2023 Summer VPK

This program will begin June 5 through July 27. Classes will be Monday-Thursday, 7:30 a.m. to 5 p.m.
*School is closed on June 9, 16, 23, 30 and July 4, 7, 14, and 21.

Please complete the following information.

Child's Name Child's Name First Last
In order to qualify for Summer VPK the child must be 5 years old on or before 9/1/23.
Child's Date of Birth Child's Date of Birth / MM / DD YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Parent Email
Phone Phone - ### - ### ####
Please choose the Summer VPK site you would like your child to attend.

Please choose the Summer VPK site you would like your child to attend. Richey Elementary School 6850 Adams St. New Port Richey Woodland Elementary School 38203 Henry Dr. Zephyrhills
Does your child have an Individual Education Plan (IEP)?

Does your child have an Individual Education Plan (IEP)? Yes No
If your child has an IEP please indicate below the school he/she has been attending for services.

Please answer the following questions:
Please answer the following questions:	No	Yes	I am not sure
Does your child have a diagnosed health condition?	Does your child have a diagnosed health condition?No	Does your child have a diagnosed health condition?Yes	Does your child have a diagnosed health condition?I am not sure
Does your child have any life threatening allergies?	Does your child have any life threatening allergies?No	Does your child have any life threatening allergies?Yes	Does your child have any life threatening allergies?I am not sure
If you did not indicate above that your child has an IEP, does your child have a suspected or diagnosed disability?	If you did not indicate above that your child has an IEP, does your child have a suspected or diagnosed disability?No	If you did not indicate above that your child has an IEP, does your child have a suspected or diagnosed disability?Yes	If you did not indicate above that your child has an IEP, does your child have a suspected or diagnosed disability?I am not sure

If you answered yes or I am not sure to any of the above, please explain below.

One of the requirements for Summer VPK in public schools is to complete the pre-registration process for kindergarten. This includes completing the myStudent online registration, current physical, immunization record and legal proof of age.
Please answer the following questions:
	Yes	No
Does your child have a current physical dated AFTER 9/1/22?	Does your child have a current physical dated AFTER 9/1/22?Yes	Does your child have a current physical dated AFTER 9/1/22?No
Does your child have an up-to-date (not expired) immunization record?	Does your child have an up-to-date (not expired) immunization record?Yes	Does your child have an up-to-date (not expired) immunization record?No
Does your child have a certified birth certificate?	Does your child have a certified birth certificate?Yes	Does your child have a certified birth certificate?No
Have you pre-registered your child for kindergarten?	Have you pre-registered your child for kindergarten?Yes	Have you pre-registered your child for kindergarten?No

If you have pre-registered your child already for kindergarten please indicate the elementary school below.
If you have NOT pre-registered for kindergarten, what school will you be pre-registering for?
Have you applied and received the VPK certificate for the summer program from the Early Learning Coalition?

Have you applied and received the VPK certificate for the summer program from the Early Learning Coalition? Yes No
Please upload your child's Certificate of Eligibility (COE). If you have not applied for the child's VPK certificate then please go to https://familyservices.floridaearlylearning.com/

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Please share any questions or other information we may need to know about your child.
Thank you for completing the above information. More information will be shared 1-2 weeks before the summer vpk program starts.
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2023 Summer VPK

2023 Summer VPK

Thank you for completing the above information. More information will be shared 1-2 weeks before the summer vpk program starts.