The Gates Chili Central School District Birth to 5 years old Census Form
To our families with young children please complete this census form to help us plan for your future students. Fill it out twice, if you have more than 3 children birth to age 5.

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* 1. Parent/Guardian Information

Parent/Guardian Names

Address

City

State

Zipcode

Email Address

Phone Number with area code

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* 2. Child's Full Name:

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* 3. Birthdate:

Date

Date

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* 4. Gender

Male

Female

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* 5. Child's Full Name:

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* 6. Birthdate:

Date

Date

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* 7. Gender

Male

Female

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* 8. Child's Full Name:

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* 9. Birthdate:

Date

Date

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* 10. Gender

Male

Female