Pre-Registration Form 24-25

NC Pre-K Pre-Registration Form 2024-2025
STOP - PLEASE READ FIRST!!! This is not the NC Pre-K Application!!!

ONLY complete this form if you have submitted a NC Pre-K PAPER APPLICATION. If you submitted an online application, DO NOT complete this form. You can find the online application by visiting our website! For assistance please call 704-630-9085.
Child's Name*

First NameMiddle NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Gender*

MaleFemale
Is your child a twin/triplet?*

YesNo
Child Lives With:*

Both ParentsMotherFatherLegal Guardian or Custodian (must provide court order)Kinship Care (Relative without legal documents)Foster CareOther, please explain:
Contact Information
Physical Address*

Street Address

Street Address Line 2

City

Zip Code
Primary Phone Number*
Please enter a valid phone number.
Primary Email (an email address is required)*
example@example.com
Mother/Guardian Information

If the child does not live with mother/guardian please enter N/A.
Mother/Guardian's Name*

First NameLast Name
Father/Guardian Information

If the child does not live with father/guardian please enter N/A.
Father/Guardian's Name*

First NameLast Name
Additional Information About Your Household
Does your child have an IEP or IFSP?*

NoYes
Is your child currently receiving any specialized services?

NoYes, please explain:
Does your child have any chronic health concerns?*

NoYes, please explain:
Is English spoken in the home?*

No EnglishSome EnglishWe speak fluent English
Please list all languages spoken in the home:*
Site Selection

Refer to the FAQ document to learn how placement is handled.

Please pick your top 3 choices, for your NC Pre-K placement if eligible. *

	1st Choice	2nd Choice	3rd Choice
Select Facility

I give SSR permission to send me text notifications.*

YesNo
What do you think it means for your child to be ready for school?
How do you think you can help your child with the transition to kindergarten?
Parent or Legal Guardian's Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

NC Pre-K Pre-Registration Form 2024-2025

STOP - PLEASE READ FIRST!!! This is not the NC Pre-K Application!!!

Contact Information

Mother/Guardian Information

Father/Guardian Information

Additional Information About Your Household

Site Selection