Lexington School District One 4-Year-Old Kindergarten Program Application
This form is to be completed if you are applying for a NEEDS-BASED 4-year-old kindergarten program. Your current residence must be in the attendance zone for the school to which you are applying.
Email address *
Choose your zoned elementary school. Your current residence must be in the attendance zone for the school to which you are applying. *
Child's First Name: *
Child's Last Name: *
Date of Birth: (To be eligible for a 4-year-old kindergarten program for the 2021-2022 school year, your child must turn 4 by September 1, 2021). *
Sex: *
Race: *
Child's Primary Language: *
Language Spoken at Home: *
Please check any services your child is receiving or has received in the past (check all that apply): *
This child is in my care as a foster child. *
Is your child currently in a childcare, daycare or church center? *
If yes, which center?
Children must be fully toilet trained and independent in the bathroom prior to their enrollment in a NEEDS-BASED 4-year-old kindergarten program. Independence means that the child wears regular underwear (not in pull-ups or diapers), must have the awareness to use the bathroom without reminders, be able to manage clothing without assistance, and have the ability to wipe or clean themselves appropriately to maintain proper hygiene. If your child is not yet fully toilet trained and you have concerns about his or her development, you may contact Special Services at (803) 821-1101 to schedule a screening appointment. *
Contact Information
Street Address: *
City: *
Zip Code: *
Primary email address (Please be sure that you monitor this email address regularly as this will be our main method of communication.) *
Phone Numbers
Primary Phone Number ###-###-#### *
Alternate Phone Number ###-###-####
Family Information
Parent(s) in Household *
Parent/Guardian 1 relation: *
Parent/Guardian 1 Employer:
Parent/Guardian 1 Education Level:
Parent/Guardian 2 relation:
Parent/Guardian 2 Employer:
Parent/Guardian 2 Education Level:
Children living in the household (list name (first and last), age and school attending):
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