Valley Springs School District

Please Fill Out The Kindergarten Pre-Enrollment Form 2020-2021 Below

Student Information

Child's Legal First Name

Child's Middle Name

Child's Legal Last Name

Child's Preferred Name

Date of Birth:

Gender

Female

Male

Social Security #

Ethnic Group:

Caucasian

Black

Hispanic

Asian

Native American

Multi-Racial

Special Education:

Yes

ESL:

Yes

If Yes, what is the Native Language:

Home Street Address

Apt. #

City

Zip Code

Phone Number

Mailing Address (if different than home address)

Parent Information

Mother's First and Last Name

Mother's Cell Phone

Mom's Email Address

Mother's Place of Employment

Mother's Work Phone

Father's First and Last Name

Father's Cell Phone

Dad's Email Address

Father's Place of Employment

Father's Work Phone

Student resides with:

Both Parents

Mother

Father

Other

If Other, Name and Relationship:

If student resides with only one parent, do you have legal custody documentation?

Yes

Do the parents/guardians reside in the Valley Springs School Distict ?

Yes

If no, have you submitted a school choice form? (must be turned in by May 1)

Yes

Guardian Information if applicable

Guardian's First and Last Name (if applicable)

Guardian's Cell Phone

Guardian's Email Address

Guardian's Place of Employment

Guardian's Work Phone

Pre-School Program Information

Arkansas Better Chance (ABC, includes Little Red Schoolhouse)

Early Childhood Special Education

Head Start

Preschool (Private or Public)

Did not attend preschool

Other

List name and grade of siblings

Emergency Contact Information

Emergency Contact First and Last Name

Emergency Contact (Phone Number):

Relationship to Child:

Email a copy to

optional

Required Fields

Kindergarten Pre-Enrollment Form 2020-2021

2020 -2021 Kindergarten Pre-Enrollment Form