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VALLEY SPRINGS SCHOOL DISTRICT
VALLEY SPRINGS SCHOOL DISTRICT
VALLEY SPRINGS SCHOOL DISTRICT
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Elementary School
Kindergarten Pre-Enrollment Form 2020-2021
Kindergarten Pre-Enrollment Form 2020-2021
2020 -2021 Kindergarten Pre-Enrollment Form
Please Fill Out The Kindergarten Pre-Enrollment Form 2020-2021 Below
Student Information
Child's Legal First Name
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Child's Middle Name
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Child's Legal Last Name
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Child's Preferred Name
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Date of Birth:
Calendar
Gender
Female
Male
Social Security #
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Ethnic Group:
Caucasian
Black
Hispanic
Asian
Native American
Multi-Racial
Special Education:
No
Yes
ESL:
No
Yes
If Yes, what is the Native Language:
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Home Street Address
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Apt. #
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City
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Zip Code
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Phone Number
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Mailing Address (if different than home address)
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Parent Information
Mother's First and Last Name
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Mother's Cell Phone
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Mom's Email Address
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Mother's Place of Employment
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Mother's Work Phone
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Father's First and Last Name
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Father's Cell Phone
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Dad's Email Address
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Father's Place of Employment
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Father's Work Phone
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Student resides with:
Both Parents
Mother
Father
Other
Other
If Other, Name and Relationship:
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If student resides with only one parent, do you have legal custody documentation?
No
Yes
Do the parents/guardians reside in the Valley Springs School Distict ?
Yes
No
If no, have you submitted a school choice form? (must be turned in by May 1)
Yes
No
Guardian Information if applicable
Guardian's First and Last Name (if applicable)
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Guardian's Cell Phone
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Guardian's Email Address
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Guardian's Place of Employment
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Guardian's Work Phone
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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
Other
List name and grade of siblings
Emergency Contact Information
Emergency Contact First and Last Name
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Emergency Contact (Phone Number):
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Relationship to Child:
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