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Brookdale Kindergarten Information Sheet
Complete this form for students who will be entering kindergarten in the 2021-2022 school year.
( Child must be the age of 5 on or before September 1, 2021)
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* Indicates required question
Email
*
Your email
Legal Student First Name
*
Your answer
Student Middle Name
Your answer
Student Last Name
Your answer
Gender
Female
Male
Prefer not to say
Clear selection
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian First and Last Name
*
Your answer
Current Address
*
Your answer
Subdivision
Your answer
Phone Number
*
Your answer
Primary language spoken in the home
*
Your answer
Race/Ethnicity
*
Hispanic or Latino
American Indian or Alaskan Native
Asian
Black/African American
Native Hawaiian or other Pacific Islander
White
Did your child attend preschool?
*
Yes
No
If yes, name of preschool attended
Your answer
Do you have other children attending D204?
*
Yes
No
If yes, what school are they attending?
Your answer
Health concerns, other services needed, or any additional information you wish to share:
*
Your answer
A copy of your responses will be emailed to the address you provided.
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