2021-2022 Kindergarten Registration Form
Children who will be five years old by August 1, 2021, are eligible to register for the 2021-2022 school year.
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My child will be five years old by August 1, 2021. *
Child's Full Name (First, Middle, Last): *
Parent(s)/Guardian(s) *
Child's Date of Birth *
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Child's Gender *
Race: *
Primary Language Spoken at Home: *
Home/ Primary Phone Number *
Mother's Cell Phone:
Father's Cell Phone:
Name & Phone Number of Local Emergency Contact (contact person in the event of emergency):
Parent Email Address *
Father's Place of Employment & Phone:
Mother's Place of Employment & Phone:
Physical Address: *
Mailing Address: *
List known physical and/or medical conditions:
Thank you for completing the survey & please feel free to leave any additional comments in this section. Also, I encourage you contact me @ jason.gullickson@k12.nd.us if you have any questions. We look forward to working with you and your child in the coming school year.
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