REGISTRATION

Children Registering for Preschoolrequired

Please select the number of children you are registering for preschool at Rockford Christian.

Charge: 0.00

Admin Override

CHILD'S INFORMATION

Child 1 — Information

CURRENT School THIS CHILD Attends*

Please indicate which school, if any, the child you are registering currently attends.

Currently attends GRCES Evergreen Currently attends Olivia Haverkamp Early Learning Center Currently attends GRCES Iroquois Currently attends Rockford Christian Currently attends another school/childcare Not currently in school

Other/Childcarerequired

Please provide school or facility name(s) and dates.

First Namerequired

Preferred/Nick Name

Middle Namerequired

Last Namerequired

Gender*

Female Male

Date of Birthrequired (mm/dd/yyyy)

Accommodations*

Does this child have any special academic, social, or physical needs?

Yes No

Please explainrequired

IEP/Plan*

Does this child have an IEP, non-public service plan, and/or receive special services?

Yes No

Please explainrequired

Additional Informationrequired

Please provide any additional information about this child that may be relevant to their entrance into preschool.

Child 1 — Registration Options

RCS Preschool Options*

AM - 2 days (T/Th) AM - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 2 days (T/Th) - - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 5 days (M - F) - SESSION FULL, if you select this option, your child will be added to a wait pool Young Fives: Full day - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool

Child 2 — Information

CURRENT School THIS CHILD Attends*

Please indicate which school, if any, the child you are registering currently attends.

Currently attends GRCES Evergreen Currently attends Olivia Haverkamp Early Learning Center Currently attends GRCES Iroquois Rockford Christian Currently attends another school/childcare Not currently in school

Other/Childcarerequired

Please provide school or facility name(s) and dates.

First Namerequired

Preferred/Nick Name

Middle Namerequired

Last Namerequired

Gender*

Female Male

Date of Birthrequired (mm/dd/yyyy)

Accommodations *

Does this child have any special academic, social, or physical needs?

Yes No

Please explainrequired

IEP/Plan*

Does this child have an IEP, non-public service plan, and/or receive special services?

Yes No

Please explainrequired

Additional Informationrequired

Please provide any additional information about this child that may be relevant to their entrance into preschool.

Child 2 — Registration Options

RCS Preschool Options*

AM - 2 days (T/Th) AM - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 2 days (T/Th) - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 5 days (M - F) - SESSION FULL, if you select this option, your child will be added to a wait pool Young Fives: Full day - 3 days (M/W/F)- SESSION FULL, if you select this option, your child will be added to a wait pool

Child 3 — Information

CURRENT School THIS CHILD Attends*

Please indicate which school, if any, the child you are registering currently attends.

Currently attends GRCES Evergreen Currently attends Olivia Haverkamp Early Learning Center Currently attends GRCES Iroquois Rockford Christian Currently attends another school/childcare Not currently in school

Other/Childcarerequired

Please provide school or facility name(s) and dates.

First Namerequired

Preferred/Nick Name

Middle Namerequired

Last Namerequired

Gender*

Female Male

Child 3 Date of Birthrequired (mm/dd/yyyy)

Accommodations*

Does this child have any special academic, social, or physical needs?

Yes No

Please explainrequired

IEP/Plan*

Does this child have an IEP, non-public service plan, and/or receive special services?

Yes No

Please explainrequired

Additional Informationrequired

Please provide any additional information about this child that may be relevant to their entrance into preschool.

Child 3 — Registration Options

RCS Preschool Options*

AM - 2 days (T/Th) AM - 3 days (M/W/F) -SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 2 days (T/Th) - - SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 3 days (M/W/F) -SESSION FULL, if you select this option, your child will be added to a wait pool Full day - 5 days (M - F) - SESSION FULL, if you select this option, your child will be added to a wait pool Young Fives: Full day - 3 days (M/W/F) - SESSION FULL, if you select this option, your child will be added to a wait pool

CHILD(REN) HOME ADDRESS

Addressrequired

Cityrequired

Staterequired

Ziprequired

PARENT/GUARDIAN INFORMATION

Parent(s)/Guardian(s)required

Please select the number of parent(s)/guardians(s) for the student(s) being registered.

First Parent/Guardian

First Namerequired

Preferred Name

Last Namerequired

Relation to childrequired

Check if GRCS Staff

Parent/Guardian Responsibility*

Please select all that apply.

Parent/Guardian Responsibility Definitions

Contact Allowed: Indicates the parent/guardian is allowed contact with the student.
Educational Rights: Indicates the parent/guardian has rights to make decisions regarding the student's education and access to student information in ParentVUE.
Has Custody: Indicates the parent/guardian has legal custody of the student.
Mail/Email Allowed: Indicates the parent/guardian may receive mail or email regarding the student.
Release To: Indicates the school may release the student to the parent/guardian.
Financial Responsibility: Indicates the parent/guardian is financially responsible for the student.

Emailrequired

Phonerequired

Phone Type

Cell Home

Address same as child's?*

Yes No

Addressrequired

Cityrequired

Staterequired

Ziprequired

Second Parent/Guardian

First Namerequired

Preferred Name

Last Namerequired

Relation to childrequired

Check if GRCS Staff

Parent/Guardian Responsibility*

Please select all that apply.

Parent/Guardian Responsibility Definitions

Contact Allowed: Indicates the parent/guardian is allowed contact with the student.
Educational Rights: Indicates the parent/guardian has rights to make decisions regarding the student's education and access to student information in ParentVUE.
Has Custody: Indicates the parent/guardian has legal custody of the student.
Mail/Email Allowed: Indicates the parent/guardian may receive mail or email regarding the student.
Release To: Indicates the school may release the student to the parent/guardian.
Financial Responsibility: Indicates the parent/guardian is financially responsible for the student.

Emailrequired

Phonerequired

Phone Type

Cell Home

Address same as child's?*

Yes No

Addressrequired

Cityrequired

Staterequired

Ziprequired