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Memorial Kindergarten Preregistration 2020
Please complete and submit the information below by May 1, 2020. Your preregistration information will help us make staffing determinations as well as provide us with the opportunity to begin the registration process for your incoming kindergarten child.
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* Indicates required question
STUDENT’s Last Name
*
Your answer
STUDENT’s First Name
*
Your answer
Preferred Name
Your answer
Gender
*
Female
Male
Student’s Date of Birth: Student must be 5 years old prior to August 1, 2020 to attend kindergarten.
*
MM
/
DD
/
YYYY
Ethnicity (Check all that apply)
*
Black
White
Native American
Asian
Hawaiian
Hispanic
Required
Student’s House Number (Example: 675)
*
Your answer
Student’s Street Name (Example: Franklin St, please use abbreviation Ave, Cir, Ct, Dr, Ln, Pkwy, Pl, Rd, St, Ter)
*
Your answer
Apartment (Example: 1/A)
Your answer
Student’s Zip Code
*
46383
46385
Student’s Primary Contact Number (Enter Primary Contact Number in this format: 219-531-3000)
*
Your answer
Student’s Primary Contact Number Phone Type
Cell
Landline
Clear selection
Name of primary contact for student
*
Your answer
Relationship of primary contact for student
Your answer
Guardian 1 Last Name
*
Your answer
Guardian 1 First Name
*
Your answer
Guardian 1 Contact Number (Enter Number in this format: 219-531-3000)
*
Your answer
Select Guardian 1 Contact Number Phone Type
*
Cell
Landline
Guardian 1 Address
Your answer
Guardian 1 Email
*
Your answer
Guardian 2 Last Name
Your answer
Guardian 2 First Name
Your answer
Guardian 2 Contact Number (Enter Primary Number in this format: 219-531-3000)
Your answer
Select Guardian 2 Contact Number Phone Type
Cell
Landline
Clear selection
Guardian 2 Address
Your answer
Guardian 2 Email
Your answer
Has your child been evaluated or is he or she being evaluated for special education services through Porter County Educational Services (SELF) or another public agency?
*
Yes
No
I don’t know
Is your child currently receiving special education services through an Individualized Education Plan (IEP) or an ISP (Individualized Services Plan)?
*
Yes
No
I don’t know
List all names of siblings attending Valparaiso Community Schools
Your answer
Has your child attended preschool?
*
Yes
No
If your child has attended preschool, what is the name of the preschool your child attended?
Your answer
If your child attended preschool, how long did your child attend preschool?
1 year
2 years
3 or more
Clear selection
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