Part 1: Student & Family Information
This form asks a series of standard registration questions. Some are federally mandated so that Kairos can identify students who qualify for free-or-reduced-priced lunch, special education services, or curricular language modifications. Answers provided will be kept as part of your student’s education record.

By completing this form, you are registering at Kairos. We will report to the Missouri Department of Elementary and Secondary Education that your child is scheduled to attend Kairos MIddle School next year. Per pupil funding can only be allocated to one school at a time, so by registering at Kairos, you are affirming that you are not also enrolled elsewhere.

Have questions about Kairos (e.g., transportation)? Check out the FAQ in our registration packet (tinyurl.com/kairosregister), call our office (314-246-9615), or email our principal (jack@kairosacademies.org).

First Adult: General Information
This section requests information about YOU, the student's parent, guardian, caretaker, or adult point-of-contact.
First Adult: First Name *
Your answer
First Adult: Last Name *
Your answer
First Adult: Phone Number *
Your answer
First Adult: Email Address *
Your answer
First Adult: Relationship to Student *
First Adult: Legal Custody? *
Do you have legal custody of the student? Are you authorized to enroll the student in a new school? (In the case of custody issues or court orders, please describe the terms in the "Other" line. Kairos will follow up for supporting documentation.)
First Adult: Annual Household Income?
The state and federal governments fund students at different levels depending on annual household income (e.g., reimbursements on free-and-reduced-priced lunches). To budget accordingly, we're requesting general census-style income information. Answers will not impact your registration at Kairos. To calculate the number of family members in your house, add: (i) yourself + (ii) your spouse/partner + (iii) the number of children (even if they don't live with you) who receive more than half of their support from you + (iv) the number of people (not children or spouse) who live with you and receive more than half of their support from you. This is a required question, but if you prefer, you can submit the answer anonymously by clicking here: http://tinyurl.com/KairosAlternate.
Family Members in House: 2
Family Members in House: 3
Family Members in House: 4
Family Members in House: 5
Family Members in House: 6
Family Members in House: 7
Family Members in House: 8
< $20,000 (less than $20,000)
$20,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000-$60,000
$60,000-$70,000
> $80,000 (more than $80,000)
First Adult: Financial Assistance (Have you or the student ever applied for or received...)
Like the previous question, this answer affects state funding and is required for budgeting purposes. If you'd prefer, you can answer anonymously by opening http://tinyurl.com/KairosAlternate. After you submit, you'll come back to complete this form.
Second Adult: General Information
If there is no second parent, guardian, caretaker, or point of contact, please skip this section.
Second Adult: First Name
Your answer
Second Adult: Last Name
Your answer
Second Adult: Phone Number
Your answer
Second Adult: Email Address
Your answer
Second Adult: Relationship to Student
Second Adult: Legal Custody?
Does the second adult have legal custody of the student? (In the case of custody issues or court orders, please describe the terms in the "Other" line. Kairos will follow up for supporting documentation.)
Student: General Information
Student: First Name *
Your answer
Student: Last Name *
Your answer
Student: Phone
If the student has a phone number, otherwise leave blank.
Your answer
Student: Email
If the student has an email address, otherwise leave blank.
Your answer
Student: Date of Birth *
MM
/
DD
/
YYYY
Student: Race *
Student: Gender Pronoun *
Student: Schooling Information
Student: Current School Name *
Your answer
Student: Current School City & State *
Student: Date Student Last Attended (approximate) *
MM
/
DD
/
YYYY
Student: Other Schools Attended in the Past 24 Months
Your answer
Student: Current Grade Level *
Student: IEP or 504 Plan *
Does your child have an IEP (i.e., diagnosed learning disability) or 504 Plan?
Student: Disciplinary History *
Has your child been expelled from another school for violations of school policies relating to weapons, drugs, or alcohol? (Answering falsely could result in your conviction of a class B misdemeanor.)
Student: Record Release *
To enroll at Kairos, you must authorize the students' previous school(s) to release student records to Kairos Academies. This is standard procedure, pursuant to state law, any time a student enters a new school. Kairos will request the following records from the students' previous school(s): health records, report cards, behavior/discipline reports (including Safe Schools Act violations), standardized test scores, 504 Plans, ELL plans, special education documentation (including evaluation reports and IEPs).
Student: Housing Information
Student: Zip Code *
Example: "63118."
Your answer
Student: Street Address *
Example: "2315 Miami St." (Pursuant to state law, Kairos must rescind enrollment if you cannot prove residency at the address provided. For ways to prove residency, please see www.tinyurl.com/KairosRegister.)
Your answer
Student: Are you or the student currently...
Check all that apply. If none apply, please leave blank. If desired, use "Other" to add further explanation.
Student: Language Information
Student: What was the student's first language? *
If not English, please write the language(s) in "Other."
Student: Which language(s) does the student speak at home? *
If not English, please write the language(s) in "Other."
Student: Which language(s) does your child hear at home and understand? *
If not English, please write the language(s) in "Other."
Referrals & Community Building
Will you & your family attend the Kairos Community Day (May 18 from 4-6:30 p.m.) in the Benton Park Pavilion? *
This is an opportunity to meet Kairos families and faculty, enjoy some good food, and get some sunshine. Any announcements (e.g., the annual calendar) will be sent out in an email afterward.
What is your student's t-shirt size? *
We'll be handing out Kairos t-shirts to families who complete every step in the Kairos registration packet (www.tinyurl.com/KairosRegister) by Kairos Community Day. (Don't worry if you're a few days late—your child will get a t-shirt as soon as you do submit!)
Would you like to join the Kairos Family Council (our PTA/PTO)? *
If so, we'll follow up with more information in spring/summer.
Do you know other families that we should contact about enrolling at Kairos?
Please put the names and contact information for parents of 3rd-5th graders who might want to learn more about Kairos (e.g., your student's classmates, friends, relatives). We'll reach out to them! If you don't know anybody, please leave blank.
Your answer
Would you be willing to host a small gathering of parents interested in learning more about Kairos, either at your home or at Kairos' offices? *
If so, we'll follow up with more information. Kairos will organize all logistics.
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