RCPS Kindergarten Registration Form

Section 1: Student Information
Student Legal Name (as it appears on birth certificate)*

First NameMiddle InitialLast NameSuffix
Student Previous Name (if any)

First NameMiddle InitialLast NameSuffix
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Residence Address of Student*
Home Telephone

Area CodePhone Number
Home Telephone Number

ListedUnlisted
Mailing Address (if different)
Section 2: Parent/Guardian Information
Enrolling Parent/Guardian Information
Name*

First NameMiddle NameLast NameSuffix
Relationship to Student:*
ex: Parent, Grandparent, etc.
Does the student live with you?*

YesNo
Home Phone

Area CodePhone Number
Home Telephone Number

ListedUnlisted
Cell Phone

Area CodePhone Number
Email Address
example@example.com
Is this parent/guardian a federal employee?*

YesNo
Is this parent/guardian: (choose one )*

Active Military DutyActive ReservesNot applicable
Employer Name
Employer Phone

Area CodePhone Number
Other Parent/Guardian Information
Name

First NameMiddle NameLast NameSuffix
Relationship to Student:
ex: Parent, Grandparent, etc.
Does the student live with you?

YesNo
Home Phone

Area CodePhone Number
Home Telephone Number

ListedUnlisted
Cell Phone

Area CodePhone Number
Email Address
example@example.com
Is this parent/guardian a federal employee?*

YesNo
Is this parent/guardian: (choose one )*

Active Military DutyActive ReservesNot applicable
Employer Name
Employer Phone

Area CodePhone Number
Custody and Visitation
Are there any legal custody orders?*

YesNo
If so, specify and provide court order.
Additional Contacts
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to student (specify)
Ex: Aunt, Uncle, Family Friend
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to student (specify)
Ex: Aunt, Uncle, Family Friend
Ethnic Group and Race Categories

The federal government requires that both of these questions be answered and provides only the following categories for ethnic group and race. If either question is not answered, school personnel are required to complete the selection.
Is the student Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of race. (Choose only one.)*

No, not Hispanic or LatinoYes, Hispanic or Latino
What is the student's race? (Choose one or all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific HighlanderWhite
Other Children in Family
Section 3: Preschool and Language Information
Has your child attended preschool?*

YesNo
If yes, where?
Number of hours of preschool attendance per week:
What are the primary languages used in the home?*
What is the language most often spoken by the student?*
What is the language first learned by the student?*
Preferred language for communication from the school:
Written Communication*
Oral Communication*
Has your child ever attended Roanoke City Public Schools before?*

YesNo
If yes, name of last school attended in RCPS:
Is the student a foster child?*

YesNo
Does your child have health insurance?*

YesNo
Section 4: Citizenship Information
Country of Birth:*
Country of Citizenship:*
Entry from which country:
Original U.S. Entry Date

MonthDayYear
Original U.S. School Entry Date

MonthDayYear
Section 5: Additional Information
Has your child ever received Special Services*

YesNo
Select all that apply:

IEPGiftedELL504Other
Has your child ever been suspended, expelled, or dismissed from another school,public or private, in the Commonwealth of Virginia or in another state for an offense in violation of school board policies related to weapons, alcohol, or drugs, or for the willful infliction of injury to another person?*

YesNo
Is your child presently suspended, expelled, or dismissed for any cause from any school?*

YesNo
Section 6: Device and Internet Access
Please choose all devices child has access to at home:*

School Provided (desktop, laptop, Chromebook, tablet)Personal (desktop, laptop, Chromebook, tablet)Shared with family members (desktop, laptop, Chromebook, tablet)Smartphone onlyAny public device (library, community center, etc.)No device accessUnknown
Please the type of internet access child has at home:*

Internet access at home allows for live streaming, classroom instruction, real time interaction with teachers and classmatesInternet access at home is available but too slow for live streaming or real time interactionPublic connection NOT at home (coffee shop, fast food restaurant, recreation center, etc.)OtherNo internet connection availableUnknown
Section 7: Document Uploads
The documents listed below are all required to be fully registered for kindergarten for the 2024-2025 school year. Please upload all documents you currently have available.

NOTE: You will be required to provide all of the documents for the registration process to be complete. You will be contacted by the school regarding any missing items.
Child's Birth Certificate

Browse Files
Child's Birth Certificate Cancelof
Proof of Residency: Mortgage or Lease

Browse Files
Current Lease or Mortgage Cancelof
Proof of Residency: Utility Bill

Browse Files
Utility Bill Cancelof
Photo ID

Browse Files
Photo ID Cancelof
Child's Current Physical and Immunization Record

Browse Files
Child's Current Physical and Immunization Record Cancelof
All of your child and family information will be handled respectfully and confidentially.
Please notify the school should phone numbers change.
Signature
If you are unable to create a signature in the space above, you may sign your application by typing your name in the space below.
Please type your name.
Should be Empty:

Section 1: Student Information

Section 2: Parent/Guardian Information

Section 3: Preschool and Language Information

Section 4: Citizenship Information

Section 5: Additional Information

Section 6: Device and Internet Access

Section 7: Document Uploads