Rebel Kids Care & Early Childhood Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is to be used by families whose children are 3, 4 and 5 years old and those students who are not starting Kindergarten in the 2023-2024 school year. If you are wanting to "request" your student to be in Rebel Kids Care and/or Early Childhood classes, please complete this form. One form per child.

Rebel Kids Care Childcare & Early Childhood: Students must be toilet trained.

Early Childhood: To participate in the following programs, please see age requirements.

Terrific Tott's (3's): Must be 3 by 9/1/2023

School Readiness: Must be 4 by 9/1/2023

Registration is not confirmed until you receive confirmation from the Community Education Office. Once you receive confirmation that we have room for your student, we will send you the enrollment forms and additional information.

If you have any questions, please contact Tracy Tollefson at 218-477-6805 or Sarah Iwen at 218-477-6870.

Email *

Student First and Last Name *

Student Birthdate *

YYYY

Student Age for 2023-2024 School Year

3 years old (by 9/1/23)

4 years old (by 9/1/23)

5 years old (not starting Kindergarten in Fall 2023)

Clear selection

Student Address *

City *

State *

Zip *

Parent First and Last Name *

Parent Address *

City *

State *

Zip *

Parent Email *

Program Requesting *

Rebel Kids Care Only - All Day

Rebel Kids Care Morning Session and Early Childhood Morning Session

Rebel Kids Care Morning Session, Early Childhood Morning Session, and Rebel Kids Care Afternoon Session

Early Childhood - Morning Only

Early Childhood - Afternoon Only

Early Childhood Morning Session and Rebel Kids Care Afternoon

Early Childhood Afternoon Session and Rebel Kids Care Afternoon Session

Parent/Child Evening Class

Required

Has your child participated in Early Childhood classes previously at DGF? *

Yes

Each child brings their own uniqueness to the program. If your child receives services through Special Education or an outside agency, or has a behavior plan developed, please contact Tracy Tollefson at 218-477-6805 or dgfcommunityeducation@dgf.k12.mn.us. A meeting will need to be set up with you to do an individualized assessment regarding your request to have your child participate in Rebel Kids Care and/or Early Childhood classes. This meeting will determine if Rebel Kids Care and/or Early Childhood is an appropriate and safe setting for your child to succeed. The child’s start date may be delayed depending on the number or staff available with the skill-set necessary to meet the needs of your child.
*

My child receives Special Education services

My child does not receive Special Education services

My child does not receive Special Education services but is being evaluated at this time.

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

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Dilworth Glyndon Felton School District 2164. Report Abuse

Forms