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Central Cass Public School
Pre-Kindergarten WAITING LIST
for the 2021-22 School Year
Registration will be based on first come first serve and is limited. A deposit of $100.00 will need to be turned into the main office within one week after being notified, to hold your spot. Deposits will only be processed if your child is placed in the Pre-K program.
A monthly tuition fee not including hot lunch fees) will be due by the 5th of each month starting in September.
Families who qualify for Free and Reduced Lunch will have a discount in tuition. See the main office for more details.
Student Information
Student's Legal Name, First
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Middle
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Last
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Birthdate (MM/DD/YYYY)
*
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Name your child would like to go by at school
*
Gender
*
Male
Female
Will your child turn 4 before August 1 of this coming school year?
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Yes
No
Race/Ethnicity
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African American
Asian
Caucasian/White
Hispanic/Latino
Native American or Alaska Native
Other
Other
Special Services (Check any that apply)
Current IEP
504 Plan
Other
Other
Does your Child speak any language(s) other than English?
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Yes
No
If "Yes" please list:
If "Yes" please list:
Do you give consent to have your child screened for hearing or speech at the school if needed?
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Yes
No
Does your child have any health concerns we should be aware of including allergies?
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Yes
No
If "Yes" please list:
If "Yes" please list:
Student's Primary Address
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City
*
State
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Zip Code
*
Before and After School Care:
Will your Pre-Kindergartener take advantage of the optional After School Care? This service will be available M-F 3:20 pm-5:30 pm. Included in the daily fee but does not include breakfast and an afternoon snack.
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No
Undecided
Yes
If spots are available we will open the After-School Care program to the Pre-Kindergartener's school-aged siblings. We will let you know if spots are available. All openings will be available to Central Cass Pre-Kindergartener first, then their school-aged-siblings second. Will your Pre-Kindergartener's school-age siblings be interested in the after school care for an additional fee?
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No
Undecided
Yes, Number of siblings:
Yes, Number of siblings:
Parent/Guardian #1 Information:
Parent/Guardian #1 Name:
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Relationship to Child
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Father
Mother
Other (Please List)
Other (Please List)
Check any that apply
Student resides with parent/guardian
Student resides in your Foster Home
Cell Phone Number
Home Phone Number
Email Address
Address (If different from child):
City
State
Zip Code
Employer
Work Phone Number
Parent/Guardian #2 Information:
Parent/Guardian #2 Name
Relationship to Child
Father
Mother
Other (Please List)
Other (Please List)
Check any that apply
Student resides with parent/guardian
Student resides in your Foster Home
Cell Phone Number
Home Phone Number
Email Address
Address (If different from child)
City
State
Zip Code
Employer
Work Phone Number
Additional contact you would like listed:
Name
Relationship
Home Phone Number
Cell Phone Number
Work Phone Number
Email Address
Address
City
State
Zip Code
Other:
Daycare Provider (If applicable)
Other adults allowed to pick up your child who are not listed above:
Please list Siblings & Grades
+
-
Will ride Rural Bus
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Yes
No
Federal law mandates that we ask the following question:
What is your CHILD'S family living situation?
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Own house or motor home
Rent an apartment, mobile home, house or other living space with your name on a lease for that location
Share housing with family, friends or others due to a economic hardship, loss of housing or similar reason and your name is NOT on a lease for that location
In a hotel/motel
In a camper/5th Wheel, care or public place (parking lot, construction site, trucks yard, private yard, park, abandoned building)
Move from place to place
At an emergency transitional shelter
Lives alone without an adult
Lives with an adult that is not his/her parent or legal gaurdian
Signature:
Please sign below with your trackpad or mouse stating you understand the Central Cass Regular Education Pre-Kindergarten is a tuition-based program and there will be a lottery drawing if we get more applicants then spots available. If your child receives a spot in the Central Cass preschool program you will need to bring a $100 deposit, your child's birth certificate, Social Security card, and immunization record to the District Office within one week of being notified in order to hold your spot or it will be given to the next person in the lottery drawing. The deposit will go towards your first month's payment in the fall. (Checks or cash only)
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