EHPS Kinder Cubs Application 2022-2023
Applications are required for the 2022-2023 Eastgate Elementary Kinder Cub program.  A completed form does not necessarily guarantee acceptance into the program.  Parents will be notified when the selection process has completed.


Sign in to Google to save your progress. Learn more
Email *
Student First Name *
Student Middle Name *
Student Last Name *
Student Nickname (Name students goes by, Ex: Beth for Elizabeth)
Student Gender *
Student Date of Birth *
MM
/
DD
/
YYYY
Physical Street Address *
City *
State *
Zip Code *
Home Phone  (Example: 406-227-1234) *
Mailing Address *
Mailing City *
Mailing State *
Mailing Zip *
Father's Full Name *
Father's Day Phone  (Example: 406-227-1234)
Father's Home Phone  (Example: 406-227-1234) *
Mother's Full Name *
Mother's Day Phone  (Example: 406-227-1234)
Mother's Home Phone  (Example: 406-227-1234) *
Emergency Contact 1 Name *
Emergency Contact 1 Relationship *
Emergency Contact 1 Phone Type
Clear selection
Emergency Contact 1 Phone  (Example: 406-227-1234) *
Emergency Contact 2 Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone Type
Clear selection
Emergency Contact 2 Phone  (Example: 406-227-1234)
Parent e-mail Address *
Child lives with: *
If previous answer Other, please describe:
Other Sibling(s) in the District? If Yes, please include full name(s).
State and Federal Required Information
Is the student Hispanic or Latino? *
What is the student's race? *
Is your child's first learned language or home language anything OTHER than English? *
Is student on a Special Education IEP? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of East Helena Public Schools. Report Abuse
Google Forms