IT IS VERY IMPORTANT THAT YOUR CHILD

ATTENDS KINDERGARTEN ROUNDUP!

KINDERGARTEN ENROLLMENT FORM

1. Child’s Full Legal Name (as it appears on their birth certificate):

______________________________________________________________________________

First Middle Last

2. Date of Birth: _______________________________ (month/day/year)

3. Male __________ Female __________

4. City of Birth: _________________________

5. Social Security #: ___________________________________ (must have to register)

6. Address: ___________________________________________________________________

7. City: __________________

8. Zip: __________ (proof of residency is required for elementary school)

9. Home Phone #: ___________________________________

10. Cell Phone #: ___________________________________

11. Father’s Name: ___________________________________

12. Mother’s Name: ___________________________________

13. Mother’s Maiden Name: ___________________________________

14. Does child reside with both parents? Yes ______ No______

15. Who is the custodial parent? ___________________________________

16. Do you have legal custody papers? Yes ______ No______*

*Please provide us with a copy of these papers.

17. Did your child attend pre-school? Yes ______ No______

18. Name of pre-school: ___________________________________

19. How long? ______

20. Do you or your child currently work with a caseworker or counselor? Yes _____ No_____

21. What agency? ___________________________________

22. Is your child currently on an IEP? Yes _____ No_____

If Yes, Please Explain: ___________________________________________________________

PLEASE RETURN THIS COMPLETED FORM TO THE SCHOOL OFFICE