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EK/K Registration Form
* Indicates required question
Email
*
Your email
Student’s Legal Full Name:
Your answer
Student’s Date of Birth:
MM
/
DD
/
YYYY
Student’s Age:
Your answer
Student’s Address:
Your answer
Student’s Sex:
Your answer
Student Resides With:
Mother and Father
Mother
Father
Other:
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Mother’s Name:
Your answer
Mother’s Address:
Your answer
Mother's Marital Status
Single
Married to Student's Father
Married
Other:
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Mother’s Phone:
Your answer
Mother’s Email:
Your answer
Mother’s Employer:
Your answer
Father’s Name:
Your answer
Father’s Address:
Your answer
Father's Marital Status
Single
Married to Student's Mother
Married
Other:
Clear selection
Father’s Phone:
Your answer
Father’s Email:
Your answer
Father’s Employer:
Your answer
Family’s Preference of Student’s Placement: *Please keep in consideration, the Kindergarten Board will provide an educated recommendation at the time of your child’s screening.*
Early Kindergarten
Kindergarten
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Student’s Previous Education:
Pre-School
Pre-Kindergarten
Head Start
Other:
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Does your student receive any special services?
Speech
Occupational Therapy (O.T.)
Special Education for Learning Disability
Behavior Services
Other:
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Does your student have any medical issues or take any medication? If so, please explain.
Your answer
How will your child arrive to school?
*
Bus
Drop Off
Drop Off/Morning Daycare
Walk
Other:
If you selected bus, what is the address he/she will be picked up from?
*
Your answer
How will your child arrive at home?
*
Bus
Pick Up
Pick Up/After School Daycare
Walk
Other:
If you selected bus, what is the address he/she will be dropped off at?
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Submit
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