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Walk-In Parent PreK Packet
This is a parent request for Special Education form for Pre-School aged children.
Please also email the following to kmadrid@silverschools.org
  • Vision/Hearing Screening (recent in the last year)
  • Medical Report (if the child has a medical diagnosis that may be a barrier to academic success)
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Email *
Student Name and Nicknames *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Person Referring Child (Your name) *
2. Relationship to Child
Physical Address & Mailing Address
(City, State, Zip)
 *
Phone number?  *
3. Mother or Female Guardian Name
Age:
Address:
Employer:
Occupation:
Highest Level of Education
4. Father or Male Guardian Name:
Age:
Address:
Employer:
Occupation
Highest Level of Education 
Ethnicity of Child *
Is this child currently attending a pre-school program and where? *
Does the child have an immunization (shot) record for registration? *
Does the Child have a birth certificate for registration? *
Concerns
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