4-Year-Old Full-Day UPK

4-Year-Old Full-Day UPK

2024–25
Student Information
Student's name*

First NameMiddle InitialLast Name
Student's date of birth*

MonthDayYear
Age student will be on Dec. 1, 2024*
Student must be 4 by Dec. 1, 2024 and must not turn 5 before Dec. 1, 2024.
Student's gender*
Student's preferred language*

EnglishSpanishOther
Other language(s) the student speaks
Student's primary address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has the student ever lived anywhere else?*

YesNo
Student's previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Did the student participate in the Geneva CSD 3-Year-Old UPK Program?*

YesNo
Which site did the student attend?

Happiness HouseJim Dooley CELYMCA
Has the student ever attended a childcare or preschool program?*

YesNo

Parent/Guardian
Parent/Guardian's name*

First NameLast Name
Parent/Guardian's relationship to student*
Parent/Guardian's date of birth*

MonthDayYear
Does the Parent/Guardian live at the student's primary address?*

YesNo
Parent/Guardian's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian's cell phone
Please enter a valid phone number.
Parent/Guardian's alternate phone
Please enter a valid phone number.
Parent/Guardian's email
example@example.com
A valid cell phone number and email address are necessary for full functionality of ParentSquare, our school-to-family messenger app. If you do not provide this information, you may miss important messages from the school.

Many companies (Google, Yahoo, etc.) provide email addresses free of charge.
Parent/Guardian's employer
Parent/Guardian's work phone
Please enter a valid phone number.
Parent/Guardian's preferred language*

EnglishSpanishOther
Other language(s) the Parent/Guardian speaks

List any additional persons living with the student

Transportation
Yes, I acknowledge there is no transportation, and I will be responsible for arranging transportation to and from the UPK site.*

Check the box to indicate agreement.

Site Preference
Transportation is not provided.

All programs run Monday–Friday, six hours per day, and align with the school district calendar. Participation will be determined by a lottery drawing and is subject to the program receiving New York State funding. While there is no guarantee that each child will receive a UPK spot, when an application is selected, every attempt is made to place your child with the first choice indicated.

Please rank in order your preferences from 1 to 3 (1 = your first choice). If you are not able to have your child attend any program other than your first choice, please do not select an alternative.
Happiness House — Christine Schultz (315) 789-6850

1

2

3

1 is First Choice, 3 is Last Choice
Jim Dooley Center for Early Learning — Kyle Vanderlip (315) 787-4190

1

2

3

1 is First Choice, 3 is Last Choice
District-Operated UPK at North Street School — Cecilia Rodriguez (315) 781-4104 ext. 7008

1

2

3

1 is First Choice, 3 is Last Choice

Supporting Documents

All applications must include acceptable proof of age and proof of residency, proof of a physical and immunizations, and, if applicable, custody orders or proof of guardianship. (Students who are protected under the McKinney-Vento Act are entitled to immediate enrollment in school even if they don’t have the documents normally needed.)
You may upload the supporting documents here, drop them off at North Street School, or mail them to:

Geneva CSD Head Start/UPK

Attn: UPK

400 West North St.

Geneva, NY 14456
Proof of age

Cancelof
Proof of residency

Cancelof
Proof of physical

Cancelof
Proof of immunizations

Cancelof
Custody papers or proof of guardianship (if applicable)

Cancelof

Additional Records Requests
I consent to the release all health and dental records to the Geneva City School District for the purpose of registering of the above student.*

Check the box to indicate agreement.
Parent/Guardian's signature*

Clear
Today's date*

MonthDayYear
Should be Empty:

Student Information