Exit this survey Kindergarten Registration Survey 1. Welcome to the Burlington School District! We want to find out more children age 5 and under who will be entering our schools in the future. Please fill out this survey to help us plan. We look forward to seeing you at school! Question Title * 1. Please tell us how to reach you. ( * required ) Name * * Address * * Address 2: City/Town * * State * * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number * * Question Title * 2. Please tell us the name and birthday (month, day and year) of your children who are not yet enrolled in kindergarten. Name of Child/Date of Birth Name of Child/Date of Birth Name of Child/Date of Birth Name of Child/Date of Birth Name of Child/Date of Birth Question Title * 3. Please tell us which school you live closest to: Champlain Elementary (Pine Street) Edmunds Elementary (Main Street) Integrated Arts Academy (Archibald Street) Sustainability Academy (North Street) Flynn Elementary (North Avenue) CP Smith Elementary (Ethan Allen Parkway) Thank you for completing this survey. You can find out more information about all of our schools at http://www.bsdvt.org. If you have a child ready to be enrolled for 2011-2012, be sure to register your before March 17! Forms are available at each local school, the district office, and on our website at www.bsdvt.org. Done