PHCS Kindergarten Registration (2024-2025)

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Kindergarten Registration:

Parishville-Hopkinton Central School is planning for the 2024-2025 school year. Please fill out this form if you have a student that will be Kindergarten age and joining our school this Fall.

If your child is a UPK student at Parishville-Hopkinton you DO NOT need to fill out this form.

If your child is a Head Start student at Parishville-Hopkinton you DO ned to fill out this form.

Registration is for children who will be 5 years old by December 1, 2024.

A student's primary address must be within the Parishville-Hopkinton School District.

Please complete applications by May 1, 2024.

Requirements/Materials Needed:

Copy of Birth Certificate

Copy of updated shot records and physical

Copy of Proof of Residency

Child must be 5 years old by December 1, 2024 to register

Email *

Student Last Name: *

Student First Name: *

Date of Birth: *

YYYY

Current Age: *

Gender: *

Male

Female

Place of Birth: *

Race: *

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Name of Parent/Guardian #1 *

Receives Mailing: *

Yes

Home Address: *

Mailing Address (if different from home) *

Phone Number for Contact Person #1 *

Email for Contact Person #1 *

Place of Employment: *

Name of Parent/Guardian #2 *

Receives Mailings *

Yes

Home Address: *

Mailing Address (if different from home) *

Phone for Contact Person #2 *

Email for Contact Person #2 *

Place of Employment *

Who lives with this child in his/her primary household? Please include all adults, children and/ or sibling's first and last names, along with ages.
*

Does your child spend a significant amount of time in another household?
*

Yes

If yes, please explain.

Emergency Contact #1:
*

Emergency Contact #1 Phone Number:
*

Emergency Contact #1 Relationship to Student:
*

Emergency Contact #1 Can pick up child?
*

Yes

Emergency Contact #2:
*

Emergency Contact #2 Phone Number:
*

Emergency Contact #2 Relationship to Student:
*

Emergency Contact #2 Can pick up child?
*

Yes

Do you have any concerns regarding your child's health or development (i.e., speech, vision, hearing, or physical needs)(please check all that apply).
*

speech

vision

hearing

physical needs

n/a

Required

Child's Doctor: Name & Address:
*

Were there any issues during pregnancy, labor and/or delivery for your child?
*

Did your child meet all developmental milestones on time? (crawling, speaking, walking, etc)
*

Does your child have any ongoing health concerns? (asthma, diabetes, etc.)
*

YES

If your child has any ongoing health concerns, please explain.
*

Does your child have any allergies?
*

Yes

If your child has any allergies, please list and explain.

Has the allergy required emergency treatment?
*

Yes

If yes to above, please explain.

Are your child's immunizations up to date? (Up to date immunizations are required for ALL students before they are permitted to start school in New York State.)
*

Yes

Is there history of any hospitalizations, significant injuries, or surgery?
*

Does your child take any medication regularly at home?
*

Yes

If your child takes any medication regularly at home, please provide the name and purpose of medication(s).

Will your child require medication during the school day?
*

Yes

Are there any current medical concerns/issues you would like to discuss with the school nurse?
*

Are there any issues in the home that might affect your child's learning?
*

Do you have concerns about your child's eating habits?
*

Does your child receive any support services?
*

Do you have any concerns about recent occurrences in your family (i.e., recent move, new sibling(s) separation of parents, etc)
*

My child has an active Individualized Education Plan (IEP) from a previous district.
*

Yes

Has your child previously received Special Education services in the past?
*

Yes

Does your child have an active 504 Plan from a previous school district?
*

Yes

Has your child had a 504 Plan in the past?
*

Yes

If your child has/had 504 Plan or an IEP, please explain.

Child resides with:
*

I have provided the Parishville-Hopkinton Central School District with the most recent custody documents and will continue to provide the district with any updates or changes that are made to these documents in the future.
*

Yes

N/A

I have NOT provided Parishville-Hopkinton Central School District with custody documents and am aware that both parents on my child(ren)'s birth certificate will have the same legal parental rights until I present the district with such custody papers stating contrary.
*

Yes

N/A

Residency: Please choose your living arrangements.
*

Permanent Housing

Temporary Living Arrangement

In a hotel/motel, shelter, or moving place to place

With another family or other person

In a place not designated for ordinary sleeping accommodations

If you checked off other than permanent housing: Would you like to meet with our Homeless Liaison to discuss services you may be eligible to receive?
*

Yes

What language(s) is(are) spoken in the student's home? Please list all languages.
*

What was the first language your child learned?
*

What is the primary language of each parent/guardian?
*

Is there anything else you think is important for the school to know about your child?
*

Send me a copy of my responses.

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