2021-2022 PreKindergarten Registration
Child Information
Which school will you be enrolling your child ?
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Please Select
Centralhatchee Elementary
Ephesus Elementary
Heard County Elementary
Child's Last Name
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Child's First Name
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Child's Middle Name
Name Suffix (i.e. Jr., Sr., III)
Child's Social Security Number
xxx-xx-xxxx
Child's Date of Birth (MM/DD/YYYY)
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XX/XX/XXXX
Sex
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Male
Female
Home Physical Address (Do Not Enter a PO Box)
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City
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State
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Zip
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xxxxx
County
*
Home Phone Number
*
Please enter a valid phone number.
Child's Legal Guardian
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Both Parents
Mother
Father
Other
Child's Living Arrangements
*
Both Parents
Mother
Father
Other
Mother/Guardian #1 Information
Name
First Name
Last Name
Address (if different from child)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Father/Guardian #2 Information
Name
First Name
Last Name
Address (if different from child)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
I verify the above information to be correct, and I understand that completion of this form does not guarantee placement in a Pre-K class. If my child is placed in a Pre-K class, I agree that my child will attend the program for the required number of hours and days as prescribed by the Georgia Department of Early Care and Learning and outlined by the school where my child is enrolled. I understand that failure to comply with these attendance requirements could result in disenrollment. I understand that I cannot register my child with proof of residency and appropriate age documentation. I have attached a copy of appropriate age documentation to this registration form (i.e birth certificate) and will complete the required proof of residency.
Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit a copy of your child's birth certificate here or drop off a copy at the central office (131 East Court Square)
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Complete the required 2020-2021 proof of residency by visiting this website (copy and paste url into your search engine) or come by the central office to complete one in person (131 East Court Square) : http://heardcountyga.apptegy.us/o/hes/page/affidavit-of-residency--5
You will be required to submit an updated 2021-2022 proof of residency when school starts in August 2021.
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