Garden Plain Elementary School

Please Fill Out The Preschool Student Data Form Below

Child's First Name

Child's Middle Name

Child's Last Name

Child's Preferred Name

Gender

Reaquired field: Female

Reaquired field: Male

Date of Birth:

Hispanic/Latino?

Reaquired field: Yes

Reaquired field: No

Race (check all that apply)

Reaquired field: American Indian or Alaska Native

Reaquired field: Asian

Reaquired field: Black or African American

Reaquired field: Native Hawaiian/Pac. Islander

Reaquired field: White

Please list older siblings in K-8

Please list the last school your child attended

Does this student have an IEP?

Reaquired field: Yes

Reaquired field: No

Child resides with:

Reaquired field: Both Parents

Reaquired field: Mother

Reaquired field: Father

Reaquired field: Other

Mother's First and Last Name

Reaquired field: Mother's Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Home Phone if available

Mother's Cell Phone:

Mother's Email:

Mother's Place of Employment

Mother's Work Phone:

Father's First and Last Name

Father's Address if different than Mother's address:

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Father's Cell Phone:

Father's Email Address:

Father's Place of Employment

Father's Work Phone:

Emergency Contact #1 First & Last Name (if parents are unavailable):

Emergency Contact #1 Phone Number:

Emergency Contact #1 Relationship

Grandmother

Grandfather

Sibling

Daycare

Relative

Other

Emergency Contact #2 First & Last Name (if parents are unavailable):

Emergency Contact #2 Phone Number:

Email a copy to

optional

Required Fields

Garden Plain Elementary

Preschool Student Data Form

GARDEN PLAIN KINDERGARTEN

2024-25 Student Data Form