Sequatchie County Schools PreK Enrollment
Student's Name (as it appears on the Birth Certificate) *
Your answer
Student's Preferred Name
Your answer
Gender *
Birth Date *
MM
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DD
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YYYY
Mother's Maiden Name *
Your answer
Birth Country *
Your answer
Birth State *
Your answer
Birth County
Your answer
Birth City
Your answer
Ethnicity (check one) *
Race (Check all that apply) *
Required
Military (check the appropriate box if this student has a parent/guardian that is)
List other children in the family
Your answer
Are there Legal/Custody issues we should be aware of? (Please answer yes/no and explain if necessary)
Your answer
Custody *
Required
Parent/Guardian #1 *
Your answer
Relationship *
Your answer
Check all that apply *
Required
Physical Address *
Your answer
Mailing Address (if different)
Your answer
Phone Number (please indicate home/work/cell) *
Your answer
2nd Phone Number (please indicate home/work/cell)
Your answer
Occupation
Your answer
Email Address (Required for Skyward Family Access)
Your answer
Parent/Guardian #2
Your answer
Relationship
Your answer
Check all that apply
Physical Address
Your answer
Mailing Address (if different)
Your answer
Phone Number (please indicate home/work/cell)
Your answer
2nd Phone Number (please indicate home/work/cell)
Your answer
Occupation
Your answer
Email Address (Required for Skyward Family Access)
Your answer
The Pre-K program requires the reporting of household income. Please choose your annual household income. Proof of Income will be required at a later date. *
Total number of people living in the household *
Please check if child/family/household member has participated in one or more of the following programs, currently or during the past school year.
The McKinney-Vento Act requires the completion of the following information. Where does your child stay at night? Choose only one answer. *
Does your child need to be evaluated for speech services? *
Does your child need to be evaluated for other special education services? *
Parent/Guardian Signature *
Your answer
Date *
MM
/
DD
/
YYYY
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