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23/24 Kindergarten Enrollment Form

Required

Student Information:
Student's Name:required
First Name
Middle
Last Name
Must contain a date in M/D/YYYY format
This will be the primary number you use.
Genderrequired
Racerequired
Father/Legal Guardian Information:required
First Name
Last Name
Mother/Legal Guardian Information:required
First Name
Last Name
Are there any legal matters regarding custody of this student?required

If yes, please submit a copy to the school signed by a judge.  This will enable us to assure you of your child's safety.

First Middle and Last Name; Birth Date; Gender; Grade; School Attending (if applicable); Relationshi

In the event the parent/guardian cannot be reached, please list the names and daytime phone numbers of persons who are permitted to pick up your child and give temporary care for your child.  Your child will not be released to any person not listed below nor will they be dismissed froms school at any time without parent permission.  This includes 18 year olds or older living at the household.  Please list step parents, relatives, friends or neighbors who are available during the hours of 7:00 AM - 4:00 PM.  Please notify the school immediately in writing of any changes or modifications to information stated in this form.

 

Emergency Contact Information

1. Emergency ContactrequiredName: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo
First Name
Last Name
Name: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo
2. Emergency ContactrequiredName: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo
First Name
Last Name
Name: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo
3. Emergency ContactrequiredName: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo
First Name
Last Name
Name: Relationship to student; Phone # from 7 AM - 4 AM - please list all numbers including Home, Wo

Home Language Survey (Required by Law)

Most of the time, student: (Check one)requiredPlease select up to 6 choices
Please select up to 6 choices

Services Received and Medical Information

**** Students taking Medications are required to have the necessary paperwork on file.  Please obtain these forms from your child's school.

Please Check any medical conditions your child has:required
Submitter's Namerequired
First Name
Last Name
Must contain a date in M/D/YYYY format
All students must have the following on file: birth certificate, immunization, SS card, eye, dental, and physical exams. You will get a letter from Mrs Mindy in June for more information and forms!