21-22 Preschool/TK/Kindergarten Registration
Preschool will be held 5 days a week, Monday - Friday and you will have a choice between an AM Session and a PM Session - the AM Session will be from 8:05 - 11:15 and PM Session will be from 12:05 - 3:15. Students must be 4 by September 15th, 2021 to be eligible for Preschool.
Transitional Kindergarten will be held 5 days a week and is from 8:05 - 11:15 and is for students that are 5 before September 15th, 2021.
Kindergarten is full days and is for students that are also 5 before September 15th, 2021.
If you have additional questions regarding the programs being offered please call the Primary Office at 755-5903.
Child's Legal Name (first, middle, last)
Child's Date of Birth
Child's Place of Birth (City/State)
Names of Parents / Guardians
American Indian / Alaskan Native
Black / African American
Hawaiian / Pacific Islander
Hispanic / Latino
White / Caucasian
Parental Status (optional)
Mother's Cell Number
Mother's Workplace & Work Phone Number
Father's Address (if different from Mother's)
Father's Cell Number
Father's Workplace & Work Phone Number
Other children in the household (names, dates of birth & relationship to child)
If there are no other children in the household, please reply "N/A" for not applicable.
Has your child attended preschool prior to the 2021-2022 school year?
Do you have any concerns about your child in the following areas?
Mark all that apply
Speech & Language
Health (ADHD, allergies, etc...)
Social / Emotional
No concerns at this time
If you marked any concerns above, please explain below. Also, please state whether or not your child is currently working with anyone based on your concerns.
If your child will be 4 yrs old on or before Sept. 15, 2021, please pick your preference for your child to attend. (Please Note: your preference does not guarantee your spot, but we will do what we can to accommodate as many families as we can.)
Preschool Morning session, 5 days a week, 8:05 - 11:15 (must be 4 by Sept. 15, 2021)
Preschool Afternoon session, 5 days a week, 12:05 - 3:15 (must be 4 by Sept. 15, 2021)
Transitional Kindergarten, 5 days a week, 8:05 - 11:15 (must be 5 by Sept. 15, 2021)
Kindergarten (must be 5 by Sept. 15, 2021)
Please acknowledge that you are the legal guardian of this child and that the information provided is accurate and correct to the best of your knowledge.
I am the legal parent / guardian of this student, and I attest that the information I have provided is accurate and correct to the best of my knowledge.
Name of the person completing this application.
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This form was created inside of Harlan Community School District.