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Registration Form



Welcome to the Whitman Family!  Thank you for filling out this pre-registration form.  This information helps us in planning for the best start to school in September.   To be eligible for UPK this coming school year, your child must be 4 years old by December 1.  Incoming kindergarteners must be 5 years old by December 1.  All students enrolling in the district must reside inside our borders.  Proof of birthdate, residence and any relevant court paperwork will need to be provided with the formal registration paperwork.
Students Namerequired
First Name
Middle (optional)
Last Name
Date of Birthrequired
Must contain a date in M/D/YYYY format


What adults does this student live with?required
First Name
Last Name
Phone Numberrequired
Alt Phone Number
Email Address
Is there another adult in the household?requiredSelect yes if there is another adult responsible for this student.
Select yes if there is another adult responsible for this student.
Another Adultrequired
First Name
Last Name
Phone Numberrequired
Alt Phone Numberrequired
Email Addressrequired


Address where student livesrequired
123 Main St
New York
Zip Coderequired
Is there a separate mailing address?required
Mailing Address
123 Main St
New York
Zip Code
Any other children in the house?required
Other childrens names and ages


Is there any court or custody paperwork associated with this student?required
Does the Student have an IEP or 504 plan?required
Does the student have permanent, fixed & adequate housing?required
What is the Home Language for this student?required
Is there medical or any other information we should be aware of?required
Please describe medical infomation further


*All students should have a recent physical and updated immunizations to begin school.*


This form is the first part of our UPK registration process. The complete enrollment packet will be sent to you.

If you have any questions, please contact Dr. Clayton Cole at 585-554-6441 x1444 or


Welcome to Whitman!