
• O Gravenstein Elementary School
• O Hillcrest Middle School
• Student’s Legal Name:
• First Middle Last
• Date of Birth: Gender: O Male O Female O Non-Binary
• Student’s Birthplace
• City State Country
• Primary Guardian Household: O Father O Mother O Guardian O Step Parent O Grandparent
• Lives With: O Full-time O Other, Explain
• Name
• First Last
• Home Address
• Street City State, Zip Code
• District of Residence
• Mailing Address if different
• Home Phone Cell Phone
• Area Code and Number Area Code and Number
• Work Phone Email
• Area Code and Number and extension, if applicable
• Secondary Guardian Household: O Father O Mother O Guardian O Step Parent O Grandparent
• Rev. 01/25/2024

• PARENT EDUCATION LEVEL: Please check selections applicable to each Parent/Guardian.
• Primary Guardian
• Not a high school graduate
• High school graduate
• Some college
• College graduate
• Graduate school/postgraduate training
• Declined to state or unknown
• Secondary Guardian
• If child divides time between two households, please list other responsible adults in household who can be contacted in case of Emergency:
• NAME PRIMARY OR SECONDARY HOME PHONE # EMAIL RELATIONSHIP
• Are parents separated? O Yes O No
• If so, may the other parent pick up their child at school? O Yes O No
• If there is a legal custody agreement regarding this student, please check one:
• Joint Custody Sole Custody Guardianship
• If there is a legal custody agreement, the school needs to have supportive legal documents.
• OTHER CHILD(REN) IN HOME DATE OF BIRTH RELATIONSHIP
• (Even if not in School)

• HOME LANGUAGE SURVEY
• The California Education Code contains legal requirements which direct schools to assess the English language proficiency of students. The process begins with determining the language(s) spoken in the home of each student. The responses to the home language survey will assist in determining if a student’s proficiency in English should be tested. This information is essential in order for the school to provide adequate instructional programs and services.
• As parents or guardians, your cooperation is requested in complying with these requirements. Please respond to each of the four questions listed below as accurately as possible. For each question, write the name(s) of the language(s) that apply in the space provided. Please do not leave any question unanswered. If an error is made completing this home language survey, you may request correction before your student's English proficiency is assessed.
• 1. What Language/dialect did your child learn when they first began to talk?
• 2. What language/dialect does your child most frequently speak at home?
• 3. What language/dialect do you most frequently use when speaking with your child?
• 4. What language/dialect is most often spoken by adults in the home? (parents, guardians, grandparents, or any other adults)
• PARENT MILITARY DUTY: Please select whether or not at least one parent/guardian of this student is active in the United States Armed Forces: O Yes O No Please list service branch:
• STUDENT’S ETHNICITY (U.S. Department of Education requires collection of information from this section)
• O Hispanic or Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture/origin, regardless of race).
• O Not Hispanic or Latino
• The above part of the question was about ethnicity, not race. No matter what you selected above, please continue to answer the following by filling in the below with the number(s) of what you consider your race to be.
• What is your child’s Race? Primary Secondary, if applicable
• 100 American Indian 204 Vietnamese 301 Hawaiian 400 Filipino
• Or Alaskan Native 205 Asian Indian 302 Guamanian 600 Black or
• 201 Chinese 206 Laotian 303 Samoan African American
• 202 Japanese 207 Cambodian 304 Tahitian 700 White
• 203 Korean 299 Other Asian 399 Other Pacific Islander 999 Decline to State

• OTHER STUDENT INFORMATION
• When did your student first attend school in the United States? Grade
• Month/Year
• When did your student first attend school in California? Grade
• What school did the student attend before enrolling in one of the schools in the Gravenstein Union School District? Check one:
• Public Private Home School None
• At what grade level? (K-12)
• Previous School Attended
• Address and Phone Number
• Dates (month/year) of Attendance at Previous School From To
• Has your child ever been retained? O Yes (which grade? ) O No
• Has your child ever been at risk of retention? O Yes (which grade? ) O No
• Additional Enrollment/Placement Information: Please answer all questions.
• I certify that my child:
• O Has never been enrolled in a special educational program
• O Was previously enrolled in a special educational program and is no longer enrolled
• O Is currently enrolled in a special educational program
• My child has participated in the following program(s): Mark the appropriate box for each.
• O Yes O No Special Education (IEP) O Yes O No English Language Development (ELD)
• O Yes O No Special Day Class (SDC) O Yes O No 504 Plan
• O Yes O No Resource Specialist Program (RSP) Qualifying Condition
• O Yes O No Speech and Language Program O Yes O No Special health or medical needs Other
• O Yes O No Visually Impaired Program (Specify)
• O Yes O No Gifted & Talented Education Program
• Upon enrollment, if your student currently has a 504 plan or an IEP, a current copy of said plan must be submitted.
• Does your child have any physical handicaps?
• Any convulsions or seizures?
• Any serious illnesses or operations?

