Clinton Valley Elementary ~ Kindergarten Information Form
Student Information

Please complete the following information for each child you will be registering. This form will be used during the placement process to help us create balanced classrooms. Please fill out a separate form for each child you register.
Email *
Child's Last Name *
Child's First Name *
Gender *
Registering Parent's last name *
Registering Parent First Name *
Registering Parent's Cell Phone *
Parent Email *
Address (street, city, zip) *
Student's age (by September 8th) *
Date of Birth (mm/dd/yyyy) *
1 point
Did your child attend preschool? *
If you answered "Yes" above, how many days a week did your child attend? *
If you answered "Yes" above, what is the name of the preschool your child attended? *
My child prefers to be called: *
1 point
Please list any siblings and ages *
What do you view as your child's greatest strengths? *
What does your child like to do in his/her free time? *
Tell us a little but about your child's personality or preferences: (example- outgoing, shy, prefers to....does well with...…) *
Are there any social, emotional, physical or academic issues that may be an area of concern? *
What concerns and/or goals do you have for your child in his/her Kindergarten year? *
Does your child have any medical concerns we should know about? (Allergies, vision, hearing, diabetes, heart conditions, syndromes, asthma, seizures, dietary restrictions, dental appliances, motor restrictions, other) *
Will you need SACC services (School Age Child Care)? If yes, which days? *
Is your child currently receiving special education services? If yes, please provide additional information. *
Thank you so much for taking the time to complete this survey.
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