KINDERGARTEN CHILD COUNT FORM
For Students planning to enter Northeast or Northwest Primary Schools for
the 2016-2017 school year:
Students must be five (5) years of age on or before September 1, 2016.
This form may be returned to either of the above schools or The Longfellow
Administration Building, 6 Church Street by February 26, 2016.
You may also call Northwest Primary School, 773-1946 ext. 1776, or Northeast
Primary School, 773-1940 ext. 1719 and give the following information over the
phone.
Child _________________________________________
Date of Birth __________________
Parent Name __________________________________________________________________
Address______________________________________________________________________
Phone – Home ______________________________Work ______________________________
Birth Certificate and Immunization Record will need to be presented at the time of screening.
YOU WILL BE NOTIFIED OF THE DATE OF SCREENING IN THE SPRING.
Rutland Public Schools must have this information by February 26, 2016, for budget planning
purposes.
Please notify any friends or family members, with eligible children, of this registration
event.
Forms also available by going to: http://rutlandcitypublicschools.org