2021-2022 Registration Form

Kaleidoscope School

16850 N. 16th Street Phoenix, AZ 85022

602-313-0917

Please complete the form below. Required fields marked with an asterisk *

Student Information

Student Last Name*

Answer Required

Student Middle Name

Answer Required

Student First Name*

Answer Required

Date of Birth*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

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Grade Entering*

Answer Required

Kindergarten

1st

2nd

3rd

4th

5th

Parent/Guardian Information

Parent/Guardian 1 Last Name*

Answer Required

Parent/Guardian 1 First Name*

Answer Required

Parent/Guardian 1 Street Address*

Answer Required

City*

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Zip/Postal*

Answer Required

Parent/Guardian 1 Email*

Answer Required

Parent/Guardian 1 Mobile Phone*

Number Required

Parent/Guardian 1 Work Phone*

Number Required

Parent/Guardian 1 Occupation*

Answer Required

Parent/Guardian 2 Last Name

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Parent/Guardian 2 First Name

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Parent/Guardian 2 Street Address

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City

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Zip/Postal

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Parent/Guardian 2 Email

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Parent/Guardian 2 Mobile Phone

Number Required

Parent/Guardian 2 Work Phone

Number Required

Parent/Guardian 2 Occupation

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Siblings Name(s) and Age(s)

Answer Required

ONLY MILITARY FAMILIES NEED TO FILL OUT THIS SECTION

Is the student a dependent of a member of the Unites States military service in the Active Duty Army, Navy, Air Force, Marine Corps, or Coast Guard?

Answer Required

Yes

Is the student a dependent of a fulltime member of the National Guard or Reserve force of the United States Military (Army, Navy, Marine Corps, or Air Force)?

Answer Required

Yes

Is the student a dependent of a member of the National Guard, or Reserve force of the United States Military (Army, Navy, Marine Corps, or Air Force)?

Answer Required

Yes

Parent Signature*

Answer Required

Today's Date*

Answer Required

Please fix the highlighted areas below before submitting.

2021-2022 Registration Form

2021-2022 Registration Form