FY25-Kinder Kickstart Interest Form

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The information collected in this form is confidential and will be utilized by Mat-Su Central staff only. Kinder Kickstart will be held at our Palmer Office, which is downtown across from the depot. By filling out this form you are letting us know you are interested in the program. Filling out this form does not automatically mean you will be accepted. This program prioritizes students that turn four years old before September 1st of 2024.

Email *

Child's First Name *

Child's Last Name *

Child's Age (as of September 1st, 2024) *

Child's Birthday (Child must be 4 by September 1st.) *

YYYY

Parent or Guardian Name *

Phone number *

Address *

My child is: *

Male

Female

My child is potty trained *

Yes

Please list any allergies your child might have. *

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