2023 - 2024 Kaleidoscope School Registration*

Kaleidoscope School Registration

2023 - 2024
Kaleidoscope School

16850 N. 16th Street Phoenix, AZ 85022

602-313-0917
Student Information
Name*

Last NameFirst NameMiddle NameSuffix
Sex*

MaleFemale
Arizona Revised Statute 15-821 states that a child enrolling in kindergarten must be five (5) years of age on or before August 31 of the current school year.
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Does your child require special education or have physical accommodations?*

YesNo
Please choose what type of special education.*

IEP504Other
Grade Entering*

KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh Grade
Name of the previous school the student attended and the last grade attended.*
How did you hear about Kaleidoscope School?*

FriendWebsiteAdvertisementOther
If you heard about Kaleidoscope School from a friend, please tell us who. We would like to thank that person.*
Parent/Guardian Information
Parent/Guardian 1*

First NameLast Name
Is your address the same as students?

Yes
Parent/Guardian 1 Street Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Mobile Phone*
Please enter a valid phone number.
Parent/Guardian 1 Work Phone*
Please enter a valid phone number.
Parent/Guardian 1 Occupation*
Parent/Guardian 2*

First NameLast Name
Is your address the same as above?

Yes
Parent/Guardian 2 Street Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian 2 Email*
example@example.com
Parent/Guardian 2 Mobile Phone*
Please enter a valid phone number.
Parent/Guardian 2 Work Phone
Please enter a valid phone number.
Parent/Guardian 2 Occupation
Siblings Name(s) and Age(s)
ONLY MILITARY FAMILIES NEED TO FILL OUT THIS SECTION
Is the student a dependent of a member of the Unites States military service in the Active Duty Army, Navy, Air Force, Marine Corps, or Coast Guard?

YesNo
Is the student a dependent of a fulltime member of the National Guard or Reserve force of the United States Military (Army, Navy, Marine Corps, or Air Force)?

YesNo
Is the student a dependent of a member of the National Guard, or Reserve force of the United States Military (Army, Navy, Marine Corps, or Air Force)?

YesNo
I hereby certify that I am a legal adult and a parent or legally appointed guardian of the student, and have the right to make decisions for the minor. I state further that I have read the above information.
Parent / Guardian Name*

First NameLast Name
My signature verifies that the information in the form is correct.*

Powered by Jotform Sign Clear
Date*

MonthDayYear
Date
Should be Empty: