Kindergarten, 1st, 2nd, and 3rd Grade Pre-Registration Form
Complete the information below for each of your children entering Kindergarten, 1st, 2nd, and/or 3rd Grade.

Schedule the necessary physical, dental, and/or eye exams as soon as possible. You can get forms that need to be filled out at the links below or from your healthcare provider.

PHYSICAL FORM:
https://dph.illinois.gov/content/dam/soi/en/web/idph/files/forms/certificate-ofchild-health-examination-03032017.pdf 

EYE EXAMINATION:
http://www.idph.state.il.us/HealthWellness/EyeExamReport.pdf

PROOF OF SCHOOL DENTAL EXAMINATION FORM:
http://www.idph.state.il.us/HealthWellness/oralhlth/DentalExamProof10.pdf


THE PHYSICAL WITH UPDATED IMMUNIZATIONS AND VISION FORMS MUST BE TURNED IN BY SEPTEMBER 1, 2022.

A certified birth certificate (with a raised seal) turned in to the Washington School Office by May 27,2022 or to the Unit Office after that date.

Sign up below for a time to bring the required forms and certified birth certificate to Washington School:
 https://www.signupgenius.com/go/10c0f44a5a92ea5fcce9-preregistration







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Email *
Student's first name *
Student's middle name (Type "None" if they don't have one.) *
Student's last name. *
Name preferred to be called at school: (i.e. Matt instead of Matthew)
Grade in School for the 2022-2023 School Year
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Gender: *
Birth date: *
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Current Age: *
Student's place in family/birth order (not counting parents) *
How many brothers, and what are their ages? *
How many sisters, and what are their ages? *
Child lives with: *
If parents are divorced, who has legal custody? (N/A if parents are not divorced.) *
List preschool(s) attended. (If out of town please include an address.) *
List where incoming 1st-3rd graders attended school for the 2021-2022 school year. (If out of town please include an address.)
Is your child right handed or left handed? Add any comments to explain if needed. *
What is your child's favorite recreation? *
What kind of trips has your child been on? *
What kind of corrective behavior strategies do you use at home? (i.e. time out, loss of privileges, etc.) *
What kind of responsibilities are required of your child at home? *
Check mark any behavioral characteristics that describe your child...... *
Required
Describe your child's interactions with books. *
Describe your child's writing/drawing skills (attempting to write his/her name, writing some words, drawing with a crayon or pencil, etc.) *
Please describe any medical conditions your child may have. (Allergies, Attention, Hearing, Vision, Speech, Physical Handicaps, Anxieties/Fears, Family history of learning difficulties, Hyperactivity, and any others that you would like to share.) *
Has your child received any services from a professional for any of the conditions that you described in the question above (such as OT,PT, Speech/Hearing Therapist, or Counselor)? *
Additional Comments (Please indicate any information you feel will help us get to know your child better and how to meet his/her needs in school, i.e. he has had preschool with the same group of people for 2 years, please separate him from Bill and Johnny or we live next to Susie and Sally, Please do not put them in the same class so that my child can make new friends):
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