2024/25 Preschool Registration

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ADDITIONAL REGISTRATION INFORMATION:

1. Registration is ONLY valid when your NON-REFUNDABLE $35 (per child) registration fee is received within 7 days of your online registration. Your registration will remain PENDING until the registration fee is paid. You will receive a CONFIRMATION email after your registration is received by our office.

2. Registration Fee Accepted:

- pay online via My School Bucks

- drop off cash or check at Jacobson Elementary during school hours (M-F 8:00am - 4:00pm)
- mail check (Payable to Rush City Schools):
Rush City Early Childhood
95 S. Harte Ave, PO Box 566
Rush City, MN 55069

3. You must complete a separate registration form for EACH child you are registering.

I would like to register my child for the following class: *

4-year-old THREE Full Days - Monday, Tuesday, and Thursday (Child must turn four prior to September 1st, 2024) Transportation is available before and after school.

4-year-old TWO Full Day class - Monday & Wednesday (Child must turn four prior to September 1st, 2024.) Transportation is available before and after school.

3-year-old Session B : 10:15 - 12:15 Tuesday and Thursday - (Child must turn three prior to September 1st, 2024.) Transportation is not available.

Student's Last Name *

Student's First & Middle Name *

Child's Nickname (if applicable)

Student's Gender *

Male

Female

Student's Date of Birth *

YYYY

Student's Primary Physical Address *

Student's Mailing Address (If different than physical address)

Mother's First & Last Name *

Mother's Primary Phone Number *

Mother's Email Address *

Mother's Address (*if different than child)

Father's First & Last Name *

Father's Primary Phone Number *

Father's Email Address *

Father's Address (*if different than child)

Person completing this form: *

YOUR date of birth:

MN Department of Education requires we ask for this information, you may decline to provide it.

YYYY

What is your highest level of school completed?

You may decline to provide this information.

Household total yearly income (including farm income, child support/alimony, pension, retirement, disability, unemployment, and veterans benefits).

You may decline to provide this information.

How many people live in your household?

You may decline to provide this information

Under the Federal Every Student Succeeds Act, the Minnesota Department of Education (MDE) is required to report MCA and MTAS proficiency data for students with parents/guardians on active duty.

Are you on active duty?

Yes (Active Duty)

Yes (Reserve)

Decline to answer

If you answered yes, what date did you start?

YYYY

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