Potosi 3-5 Year Old Screening

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Dear Parent/Guardian,

In September of 2025, children who will be 4 on or before September 1, 2025 are eligible to participate in our 4 Year Old Kindergarten Program. Potosi 4K is offered full days Monday-Friday. Although it is only January, we are already looking forward to having your son/daughter in our school.

To pre-register your child for our program, please fill out the accompanying form by February 13, 2025. When parents register their child for the 4 Year Old Kindergarten Program, at a later date, you will need to bring a copy of a current immunization record and your child's birth certificate (not a copy). You will be receiving additional information about when this will occur at a later date.

To honor each family's individual needs and schedules, we will conduct screening times, dates, and locations based on individual family needs this year. Once you have submitted this form, an individual from Potosi School District will contact you to discuss the potential for screening.

If you have any questions please contact Tammy Cooley or Tiffany Helmke at 608-763-2161.

Families with 3 year old children or children who will be 3 in the fall of 2025 and have concerns about their speech/language, motor skills, behavior, learning or basic skills contact Debbie at 608-763-2161 extension 810.

My child will be attending (please choose one below): *

Potosi's 4K Program for 5 full days

A Catholic School Program

I do not want my child to start 4K at this time (please state the reason below)

Other:

Child's Full Name (as it appears on the birth certificate): *

Child's Date of Birth: *

YYYY

Child's Gender: *

Male

Female

Parent/Guardian's Name: *

Address and Box #: *

Town and State: *

Zip Code: *

Home/Cell Phone: *

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