KCS Registration

Thank you for your interest in registering your child(ren) for the Keller Christian School! Please fill out the form below to register.

KCS Registration

Child's First Name:

Child's Last Name:

Child's Nickname

Child's Date of Birth:

Child's Gender:

Male

Female

Select Class:

Street Address:

City:

Opt-In

ZipCode:

Primary Parent's First Name:

Primary Parent's Last Name:

Relationship to Student:

Primary Parent's Phone:

Primary Parent's Alternate Phone:

Primary Parent's Email:

Secondary Parent's First Name:

Secondary Parent's Last Name:

Relationship to Student:

Secondary Parent's Phone:

Secondary Parent's Alt Phone:

Student Lives with...

If "Other", then Who?

Has the Student Attended Any Preschool Previously

Yes

What Church do you attend, if any?

Please select if you suspect...

Please select any medical and/or psychological diagnoses the child currently has:

Please give details:

Any other information we should know about your child?

New Field:

Emergency Alt Phone:

Authorized Pickup Person 1:

New Field:

Pickup Person 3 Phone:

New Field:

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