Enrollment Form

Enrollment Form

2023-2024
STUDENT INFORMATION
Student's Full Name:*

Last NameMiddle NameFirst NameSuffix
Sex:*

MaleFemale
Date of Birth:*

MonthDayYear
Date
Grade Entering:*

KindergartenFirstSecondThirdFourthFifthSixthSeventh
Siblings Name(s) and Age(s):
Has your child ever been expelled?*

YesNo
Does your child require special education or need physical accomodations?

YesNo
How did you hear about Kaleidoscope School?*

FriendEventStreet SignageFlier/BrochureOther
Who can we thank for referring you?*
What was the event you attended?*
PARENT / GUARDIAN INFORMATION
Parent / Guardian 1 Name:*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Work Phone Number*
Parent / Guardian 2 Name:*

First NameLast Name
Email*
example@example.com
Is the address the same as parent / guardian 1?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number:*
Work Phone Number:*
Child primarily resides at:*

Parent / Guardian 1 addressParent / Guardian 2 addressBothOther
By signing, I acknowledge that the information above is correct and I have legal authorization to enroll the child.
Parent / Guardian Signature:*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty: