Kindergarten Student Information 2017-2018
Welcome to kindergarten! Please complete all portions of this form so we may pre-register your incoming kindergarten student. You will receive Powerschool access information at a later date so you may complete the online registration process in July.
'School Boundary' in which you live
Student's First Name
Your answer
Student's Middle Name
Your answer
Student's Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Did your child attend a preschool program? If 'YES' please write the name of the program in this section. If not write 'NO'.
Your answer
Gender
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Primary Phone Number (xxx-xxx-xxxx)
Your answer
Child lives with:
Required
Father's Name (first, last)
Your answer
Mother's Name (first, last)
Your answer
Best Email Address for Communication
Your answer
Student's Most Accurate Racial or Ethnic Background
Emergency Contact #1
In case of emergency, please contact:
Name (first, last)
Your answer
Relationship to Child
Your answer
Best Phone Number to Call (xxx-xxx-xxxx)
Your answer
Emergency Contact #2
Name (first, last)
Your answer
Relationship to Child
Your answer
Best Phone Number to Call (xxx-xxx-xxxx)
Your answer
List Any Medical Conditions/Allergies (if this does not apply write NONE)
Your answer
Please Enter Your Name Here (serves as electronic signature)
Your answer
Submit
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