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23/24 Baltic School District Preschool Pre-Registration
Please fill out the following information for your preschool aged student. They will need to be three years old on or before September 1, 2023 to be eligible for Baltic's Preschool.
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* Indicates required question
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Gender
Male
Female
Clear selection
Child resides
in the Baltic School District
outside of the Baltic School District
Unsure
Clear selection
Preference ( This is NOT a guarantee, but we will accommodate as best we can.)
*
Morning Session (8:30 - 11:30, Mon-Thurs)
Afternoon Session (12:15 - 3:15, Mon- Thurs)
No Preference (Mon-Thurs)
Transportation:
*
I will provide transportation for my child both to and from preschool.
I would like my child to ride the regular district school bus: to the morning session OR home from the afternoon session.
I would like mid-day transportation provided (for a fee) either to OR from an in-town daycare.
Required
For middle of the day transportation my child would need to be picked up OR dropped off at the following in-town daycare (provide name & address):
Your answer
Will your child be eating school breakfast and/or lunch (for non-Headstart, current meal price will apply)?
Check all that apply
Yes, Breakfast (morning session only)
Yes, Lunch (morning session only)
No
Parent/Guardian #1 First and Last Name:
*
Your answer
Parent/Guardian #1 relationship to child:
*
Your answer
Parent/Guardian #1 Physical Address:
*
Your answer
Parent/Guardian #1 Mailing Address (if different than physical):
Your answer
Parent/Guardian #1 Cell Phone:
*
Your answer
Parent/Guardian #1 Email:
*
Your answer
Parent/Guardian #2 First and Last Name:
Your answer
Parent/Guardian #2 relationship to child:
Your answer
Parent/Guardian #2 Physical Address:
Your answer
Parent/Guardian #2 Mailing Address (if different than physical):
Your answer
Parent/Guardian #2 Cell Phone:
Your answer
Parent/Guardian #2 Email:
Your answer
Emergency Contact #1 First and Last Name:
*
Please provide 2 emergency contacts that you give permission to pick up your child and or notify if parent/guardian cannot be reached.
Your answer
Emergency Contact #1 Address:
*
Your answer
Emergency Contact #1 Phone Number:
*
Your answer
Emergency Contact #1 Relationship:
*
Your answer
Emergency Contact #2 First and Last Name:
Your answer
Emergency Contact #2 Address:
Your answer
Emergency Contact #2 Phone Number:
Your answer
Emergency Contact #2 Relationship:
Your answer
What has your child's daytime experience been up to this point:
Childcare center
In-home daycare
Home with caregiver
Other:
Headstart Information
I have completed a Headstart application and my child qualifies for Headstart.
I have completed a Headstart application and my child does not qualify for Headstart.
I have not completed a Headstart application but intend to do so.
I have not completed a Headstart application and have no intention to do so.
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This form was created inside of State of South Dakota K-12 Data Center.
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