Thank you for your interest in the Mesa K-Ready program for the 2021-22 school year. Please complete and submit this form for each child.
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Child's first and last name *
Child's date of birth *
Child's gender *
Child's ethnicity *
Parent/guardian name *
Parent/guardian date of birth (birthdate is ONLY used for data purposes) *
Street address *
City *
State *
Zip *
Cell phone (000) 000-0000 *
Email *
Please re-enter your email address *
Relationship to child *
How many years have you lived in Mesa? *
How long have you lived in your current residence? *
Approximate annual family combined income level (include everyone working in the home) *
How many people live in your home? *
Do you have transportation to attend our Mesa K-Ready classes during daytime hours? *
What is your location preference? *
What is your preferred day of the week to attend class? *
What is your preferred class start time? *
Name of Mesa Public school you plan on sending your Mesa K-Ready child to when they start kindergarten *
Is your child currently attending any type of preschool (Head Start, daycare, etc.)? *
If yes, please list the name of the program and how long your child has attended. *
How independent is your child when using the restroom? *
How did you hear about the Mesa K-Ready program? *
Primary language spoken at home (English, Spanish, etc.) *
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