Enrollment Information

Please complete the enrollment informationPlease complete one form for each child 

Email to:
kristywoodson@wentzville.k12.mo.us

OR

Mail to:

Wentzville School District
Parents as Teachers
5275 Quail Ridge Parkway
Wentzville, MO 63385

Today's Date: 

First and last name of all parents/guardians in home:

Street Address:

City/State/Zip:

Phone Number (include area code):

Alternate Phone (include area code):

Email address:

Best time for home visit: Day (before 4:00)   or Evening (after 4:00)

Child's Name (first, middle initial and last):

Child's Date of Birth:

Child's Gender:  Male or Female

Child's Ethnicity (please choose one-required by DESE) 

American Indian or Alaska Native

Asian or Pacific Islander

Black

Hispanic

White

Do you have any concerns about your child's health or development?

If yes, please describe:

Last modified: Wednesday, 2 July 2014, 6:36 PM