Central Elementary School 2014 Kindergarten Student Information
Please complete and submit the information below prior to attending Roundup on April 17th
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Student's Last Name *
Student's First Name *
Preferred Name
Example: Michael - Mike
Gender *
Student's Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Check all that apply
Required
Student's House Number *
Example: 305
Student's Street Name *
Example: Franklin St - please use abbreviation Dr, Pl, Ct, Ln, Pkwy
Apartment
Example: 1/A
Student's Zip Code *
Student's Primary Contact Number *
Choose Type
*
Enter Primary Number/Example: 219-531-3030
Custodial Parent Last Name, Father's First Name/Mother's First Name *
Example: Smith, John/Ann
*
Custodial Parent Relationship
Custodial Parent's Email Address *
Type: 'None' if you do not have email
Non-Custodial Parent's Email Address
Mother's Last Name
Mother's First Name
Mother's Primary Contact Number *
Choose Type
*
Enter Primary Number/Example: 219-531-3030
Father's Last Name
Father's First Name
Father's Primary Contact Number *
Choose Type
*
Enter Primary Number/Example: 219-531-3030
Does your child have any special needs *
Describe any special needs information
Is Engish the primary language spoken at home? *
List other language(s) spoken at home
Does your child have siblings at this school? *
Names of siblings at this school
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