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Campbell County Schools
Preschool Registration (Version 2) Form
4/22/2019

The next screenings will be held May 13-16, 2019. In order to qualify, 1.) Your child MUST be 3 or 4 years old at the time of screening and displays difficulties in speech and/or problems attaining developmental skills needed to be successful in school. OR 2.) Is 4 years old by August 1, 2019 and family qualifies financially. *****A LETTER WILL BE MAILED OUT PRIOR TO THE SCREENING DATE NOTIFYING YOU WHAT TIME THE APPT IS, DETAILS OF THE SCREENING PROCESS, AND LOCATION OF THE SCREENING.******

Student's Last Name: *
Student's First Name: *
Student's Date of Birth: *
Street Address: *
City: *
State: *
Zip Code: *
Parent First Name: *
Parent Last Name: *
Phone Number: *()- Ext.
Email: *

For any additional questions, please email Tamra Mulberry at tamra.mulberry@campbell.kyschools.us

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