Initial Enrollment Form 25/26

Initial Enrollment Form 2025-2026

Please complete as thoroughly as possible. Additional paperwork will be required to complete registration.
STUDENT INFORMATION
Student's Full Name:*

First NameMiddle Name (Optional)Last NameSuffix
Sex:*

MaleFemale
Date of Birth:*

MonthDayYear
Date
Grade Entering:*

KindergartenFirstSecondThirdFourthFifthSixthSeventhEighth
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
ONLY MILITARY FAMILIES NEED TO FILL OUT THIS SECTION (Check If Yes):

Is the student a dependent of a member of the United States military service in the Active Duty (Army, Navy, Air Force, Marine Corps, or Coast Guard)?Is the student a dependent of a full time member of the National Guard or Reserve force of the United States Military (Army, Navy, Marine Corps, or Air Force)?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)?
By signing, I acknowledge that the information above is correct and I have legal authorization to enroll the child.
Parent / Guardian Signature:*

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Date*

MonthDayYear
Date
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Initial Enrollment Form 2025-2026