Key Up for Kindergarten Student Application
Applications must be submitted by April 30, 2021 to be considered for placement in the program. Space is limited and applications will be considered on a basis of need. You will be notified by May 14, 2021 if your child is selected for participation.
Student Name *
Student Date of Birth (Month/Day/Year) *
Home Address *
Mailing Address (if different from Home Address)
Contact Phone Number *
Email Contact
School that your child will attend in the fall: *
Is your child currently enrolled in a daycare or preschool program? *
If yes, where is your child enrolled? Please list daycare or preschool center and location.
Does your child have any medical needs? This information will be used to better serve your child and will not in any way keep them from being selected for the program. *
If you selected any of the above medical conditions or if your child has any other special needs that we need to be aware of, please describe them in the space below.
Please list two individuals that can pick up your child in case of an emergency where you cannot be reached. Please include a phone number where each person can be reached. *
Please indicate how your child will be transported to and from the program. *
Parent Signature: Please type your name and the date in the space below. Entering and dating this information will serve as your electronic signature. *
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