CENSUS INFORMATION
Please complete this card ONLY if you live in District 112
and have children ages birth to 5 years old (in your home),
not yet enrolled in kindergarten.
You may submit your Census Information using the form below.
Child’s full legal name
First
Middle
Last
Boy
Girl
Birth date
/
/
month day year
Child’s full legal name
First
Middle
Last
Boy
Girl
Birth date
/
/
month day year
Child’s full legal name
First
Middle
Last
Boy
Girl
Birth date
/
/
month day year
Father/Guardian
Father/Guardian Cellphone
Mother/Guardian
Mother/Guardian Cellphone
Address:
Street
City
Zip
Home phone
I have another child/other children already attending school.
No
Yes
Child’s name (already attending school)
Name of school they attend
Child’s name (already attending school)
Name of school they attend
Child’s name (already attending school)
Name of school they attend