All children planning to attend Kindergarten this fall must:
∙ be five years old on or before September 15, 2018
∙ bring a birth certificate or proof of birth to Kindergarten Registration
∙ bring an official record of current immunizations

Note: Required fields are marked with two red asterisks. Uinta County School District #1 will receive the data exactly as it is entered. Please be careful of spelling, capitalization, and punctuation.

Student Information
Legal Name from Birth Certificate
**First Name: Middle: **Last:
**Date of Birth: MM/DD/YYYY
**Preferred First Name:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
**Next Year's Grade Level:
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy
Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information