Camp Kindergarten Application-Raising Riley

Para las familias de habla Hispana, por favor lea las instrucciones aquí abajo!

Para cambiar la aplicación a español, por favor haga click en la “a” minúscula y “A” mayúscula en el botón de búsqueda al final o inicio de la pagina, después click en “Traducir a español” En una computadora o laptop, por favor haga click en los tres puntos en la esquina derecha de la pagina, después desplace a “Translate” y escoja la opción “Spanish”.

Child's Name (Last, First, Middle Initial)

Gender

Male

Female

Birthdate

Has your child attended preschool?

Yes

No

If yes, please specify the name

Is your child attending a USD 383 Summer Preschool Program

Yes

No

If you marked yes, which preschool are they attending this summer?

Does your child have a developmental delay, disability, or health condition?

Yes (documented)

Yes (suspicion, not formally documented)

No

Does your child have an Individualized Education Plan (IEP)? If you checked yes, please upload your child's IEP & contact information of their case manager below.

Yes

No

Does your child speak a language other than English at home?

Yes

No

Child's primary language

English

Spanish

Other

Camp Kindergarten Session Preference

Morning session - 8:30am-11:30am

Afternoon session - 12:30pm - 3:30pm

No Preference

Child's ethnicity

Hispanic/Latino/Spanish Origin

Non-Hispanic/Non-Latino/Non-Spanish Origin

Race

Child's Health Insurance Status

Medicaid/State Medical Program Insurance

Lacking or no health insurance

Private or other

Tri-Care (Military insurance)

Which USD 383 Elementary School will your child be attending for the 2025-2026 school year?

Is your child able to attend all 4-weeks of Camp Kindergarten?

List any dates your child will be absent from Camp Kindergarten:

Primary Caregiver Name (Last, First, Middle Initial)

Gender

Birthdate

Street Address

City

Zip Code

County

Phone Number

Email

Marriage Status

Relationship to Child

Mother

Father

Other

Please specify relationship to child if "other" is selected

Primary Caregiver Race

Primary Caregiver Ethnicity

Hispanic/Latino/Spanish Origin

Non-Hispanic/Non-Latino/Non-Spanish Origin

Parent/Guardian Primary Language

English

Spanish

Other

Parent/Guardian Health Insurance

Lacking or no health insurance

Private/other

Tri-Care (Military Insurance)

# of adults (including yourself) in the household

# of children under 18 in the home

Housing Status

Stable housing

Temporary housing

Homeless/living in a shelter

Income Information

Upload Indivudialized Education Plan (IEP)

Contact Information for your child's Case Manager (email, phone number, school they are employed with)