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2022-23 Roseville Area Schools Pre-K Registration
Complete one form per child.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Middle Name
Your answer
Child's Last Name
*
Your answer
Gender
*
Male
Female
Other:
Race/Ethnicity- please select all that apply
*
American Indian
Asian
Black/African-American
Latino
White
Pacific Islander or Native to Hawaiian
Prefer not to answer
Required
Birthdate
*
MM
/
DD
/
YYYY
Age on September 1, 2022
*
Your answer
Street Address, Apt #
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Primary language spoken at home
*
Your answer
Do you need an interpreter?
*
Yes
No
Special Health Concerns (accommodations, allergies, dietary restrictions, or special needs we should be aware of)
*
Yes (please explain in the next section)
No
My child has the following Special Health Concerns. If they do not have any, please write NA
*
Your answer
Is your child receiving ESCE services or have an IEP? Please write Yes or No. If yes, what is your child's disability?
*
Your answer
Has your child completed an early childhood screening? Please write yes or no. If yes, when and where? If the screening was completed outside of Roseville Area Schools, please provide a copy of the summary.
*
Your answer
Who does your child live with? (check all that apply)
*
Mom
Dad
Step mother
Step father
Grandparents
Foster Parents
Required
Are you interested in volunteering?
No
Yes-in my child's class
Yes- on the Advisory Council (more to come)
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