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RCIC (Children's) 2023-24
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* Indicates required question
Child's First Name
*
Your answer
Child's Middle Name (if applicable, if not put N/A)
*
Your answer
Child's Last Name
*
Your answer
Child's Date of Birth
*
Your answer
Child's Place of Birth (City, state, county, etc.)
*
Your answer
Child's Street Address
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Your answer
City
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Your answer
State/ Zip Code
*
Your answer
School Attending for 24-25 School Year
Your answer
Grade Attending in 24-25 School Year
Your answer
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