2019-2020 Little Cats Preschool Registration
Student's Legal Name
*
First Name
Middle Name
Last Name
Student's Birth Date:
*
Month/Date/Year
Student's Age on September 15, 2019
Student must be 4 years old by September 15, 2019
Birthplace:
Upload a copy of your child's birth certificate:
Browse Files
If you cannot upload a copy of your child's birth certificate, you may provide a copy to the Administration Office at 430 School Street in Carlisle.
Cancel
of
Student's Gender
*
Female
Male
Is the student Hispanic/Latino
*
Yes
No
Student Ethnicity Information:
*
American Indian or Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Primary Language Spoken at Home:
*
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Household Phone Number:
*
-
Area Code
Phone Number
Parent/Guardian #1 - Name
*
First Name
Last Name
Parent/Guardian #1 - Phone
*
-
Area Code
Phone Number
Parent/Guardian #1 - Email
*
example@example.com
Parent/Guardian #2 - Name
First Name
Last Name
Parent/Guardian #2 - Phone
-
Area Code
Phone Number
Parent/Guardian #2 - Email
example@example.com
Emergency Contact #1 - List someone other than a parent/guardian who can be contacted if parent is unavailable.
*
First Name
Last Name
Emergency Contact #1 - Phone Number
*
-
Area Code
Phone Number
Emergency Contact #1 - Relationship
*
Emergency Contact #2 - List someone other than a parent/guardian who can be contacted if parent is unavailable.
First Name
Last Name
Emergency Contact #2 - List someone other than a parent/guardian who can be contacted if parent is unavailable.
-
Area Code
Phone Number
Emergency Contact #2 - Relationship
Daycare Provider (if applicable):
Daycare Provide Phone (if applicable):
-
Area Code
Phone Number
Will your child use the District's transportation services?
Yes
No
Do you currently have an other students enrolled in the Carlisle Community School District?
Yes
No
Does your student have an Individual Education Plan (IEP)?
No
Yes
Does your student have a 504 Plan?
No
Yes
Insurance Information:
Little Cats Preschool is part of the Iowa Voluntary Preschool Program. One of the items we are requested to have in our Child Files is your child's current health information in case of a life threatening emergency. Please provide the following information:
Do you have health insurance for your child?
*
Yes
No
If yes, please provide your insurance carrier's name, policy number and the name of the insured:
Please upload your child's most recent immunization record:
Browse Files
You may also provide your child's immunization form to the Administration Office at 430 School Street in Carlisle.
Cancel
of
Carlisle Little Cats Preschool Consent:
Please note, you may withdraw your consent at any time.
My child may go on walks around the neighborhood with the preschool teacher.
*
Yes
No
Thank you for registering your child for Little Cats Preschool!
You will be contacted in early June with your child's session (AM/PM) and teacher information. If you did not upload your child's birth certificate and/or immunization form, please provide a copy to the school nurse by August 1. You can drop them off in the Administration Office at 430 School St. in Carlisle. If you have any questions, call 515-989-3589.
Submit
Should be Empty: