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H4K Registration East
James Young
2018-01-23T11:19:43-06:00
H4K Registration EAST
Primary Information
Name of Child Registering
*
First
Last
Child's Birthday
*
MM slash DD slash YYYY
Age on September 1
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Father's First and Last Name
*
First
Last
Home Phone
Father's Cell Phone
Father's Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
If same as Child's just type the word same.
Father's Occupation and Employer
Father's Work Phone
Father's Email
Mother's First and Last Name
*
First
Last
Mother's Cell Phone
Mother's Email
Mother's Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mother's Occupation and Employer
Mother's Work Phone Number
Parent(s) marital status
*
Married
Cohabiting
Separated
Divorced
Widowed
Single
Parent(s)/Guardian(s) with legal custody:
*
Name of Adult (Besides Parent) Authorized to pick up your child
*
First
Last
Adult's Relationship to Child
*
Grandma/Grandpa
Aunt/Uncle
Brother/Sister
Cousin
Family Friend
Medical Information
Child's Primary Physician
First
Last
Physician's Phone
Are your Child's immunizations current?
*
Yes
No
List any medications your Child is taking (If none put NA)
Any medical conditions that we need to be aware of? (If none put NA)
Child's Allergies (If None put NA)
*
Name of Emergency Contact Nos
*
Add more if you have
Other Information
Elementary School your child will be attending
Child's Nickname
Your Child is
Right Handed
Left Handed
Name(s) and Age(s) of other children living at home (If none put NA) *
Name
Gender
Age
Does your child need help?
*
Dressing
Undressing
Tying Shoes
Washing Hands
Eating
None
How long has your child been potty trained?
What expression is used when he/she needs to use the restroom?
Any present concerns about your child's behavior?
Have any other individuals cared for your child?
Yes
No
If so by whom?
If so by whom? (If none put NA)
How is your child disciplined at home?
Does your child have any particular fears? (If none put NA)
*
Does your child have pets? If so list: (If none put NA)
Does your child have experience interacting with other children?
None
1-2 Days/Week
3-4 Days/Week
4-5 Days/Week
6-7 Days/Week
Does your Child play with other or alone?
Alone
With Others
What are your hopes and goals for your child's preschool experience?
Are there any family circumstances that you think we should be aware of? (If none put NA)
Registration Fee
To register you child for the 2021-2022 school year a non-refundable $35 registration fee is required.
Registration Fee
*
Wanatah (2020-2021)
None
After clicking on 'submit', if your page is not re-directing to payment page, please verify the details again and submit. Once all applicable options have been selected. Please add up your total and click the pay now button to pay your registration cost.