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PreKindergarten Enrollment Form
Maple Run Unified School District - Serving the residents of Fairfield, St Albans City and St Albans Town
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student Middle Name
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Gender
*
Female
Male
Prefer not to say
Other:
Is the Student Hispanic or Latino?
*
Choose
Yes
No
Child's Race (select all that apply)
*
White
Black/African American
American Indian/Alaskam
Asian/Pacific Islander
Required
Has your child received any of these services?
Early Ed/PreK
Speech/Language Therapy
IEP Services
Social and Emotional Services
Migrant Education
504 Services
Other
Please describe any concerns you have about your child?
Your answer
Parent 1 Name
*
Your answer
Parent 1 Street Address
*
Your answer
Parent 1 City
*
Your answer
Parent 1 Phone Number
*
Your answer
Address where Legal Parent 1 pays rent or taxes
*
Your answer
Parent 2 Name
Your answer
Parent 2 Street Address
Your answer
Parent 2 City
Your answer
Parent 2 Phone Number
Your answer
Address where Legal Parent 2 pays rent or taxes
Your answer
Where would you prefer that your child attend preschool?
*
Fairfield Center School
Northwest Technical Center (Curiosity Corners)
Saint Albans City School
Saint Albans Town School
No Preference
Undecided
Prequalified Partner Site (Please list name below in "other" line)
Other:
Required
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