Please answer the questions as accurately as possible.

The collected information will be used for student registration and for communication to the parent.

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* 1. Parent's First Name

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* 2. Parent's Last Name

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* 3. Child's First Name

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* 4. Child's Last Name

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* 5. Child's gender

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* 6. Child's Street Address

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* 7. Child's City

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* 8. Child's Zip Code

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* 9. Parent Phone Number (Home)
(Please include the area code using this format: ###-###-####)

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* 10. Alternate Parent Phone Number (cell or work)
(Please include the area code using this format: ###-###-####)

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* 11. Emergency Contact Name and Phone Number

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* 12. Parent/Guardian Email Address

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* 13. Parent/Guardian Email Address
(optional additional email address)

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* 14. Child's Current Grade Level
(2018-2019 school year)

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* 15. School attending now

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* 16. Does your child require Special Education services?

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* 17. Does your child have health or medical concerns.

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* 18. Do you need latchkey services for your child?
(hourly rates apply). If you selected yes, you will need to register at the Administration Building before June 28th. Even if you registered for latchkey this school year, you will still need to register again.

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* 19. Do you need transportation services for your child?
(transportation is available for in-district students who live more than one mile from Kment Elementary)

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