KINDERGARTEN REGISTRATION SURVEY FOR 2012-2013 SCHOOL YEAR

My child will be entering Kindergarten in September 2012.

Child’s Name     Date of Birth   

Street address and City

Phone

(Day) 

(Evening) 

(Cell) 

Babysitter/Preschool 

Father’s First and Last Name    

Mother’s First and Last Name 

Who does the child live with (i.e. Mother, Father, Both parents) ?