SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

KINDERGARTEN STUDENT ASSIGNMENT DATA

SCHOOL YEAR____________

Student Name _________________________________________ Male _____ Female _____

Student Birth Date ____________________________________________________________

Parent/Guardian Name ________________________________________________________

Address ____________________________________________________________________

Primary Means of Transportation to School ________________________________________

Preferred Kindergarten Session _____ A.M. _____ P.M.

Reason for chosen session______________________________________________________

Kindergarten assignments will be mailed to parents. Please complete a self-addressed envelope for this purpose.

FOR SCHOOL USE ONLY:

KINDERGARTEN SESSION ASSIGNED A.M. P.M.

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