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Gallia County Local Schools
Kindergarten Pre-registration Form
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* Indicates required question
Email
*
Your email
Student's Date of Birth (month, day, year)
Your answer
Student's Name
Your answer
Street Address
Your answer
City, State, and Zip
Your answer
Caregiver's Name
Your answer
Does the caregiver have legal custody of the child?
Yes
No
Clear selection
Caregiver's Preferred Telephone Contact Number
Your answer
Does your child currently attend pre-school?
Yes
No
Clear selection
If yes, where does your child currently attend pre-school?
Addaville
Hannan Trace
Southwestern
Vinton
Other: _____________________________________________________
Non Applicable
Clear selection
What school will your child attend for Kindergarten?
Addavile
Hannan Trace
Southwestern
Vinton
Other: ______________________________________________________________
Clear selection
Does your child receive books from The Imagination Library
Yes
No
Not eligible (older than 5 years old)
Clear selection
Are you registered for Ready Rosie
Yes
No
Clear selection
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