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UNITED PUBLIC SCHOOL DISTRICT 7
DES LACS - BURLINGTON SCHOOLS
Kindergarten Registration Form
STUDENT INFORMATION
Legal First Name
*
Legal Middle Name
Legal Last Name
*
Birthdate (Must be age 5 by July 31)
*
Gender
*
Female
Male
Street Address
*
PO Box
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Primary Phone Number
*
Email Address
*
Is this child Hispanic/Latino?
*
Yes
No
Please choose the child's race:
*
American Indian/Alaska Native
Asian
Black/African American
Caucasian/White
Native Hawaiian/Pacific Islander
Other
Name of Parent/Guardian 1
*
Resides With
*
Yes
No
Guardian's Employer
*
Daytime Phone / Work Number
*
Cell Phone
*
Email Address
*
Name of Parent/Guardian 2
Resides With
Yes
No
Guardian's Employer
Daytime Phone / Work Number
Cell Phone
Email Address
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