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2023-2024 Kindergarten Registration Form
Children who will be five years old by August 1, 2023, are eligible to register for the 2023-2024 school year.
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* Indicates required question
My child will be five years old by August 1, 2023.
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Yes
No
Child's First Name:
*
Your answer
Child's Middle Name
Your answer
Child's Last Name
*
Your answer
Parent(s)/Guardian(s)
*
Your answer
Child's Date of Birth
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MM
/
DD
/
YYYY
Child's Gender
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Female
Male
Race:
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Asian
American Indian
Black
Caucasian
Hispanic
Primary Language Spoken at Home:
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Your answer
Home/ Primary Phone Number
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Your answer
Mother's Cell Phone:
Your answer
Father's Cell Phone:
Your answer
Name & Phone Number of Local Emergency Contact (contact person in the event of emergency):
Your answer
Parent Email Address
*
Your answer
Father's Place of Employment & Phone:
Your answer
Mother's Place of Employment & Phone:
Your answer
Physical Address:
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Your answer
Mailing Address:
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Your answer
List known physical and/or medical conditions:
Your answer
Thank you for completing the survey & please feel free to leave any additional comments in this section. Also, I encourage you contact me @
jason.gullickson@k12.nd.us
if you have any questions. We look forward to working with you and your child in the coming school year.
Your answer
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