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Colwich Elementary

Parents and Students
Preschool Student Data Form

Preschool Student Data Form

2024-25 Preschool Student Data Form

Please Fill Out The Preschool Student Data Form Below

Reaquired field: Child's First Name
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Child's Middle Name
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Reaquired field: Child's Last Name
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Child's Preferred Name (if different):
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Reaquired field: Child's Birth Date

Gender

Male

Female

Hispanic/Latino?

Yes

No

Race (check all that apply)

Reaquired field: White

Reaquired field: Black or African American

Reaquired field: Asian

Reaquired field: American Indian or Alaska Native

Reaquired field: Native Hawaiian/Pac. Islander

Child resides with:

Both Parents

Mother

Father

Other

Other

Has your child attended preschool before?

yes

no

If yes, please list name of preschool:

My child will attend Kindergarten at:

Reaquired field: Colwich Elementary

Reaquired field: Andale Elementary

Reaquired field: St Marks Elementary

Reaquired field: Another school outside the Renwick district

Reaquired field: Other

Other

Reaquired field: Please list older siblings in K-12:
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Reaquired field: Please list school district student resides:
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Does your child have an IEP?

Reaquired field: Yes

Reaquired field: No

Reaquired field: Other

Other

Reaquired field: Mother's First & Last Name
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Reaquired field: Mother's Address

Address
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City
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State / Province / Region
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Zipcode Min: 1 Max: 5

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Country

Home Phone if available

Reaquired field: Mother's Cell Phone

Reaquired field: Mother's Email

Reaquired field: Mother's Employer

Mother's Work Phone #

Reaquired field: Father's First & Last Name
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Father's Address if different than Mother's Address

Address
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City
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State / Province / Region
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Zipcode Min: 1 Max: 5

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Country

Reaquired field: Father's Cell Phone

Reaquired field: Father's Email

Reaquired field: Father's Employer

Father's Work Phone #

Reaquired field: Medical Information:
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Reaquired field: Does your child have any allergies?
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List any medications taken routinely or intermittently:
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Reaquired field: Physician Name:
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Reaquired field: Physician Phone Number:

Reaquired field: Preferred Hospital:
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My child is potty trained. No assistance is required. If no, please comment.

Reaquired field: Yes

Reaquired field: no

Reaquired field: Other

Other

Renwick Dental Screening (in compliance with KS State Statute 72-5201)

Reaquired field: I would like my child to receive dental screening

Reaquired field: I opt my child out of the dental screening

Reaquired field: Name all people dropping off or picking up your child from preschool:
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Reaquired field: Does your child have any special interests?
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Reaquired field: What are some things your child is really good at?
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Reaquired field: What would you like your child to learn in preschool?
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Do we have your permission to share your child's picture on social media (facebook, twitter,instagram,school website) when posting student activities? No student will be named individually?

Reaquired field: Yes

Reaquired field: No

Do we have your permission to publish your student's fall photo in our yearbook?

Reaquired field: Yes

Reaquired field: No

Do we have your permission to publish your student's photo in print media such as local newspapers?

Reaquired field: Yes

Reaquired field: No

Do we have your permission for your student's name and family information to be published in the school directory?

Reaquired field: Yes

Reaquired field: No

Do we have your permission for your student to attend events within city limits of Colwich by walking (Ex: to community library or park)? I will be notified of all events and have the right to deny participation.

Reaquired field: Yes

Reaquired field: No

Is your child a dependent of active military duty (full-time)?

Reaquired field: Yes

Reaquired field: No

Is your child a dependent of National Guard or Reserve Forces?

Reaquired field: Yes

Reaquired field: No

Reaquired field: Emergency Contact #1 First & Last Name (if parents are unavailable):
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Emergency Contact #1 Relationship to Student:

Reaquired field: Grandparent

Reaquired field: Sibling

Reaquired field: Daycare

Reaquired field: Other Relative

Reaquired field:

Reaquired field: Other

Other

Reaquired field: Emergency Contact #1 Phone Number:

Emergency Contact #2 First & Last Name:
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Emergency Contact #2 Relationship to Student: Copy

Grandparent

Sibling

Daycare

Other Relative

Other

Other

Emergency Contact #2 Phone Number:

Email a copy to

optional

Required Fields

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