NEW Preschool Student Registration Form
Welcome to Skokie School District 73.5!
This form is the first step in enrolling your child as a Preschool Student at Elizabeth Meyer School in Skokie School District 73.5 school. Please carefully read and answer all the questions.
After completing this form, the next step is to bring your child's original birth certificate (must be a government-issued document), parent/guardian driver's license (with current address), and proof of home ownership/lease.*
Additional information and documents will be required to complete registration.
Thank you!
*Not required for non-resident tuition-paying preschool students
* Required
STUDENT INFORMATION
Last
*
Last name
Your answer
First
*
First name
Your answer
Middle
Middle name
Your answer
Gender
*
Boy or Girl?
Boy
Girl
DOB
*
Date of Birth
MM
/
DD
/
YYYY
USA Born
*
Was this child born in the USA?
YES
NO
If Not USA
If NO, on what date did child arrive in the USA?
MM
/
DD
/
YYYY
Birthplace
*
In what City & State (if born in USA) OR Country (if born outside USA) was this child born?
Your answer
HOME INFORMATION
Residency is defined as that place where parent/legal guardians eat, sleep, and store their belongings; furthermore, it is that place in which their child resides with them for four or more days per week. A student's residence is the same as the person who has legal custody of the student. (Board Policy 7.60)
Address
*
House number and Street
Your answer
City
*
City
Your answer
State
*
State
Your answer
ZIP
*
ZIP Code
Your answer
Residence
*
Do you own, rent or share your home?
Own
Rent
Share
If SHARED
If SHARED, who owns or rents the home that you share?
Your answer
Relationship
If SHARED, how is the owner/renter related to this child?
Grandparent
Aunt/Uncle
Friend
Other:
Clear selection
Previous Address
If you moved to Skokie School District 73.5 less than 1 year ago, what was your address?
Your answer
PARENT / GUARDIAN #1 INFORMATION
Please provide information about the person who is the primary caregiver for this child. This is the first person we would contact if the child is absent from school, or must be sent home due to illness.
Last PG1
*
Last name of Parent/Guardian #1
Your answer
First PG1
*
First name of Parent/Guardian #1
Your answer
Email PG1
*
Email address for Parent/Guardian #1
Your answer
Relationship PG1
*
Relationship of Parent/Guardian #1 to this child
Father
Mother
Guardian
Other:
Address PG1
*
House number and Street, City, State, ZIP
Same as student
Other:
Phone PG1
Preferred phone number
Your answer
Phone Type PG1
Preferred phone type
Cell
Land
Work
Clear selection
Alternate Phone PG1
Alternate phone number
Your answer
Alternate Phone Type PG1
Alternate phone type
Cell
Land
Work
No alternate phone
Clear selection
PARENT / GUARDIAN #2 INFORMATION
If Mother was listed as Parent/Guardian #1, Father should be listed here.
Last PG2
*
Last name of Parent/Guardian #2
Your answer
First PG2
*
First name of Parent/Guardian #2
Your answer
Email PG2
Email address for Parent/Guardian #2
Your answer
Relationship PG2
*
Relationship of Parent/Guardian #2 to this child
Father
Mother
Guardian
Other:
Address PG2
*
House number and Street, City, State, ZIP
Same as student
Other:
Phone PG2
Preferred phone number
Your answer
Phone Type PG2
Preferred phone type
Cell
Land
Work
Clear selection
Alternate Phone PG2
Alternate phone number
Your answer
Aternate Phone Type PG2
Alternate phone type
Cell
Land
Work
No alternate phone
Clear selection
ADDITIONAL HOME & PARENT INFORMATION
Custody
If parents DO NOT live in the same home, who has custody (the legal right to make education decisions)?
Parents live in the same home
Parent/Guardian #1
Parent/Guardian #2
Clear selection
Maiden
Mother's maiden name
Your answer
SPECIAL SERVICES
Special Education
*
Was this child ever evaluated for Special Education?
YES
NO
If YES SpEd
If YES, was an education plan established?
YES
NO
If YES IEP
If an education plan was established, what services were recommended? (check all that apply)
Occupational Therapy
Physical Therapy
Speech/Language Services
An education plan was not established
Additional Information
Is there any other information the school should know about this child?
Your answer
HOME LANGUAGE
Language
*
Is a language other than English spoken in your home?
YES
NO
If YES LANG
If YES, what is the home language?
Your answer
PROGRAM SELECTION
Students who will be age four (4) on or before September 1 must attend classes every day. Students who will be at least age three (3) on or before September 1, but younger than age four (4) may select a Monday, Wednesday, Friday OR Tuesday, Thursday schedule.
Three-year-olds may also select the full week option.
All options are half-day, either morning or afternoon, in 2½-hour sessions.
Morning sessions are 8:35-11:05 a.m
Afternoon sessions are 12:15-2:45 p.m.
Preference
Five Mornings 8:35-11:05 a.m. -- Student may be either 3 or 4 by September 1
Five Afternoons 12:15-2:45 p.m. -- Student may be either 3 or 4 by September 1
Three Mornings Mon, Wed & Fri -- Student must be younger than age 4 by September 1
Three Afternoons Mon, Wed & Fri -- Student must be younger than age 4 by September 1
Two Mornings Tue & Thu -- Student must be younger than age 4 by September 1
Two Afternoons Tue & Thu -- Student must be younger than age 4 by September 1
FAMILY INFORMATION
Please tell us about any additional children in your family.
Only Child
*
Is the child named above your ONLY child?
YES
NO
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