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Student #1 (required)

First Name (required)

Middle Name

Last Name (required)

Previous school or daycare

Grade (2020-2021) (required) —Please choose an option—Pre-K 3Pre-K 4

Will you be using before or after school care?
Before School Care
After School Care

Birthday (required)

Gender

Ethnicity--Hispanic
NoYes

*Race (see below)
MultiracialWhite/CaucasianAsianNative Hawaiian/Pacific IslanderNative American/Native AlaskanBlack/African American

Allergies/Medications (required)

Baptized Catholic
NoYes

[group baptism-student-1]
Baptism Date

[/group]

Student #2

First Name

Middle Name

Last Name

Previous school or daycare

Grade (2020-2021) —Please choose an option—Pre-K 3Pre-K 4

Will you be using before or after school care?
Before School Care
After School Care

Birthday

Gender

Ethnicity--Hispanic
NoYes

*Race (see below)
MultiracialWhite/CaucasianAsianNative Hawaiian/Pacific IslanderNative American/Native AlaskanBlack/African American

Allergies/Medications

Baptized Catholic
NoYes

[group baptism-student-2]
Baptism Date

[/group]

Student #3

First Name

Middle Name

Last Name

Previous school or daycare

Grade (2020-2021) —Please choose an option—Pre-K 3Pre-K 4

Will you be using before or after school care?
Before School Care
After School Care

Birthday

Gender

Ethnicity--Hispanic
NoYes

*Race (see below)
MultiracialWhite/CaucasianAsianNative Hawaiian/Pacific IslanderNative American/Native AlaskanBlack/African American

Allergies/Medications

Baptized Catholic
NoYes

[group baptism-student-3]
Baptism Date

[/group]

Home internet access?
NoYes

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*Race: For State reporting purposes only, please choose from the following: Multiracial, White/Caucasian, Asian, Native Hawaiian/Pacific Islander, Native American/Native Alaskan, or Black/African American. Hispanic is not a race but an ethnicity.
[multistep multistep-enroll-prek "/enrollment-form-3"]