Tamaqua Area School District Kindergarten Enrollment Form
Email address *
Student First Name: *
Student Last Name *
Student Middle Name
Student Gender *
Student Date of Birth *
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Student Current Age *
Student Place of Birth (City, State) *
Is the student in Foster Care? *
If answered Yes to previous question: What is the name of the Foster Agency? What is the address of the Foster Agency? (City, State,Zip)
Student Full Address (Including City, State, Zip) *
Name of Parent(s)/ Guardian *
Primary Telephone Number *
Mothers Work Telephone
Fathers Work Telephone
Emergency Contact Number
Does Student have Proof of Residency? *
Does Student have Proof of Immunizations? *
Student's United States School Entry Date *
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Student Ethnicity *
Student Race *
Who does the student reside with? *
Date Enrolled *
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