2024-25 Preschool Pre-Enrollment Form

SAVANNA SCHOOL DISTRICT PRESCHOOL

2024-2025 Pre-Enrollment Form For B.R.I.G.H.T. Learners Academy
Student Information
Please visit the school boundaries link on this website to determine your child's school of residence (home school) prior to beginning the steps below.
Home School:*
Child's Full Name*

First NameMiddle NameLast NameSuffix
Birthdate*

MonthDayYear
Address*

Street Address Line 1

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name of Parent or Guardian who is completing this pre-enrollment registration. *

First NameLast Name
Relationship?*

FatherMotherGuardianFoster ParentOther
Phone Number of Parent or Guardian who is completing this pre-enrollment registration. *

Area CodePhone Number
Parent E-mail*

School Health Record
Does your child have any allergies/medical/health conditions that the preschool should know about? Failure to report allergies and medical conditions might delay child's start date.*

NoYes
Comments:

Income Survey
How many people are in your household?
What is your total monthly household income?

Special Services Survey
Does your child currently receive special services via an IEP?*

YesNo
If you answered yes, what special services does your child receive? Check all that apply.

Speech and LanguageSpecial Day Class (SDC)

Enrollment Survey
Child's Gender*
Name of Previous Preschool (if your child has not previously attended a school write "none"):*
City and State of Previous Preschool
Does your child have any siblings that are currently enrolled in one of our schools?*

YesNo
If you selected "Yes" to the above question, please list the names of any siblings that are enrolled in any of our schools.
If you have another child that attends Savanna School District, what school does he/she attend? *
Which language do you prefer to be contacted in to complete your child’s registration?*

EnglishSpanish
Legal Consent: By electronically signing below you are agreeing that all the information provided above this signature is correct to the best of your knowledge. Additionally, you agree that your electronic signature is the legal equivalent of your manual/handwritten signature.
Please use your mouse to complete the signature form (or your finger if on smartphone/touch device).
Signature:*

Clear
Date and Time

Final Confirmation
Once this form has been submitted a copy will be sent to the preschool program office.

**Please note: You will be contacted regarding your registration within 3 business days to schedule a time to provide the following important documents.**

1) Proof of Birth Date: One of the following documents is acceptable: birth certificate, recorder sworn transcript, baptismal certificate, physician statement of birth, passport showing age or other valid proof of birth.

2) Proof of Residence: One of the following documents is acceptable:

* Property Tax Payment Receipt
* Rental property contract, lease, or payment receipt
* Utility service (electric, gas, water) contract, statement, or payment receipts
* Voter Registration
* Pay Stub
* Correspondence from a government agency
* Notarized Declaration of residency executed by the parent or legal guardian of a student

3) Immunization Records: Records must be originals, stamped by the doctor's office. The school will make a copy to keep on file, with originals returned to the parent. Parents must present proof that required immunizations have been completed.

4) Physician's Report: All children need a completed physician's report completed by a physician prior to starting preschool.

5) Preschool Packet: A packet with additional forms will be emailed to you upon completion of this pre-enrollment form.

**Please note that completion of this form DOES NOT guarantee placement in our preschool program. You will be contacted by phone regarding acceptance into the preschool program within 3 business days.**
Please click the submit button only once. Within 30-45 seconds you will recieve confirmation of your submittal. Multiple submissions will be submitted if clicked multiple times.

Should be Empty:

SAVANNA SCHOOL DISTRICT PRESCHOOL

Student Information

School Health Record

Income Survey

Special Services Survey

Enrollment Survey

Final Confirmation