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Kindergarten New Student Enrollment 2022-2023
Student LAST name:
*
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Student FIRST name:
*
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Student MIDDLE name:
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Street Address
*
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City
*
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State
*
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Zip
*
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Primary Phone# (xxx)xxx-xxxx:
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Gender:
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- Choose -
Male
Female
Rather not say
Age:
*
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- Choose -
4
5
6
Date of Birth:
*
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Place of Birth (City, State):
*
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Is student of Hispanic/Latino culture or origin?
*
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Yes
No
Student's Primary Race (Select only one):
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- Choose -
American Indian
Asian
Black/African American
Pacific Islander
White/Caucasian
Race continued (select ALL that apply):
*
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American Indian
Asian
Black/African American
Pacific Islander
White/Caucasian
Student resides with (Select ALL that apply):
*
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Both parents
Mother
Father
Joint Custody
Legal Guardian
Foster Mother
Foster Father
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Kindergarten New Student Enrollment 2022-2023
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