4 Year-Old Pre-K Registration

Child's Name

Name Child Will Use

Date of Birth

Gender

Does your child have an IEP in place or in progress?

Is your child Open Enrolling (out of district)?

Mother's Name

Address

Address

City

State

Zip

Phone Number

E-mail Address

Education Level

Father's Name

Address

Address

City

State

Zip

Phone Number

E-mail Address

Education Level

You must submit a copy of your child's immunization record.

If an all day (four day/week) program were offered would you be interested?

Yes No

Send a copy of the completed form to this email address: