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Summer 2026 Countdown to Kindergarten

APPLICATION INTAKE CHECKLIST

2026 Summer School

Application Date

Child's Last Name

Child's First Name

Child's Date of Birth

Parent / Guardian

Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Email

Please choose what type of care arrangement your child has been in for the past 12 months (select all that apply)

Please check the line next to the item to indicate that you have completed that task.

Custody or Court Documentation / Restraining Order Paperwork (if applicable / pending)

Permission to discuss Educational / Behavioral needs with Summer School leadership and receiving school.

IEP / Outside Services (please attach)

Foster Child

In the fall of 2026 my child will be attending (list possible schools / districts for kindergarten placements)

Schools attending

Attach documents here

Summer School program managers will have permission to assess my child on skills obtained in summer school in whatever school they are attending for the purpose of assessing the effectiveness of the program. I understand that this assessment will occur once in the fall of my child's kindergarten year.

Please initial below

Have you already enrolled in Kindergarten?

Yes

If available, is bus transportation a high priority for you?

Yes

If available, is before / after care (i.e. 5:30 am drop off / 4:00 pm pick up) important for your child's participation?

Yes

I hereby certify that all of the above has been verified (and copied if required) and the application on the above named child is complete to the best of my knowledge.