2025-26 4K EROLLMENT

PARENTAL CUSTODY INFORMATION

Unless the Augusta School District has a copy of a court order that specifies restraints against the parental rights of the non-custodial parent, the school will assume both parents may continue to exercise parental rights.
Has the court issued orders that restrict the non-custodial parent from receiving reports, visiting the child or child's teacher, or picking up the child at school?*

Yes. If yes, please provide the office with a copy of the court order. The document will be maintained as a confidential record.No
If anyone besides the parent or legal guardian will need rights to student records or will make education decisions, the Permission For Rights To Records form must be completed.

STUDENT MEDICAL INFORMATION

Please provide in the event of an emergency
Medical Clinic*
Medical Clinic Phone Number*
Preferred Hospital*
Dental Clinic*
Dental Clinic Phone Number*
HEALTH ALERT INFORMATION: Does this student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

PARENTAL MILITARY INFORMATION

Please indicate any active military service.
Is any parent/guardian on active duty in the military?*

YesNo
Is any parent/guardian a traditional member of the Guard or Reserve?*

YesNo
Is any parent/guardian a member of the Active Guard/Reserve (AGR) under Title 10 or full time National Guard?*

YesNo

LITTLE BEAVERS EARLY LEARNING CENTER
Little Beavers Early Learning Center is a state licensed child care center operated by the Augusta School District. 4K wrap around care is available for the half days opposite of your child's 4K class and all day on Wednesdays, when there is not 4K.

Registration for Little Beavers is seperate from this school enrollment, and is on a first-come, first-serve basis. Tuition rates apply.

If you are interested in 4K wrap around care, visit their website: Little Beavers Early Learning Center Enrollment Info

Student Information Form Acknowledgement

All information provided on this form is accurate as of the date of signing. All changes after this date must be reported to the Elementary School Office.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

2025-2026 Augusta School District 4K Enrollment