2021-2022 NEW Kindergarten (5K) Student Data - River Valley School District

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Please enter information for NEW Kindergarten (5K) students beginning in the fall of 2021. This is for students who did NOT attend 4K in the River Valley School District.

At this time, we are only in the collection process. We will contact you as soon as we have more information to share, such as upcoming meeting dates. Feel free to contact us at any time if you have any questions prior to upcoming meetings.

Email contact is Mrs. Nadine Westphal: nwestphal@rvschools.org

Email *

Student Legal LAST Name *

Student Legal FIRST Name *

Student Legal MIDDLE Name *

Gender *

Female

Male

Date of Birth *

YYYY

Physical Street/Road Address (If Mailing Address is different, enter below) *

City *

State *

Zip Code *

Mailing Address (If different than physical address. Please include address, city, and zip code).

Biological Mother's Full Name *

Does biological mother live at same address as student? *

Yes

Mother's Address** (**ONLY if different than student's)

Yes

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Mother's Telephone Number *

Mother's E-Mail Address *

Biological Father's Full Name *

Does biological father live at same address as student? *

Yes

Father's Address** (**ONLY if different than student's)

Father's Telephone Number

Father's E-Mail Number

Did Student attend a pre-school or 4K? *

Yes

If student attended a pre-school or 4K, where did student attend? *

River Valley Early Learning Center

St. John's

St. Luke's

Kinderplanet

Small World New Beginnings

Other:

Questions or Comments - Please type below.

A copy of your responses will be emailed to the address you provided.

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