Request for Pershing Program Screening
Please complete this form if you would like to for your child to be screened for entry into a Pershing Pre-K classroom at Pershing, RCC, Baum, or Dennis. Any child between the ages of 3 and 5 (but not yet eligible for kindergarten) can be screened. At this time, due to restrictions on face-to-face interactions, all screenings will be conducted via telephone.
Child's Last Name
Child's First Name
Child's Date of Birth
Parent/Guardian Name (First and Last)
Best Contact Phone Number
My child will turn 4 by September 1, 2020, and I would like to be considered for a full-day program.
I would prefer for my child to attend half-day class in:
The best time to contact me to schedule a screening is:
Between 8 am and 12 pm
Between 12 pm and 4 pm
After 4 pm
Never submit passwords through Google Forms.
This form was created inside of Decatur Public School District 61.