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Lyons Mill Kindergarten Pre-Registration Form 2015-2016
AT LYONS MILL, STUDENTS ARE EMPOWERED TO ACHIEVE IN LITERACY• MATH •ENGINEERING •SCIENCE!
WelcometoLyonsMillElementarySchool!
YouandyourkindergartenstudentareabouttoembarkonawonderfuladventureknownasKindergarten
Round‐Up!WhenyouattendKindergartenRound‐Up,youwillmeettheLyonsMillprincipalandsecretary.
Duringyourappointment,youwillvisitanurse,ateacher,andotherschoolprofessionals.Pleasemake
sureyouhaveallofthedocumentsneededtoenrollyourchildinkindergarten.Weknowthiscanbea
stressfultimeforyoutosendyourfirstoronlychildofftoschool.Wepromisetomakethisapainless
experienceforyouandyourchild.Listedbelowarethedocumentsyouwillneedtobringtoregistration:
 BirthCertificate statingyourchildwasbornbetweenSeptember2,2009&September1,2010  ImmunizationRecord
 ProofofResidency deadorleaseinparent’sname ;Ifyouarelivingwithsomeone,youare
consideredaSharedDomicileandyoumustcallourResidencyInvestigator,ScharrenceRichardsonat
410‐887‐6903priortoregistration.
 Three 3 piecesofcurrentmail mustbewithin60daysnojunkmail  AcurrentphotoID‐Ifyouuseyourdriver’slicense,itmustmatchthecurrentaddress.
Ifyouneedassistanceacquiringanyofthedocumentsrequiredforregistration,orifyouhavequestions,
pleasedon’thesitatetocallLyonsMill’ssecretary,Ms.Vaughnat410‐887‐1719.
Please return the completed form to Woodholme Elementary by Thursday, April 30, 2015. You will receive a phone call or email by
the second week in May announcing that your registration packet is ready for pick up at Woodholme. Your registration packet will
also include your appointment time for Thursday, May 21, 2015. If you have any questions, please email Ms. Vaughn at
[email protected] or call 410-887-1719.
PLEASE PRINT CLEARLY OR TYPE
Place an X in all boxes which apply to your situation.
Child’s Full Name:
Birth Date:
Sex:
Mother’s/Guardian’s Name:
Home Phone:
Work Phone:
Cellular Phone:
Email Address:
Father’s/Guardian’s Name:
Home Phone:
Work Phone:
Cellular Phone:
Email Address:
Male
Female
Parent’s Guardian’s Home Address (Where the child is residing):
Street Address:
City:
Residency Information:
State:
Rent
Own
Zip:
Other:
If your name does not appear on the lease or deed, please mark “Other”.
With whom does the child reside?
Do you have legal custody of this child?
Mother
Yes
Father
No
Other:
Other:
Do you have any court documents concerning this child?
No
Yes (If yes, we need a copy.)
Is a language other than English spoken in the home?
No
Yes (language):