Registration

Registration

1.     Complete the Student Information Form, Health History Form, Student Transition Form, and Income Verification Form.

2.     Take a picture of your child’s Birth Certificate, Shot Record, and Pay Stub/Tax Forms and email it to rhpreschoolregistration@rockhill.org.

***If your child attended RH Preschool last year we do not need a copy of  Birth Certificate or shot record unless they have recently gotten new shots.

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* 1. Last Name

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* 2. NAME SUFFIX (e.g. Jr., I, II, III)

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* 3. First Name

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* 4. Middle Name

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* 5. Address

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* 6. Parent/ Guardian Name

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* 7. Relation to Student

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* 8. Mothers's Maiden Name

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* 9. Sex

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* 10. Ethnic Code

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* 11. Native Language

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* 12. Birthdate

Date

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* 13. Birthplace

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* 14. Social Security Number

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* 15. Do you live in the Rock Hill Local School District

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* 16. Are you the legal guardian of the student

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* 17. Does your child have an IEP

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* 18. Does your child have a 504

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* 19. Student Health Conditions

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* 20. Please explain and conditions above or any reason for hospitalization

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* 21. Please indicate any allergies your child might have including reactions along with restrictions or recommended actions

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* 22. Please list any medication that your child takes on a regular basis, please identify the medication, time and reason.

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* 23. Do any health and/or medical conditions require school restrictions, modifications, and/or intervention?

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* 24. Does the student require any special procedures and/or treatments for their health condition

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* 25. Please indicate any other information about your child's health or development that you think would be helpful for the school to know:

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* 26. What is your gross household income? (proof of income will need to be submitted)

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* 27. Is your income

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* 28. How many people are in your household?

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* 29. How well does your child manage change?

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* 30. Are there times of the day that are consistently troublesome for your child? (Rest time, lunch/snack time, drop off/ pick- up etc)?

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* 31. Would peer support from another child be beneficial in helping support your child with transitions?

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* 32. Please provide any additional information not included above regarding any issues/concerns you may have for your child and their transitions:

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* 33. Form Complete By

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* 34. Relationship to the Student

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* 35. Today's date

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