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4k Registration Survey
Hello!! Any child who will be 4-years-old by September 1st and plans to enroll in 4K should complete this survey or call Melissa in the elementary office at 608-627-0107 by March 1st, 2021. This is an important first step for families to ensure they are connected with the School District of Kickapoo and to help prepare children for their educational journey.
With the information you provide, we will be able to contact you directly.
Valuable information will also be posted on our website.
Children will participate in a variety of play based assessments with the current 4K staff as well as receive a vision and hearing screening during our summer school session offered in June.
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Email
*
Your email
Child's first and last name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
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Parent/Guardian
Your answer
Phone Number
Your answer
Address
Your answer
Email Address
Your answer
Where does the child spend the majority of the day?
Child's home
In Home Child Care/ Daycare
Other
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Would you be interested in childcare provided at the school opposite of the 4K instructional program? (Students would attend half day 4K and half day childcare here at the school during school hours.)
Yes
No
Maybe
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Questions or concerns with your child's development?
Your answer
Does your child currently receive services (Speech, OT, PT, etc.) through a clinic, agency or hospital?
Yes
No
Maybe
Other:
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