In order to register for Kindergarten in the 2010-2011 school year, children must be five years of age on or before December 1, 2010. Please complete the pre-registration survey below in order for the District to set up appointment dates/times.

Do you have other children currently attending school in the Rocky Point Union Free School District?

Yes

No

Is the student you are registering already enrolled in the Rocky Point UFSD Pre-Kindergarten program?

Yes

No

Registrant/Student Information

First Name

Last Name

Sex

Birth Date (Ex.: 10/01/2003)

PLEASE ANSWER QUESTIONS (1) and (2). PLEASE READ THEM BEFORE YOU RESPOND. [For question select the box that best describes your child.] Select only ONE box.

Is the student Hispanic, Latino, or of Spanish origin? Hispanic, Latino, or of Spanish origin means a person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.

Yes

No

Select one or more races from the following five racial groups [Select all groups that apply to your child; select at least ONE box.]:

AMERICAN INDIAN OR ALASKA NATIVE: A person having origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliation or community recognition. e.g. Cherokee, Mohawk, Inuit

ASIAN: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: A person having origins in any of the original peoples of Hawaii, Guam

BLACK: A person having origins in any of the black racial groups of Africa

WHITE: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East

Language first used by student

Language spoken at home

Parent/Guardian Information

Relationship to Child:

Mother

Father

Guardian

Other

First Name

Last Name

Address 1

Address 2

City

State

ZIP

Home Phone

Cell Phone

E-mail Address

Please e-mail me registration updates as they become available.

Parent/Guardian Information

Relationship to Child:

Mother

Father

Guardian

Other

First Name

Last Name

Address 1

Address 2

City

State

ZIP

Do you own or rent?

Own

Rent

Other

Home Phone

Cell Phone

E-mail address

Additional Information

Does your child have any health concerns?

Yes

No

Does your child have any food allergies?

Yes

No

Census Data: Are there younger siblings in the family?

Yes

No

If yes, please list their name(s) and date of birth.

First Name

Last Name

Birth Date

First Name

Last Name

Birth Date

First Name

Last Name

Birth Date

Preferred time for registration

Morning (9 AM - 12 PM)

Afternoon (12 PM - 3 PM)

Preferred day or days of the week you are available for registration.

Do you have any questions or concerns?

Indicates Response Required

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