Kindergarten Pre Registration 2022

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Child must be 5 years old on or before August 15, 2022.

Child's Full Name *

Child's Date of Birth *

YYYY

Child's Gender *

Male

Female

Primary Contact's Name and Relationship (mother, father, guardian, etc.) *

Primary Contact's Phone Number *

Primary Contact's Email *

Current Moore County Address (Child must reside at the address.) Parent/Guardian will be required to provide TWO proofs of residency, one must be driver's license with current Moore County address. Someone will contact you for these. *

In addition to parent/guardian's driver's license with current Moore County address, please choose which additional proof of residency you will provide prior to your child's testing date in May. Someone will contact you for these. *

voter registration

motor vehicle registration

water bill

electric bill

Mother's name *

Mother's primary phone number *

Father's name *

Father's primary phone number *

Does your child have any siblings who attend Lynchburg Elementary or Moore County High School? If so, what are their names? *

Are there any custody issues at this time? If yes, please provide the name and phone number of child's legal guardian. (The school will also require a copy of current custody papers.) *

Has your child ever attended a Pre K, daycare, or head start program? If so, which one? *

Does your child currently receive any of these services? *

speech therapy

physical therapy

occupational therapy

behavioral therapy

My child does NOT currently receive any of these services.

Required

Please list any medical issues of which we need to be aware. *

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