SES Kindergarten Pre-Registration
THIS APPLICATION IS FOR STUDENTS ENTERING KINDERGARTEN FOR THE 2022-2023 SCHOOL YEAR.

This form is designed to collect basic information as a starting point, we will contact you to collect more information in the near future.

In order for your child's registration to be complete, please email copies of the requested information to alicia.skipper@southsideschools.org or bring it by the Elementary Office between the hours of 8:00am - 4:00pm.

*Copy of birth certificate
*Copy of social security card
*Updated immunization record
*Physical from doctor (before school begins in August)

If you have issues or questions, please contact Southside Elementary at 870-251-2661
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Child's Last Name *
Child's First Name *
Child's Middle Name *
Gender
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Date of Birth *
Student must be 5 years old on or before August 1st, 2021.
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Age *
Primary Language Spoken by Child at Home *
Physical Address - Street Number and Name *
Physical Address - Apt/Lot Number
Physical Address - City/State *
Physical Address - Zip Code *
Mailing Address - If different from Physical Address listed above.
Guardian/Mother Name *
Guardian/Mother Contact Phone Number *
Guardian/Mother's Email Address *
Guardian/Father Name *
Guardian/Father Contact Phone Number *
Guardian/Father's Email Address *
Please check if your child is in any of the following:
Did/Does your child attend an Early Childhood Education program (preschool, abc, etc)?
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If yes, where did your child attend?
Are there any custody issues?
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If yes, please explain.
If this child is a dependent of an active or reserve member of a branch of the United States Armed Services?
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If this child resides in a household with an active or reserve member of a branch of the United States Armed Service, please select the branch below:
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Child's Physician Name and Phone Number
Please list the first contact we can notify in case of emergency if you cannot be reached.
Please list the second contact we can notify in case of emergency if you cannot be reached.
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