• Public Random Drawing
• The Gravenstein Union School District shall endeavor to admit all pupils who wish to attend the Charter School. However, if the number of pupils who wish to attend the Charter School exceeds the Charter School’s capacity, attendance shall be determined by a public random drawing, except for existing pupils of the charter school. If a public random drawing is necessary, preference for admission in the lottery will be given in the following order:
• 1. Students currently attending Gravenstein Elementary School or Hillcrest Middle School.
• 2. Students who would otherwise qualify for attendance pursuant to District Board Policy No. 5117.
• 3. Siblings of existing students
• 4. Children of school employees
• 5. Students who reside outside the District
• In the public random drawing, all applicants are drawn and listed in order, separately, for each grade level. Once the School’s capacity is met, the remaining applicants will continue to be drawn randomly and placed on the waiting list. If space becomes available during the school year, students on the waiting list will be contacted.
• Use the attached Student Questionnaire to provide additional information about your student.
• I declare that the foregoing is true and correct.
• PARENT/GUARDIAN SIGNATURE DATE

• GRAVENSTEIN UNION SCHOOL DISTRICT EMERGENCY FORM
• Office Use Only
• MEDICAL
• CUSTODY
• SPECIAL NEEDS:
• Student’s Name (Last) (First)
• Birthdate Gender Language Spoken at Home
• Street Address City Zip
• Mailing Address City Zip
• Allergies
• EMERGENCY CONTACTS
• Child lives with Relationship to Child
• Phone # Cell # Work #
• Physician Phone #
• Medical Insurance Provider Phone #
• Preferred Hospital Phone #
• IN CASE OF EMERGENCY
• I/we, the undersigned parent(s) or legal guardian of , a minor, do hereby give authorization and consent to the school to obtain emergency medical care and necessary transportation, including x-ray examination, anesthetic, medical or surgical diagnosis and emergency hospital which is deemed advisable by and is to be rendered under the general or specific supervision of medical and emergency room staff licensed under the provisions of the Medicine Practice Act and the State of California Department of Public Health. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the student, but that any of the above treatment will not be withheld if the undersigned or authorized adults cannot be reached.
• I/we understand that the school district does not provide accident/medical insurance for students, and I/we further understand that all costs related to medical treatment may be my/our responsibility and not that of the school district.
• Parent/Guardian Signature Date

• EMERGENCY AUTHORIZATION CONTACT AND RELEASE INFORMATION
• In the event of an emergency, illness, accident or disaster, we will do our best to contact the parent(s) or guardian(s) listed above. Please list the names of relatives/neighbors/friends in close proximity to the school to which we may release your child or contact if you cannot be reached. NO STUDENT WILL BE RELEASED TO ANYONE OTHER THAN THE PARENTS, GUARDIANS OR ADULTS LISTED ON THIS FORM. In selecting someone to whom you authorize the release of your child, consider: (a) Would your child feel safe and comfortable with this person and family? (b) Could this person care for your child for several days? (c) Is this person prepared to handle any special medical needs required by your child?
• I/we hereby authorize the release of my child to the following persons in the event of illness, injury, evacuation or emergency that may occur while students are in school.
• Name Relationship
• Phone # Cell # Work #
• IN THE EVENT OF A LIFE-THREATENING ALLERGIC REACTION, I AUTHORIZE TRAINED SCHOOL PERSONNEL TO GIVE EMERGENCY TREATMENT (EPINEPHRINE VIA EPI-PEN) TO MY CHILD.
• Parent/Guardian Signature Date

• GRAVENSTEIN UNION SCHOOL DISTRICT
• 725 Bloomfield Rd
• Sebastopol, CA 95472
• STUDENT CUMULATIVE FILE REQUEST
• Date:
• Previous School:
• Address:
• Fax #: Phone #:
• Email: Attn:
• Please forward copies of any records, report of examinations, test scores, immunization records, psychological reports and all other information regarding my child(ren) to school checked below:
• Hillcrest Middle School
• 725 Bloomfield Road
• Telephone (707) 823-7653
• Fax (707) 823-4630
• Gravenstein Elementary School
• 3840 Twig Avenue
• Telephone (707) 823-5361
• Fax (707) 823-0478
• Name of Child(ren) Birth Date Current Grade
• PLEASE FAX IMMUNIZATIONS AND ANY IEP INFORMATION ASAP TO SCHOOL CHECKED ABOVE.
• Signature of Parent or Guardian Date
• Please Print Name Here