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Young 5's/Kindergarten Information
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* Indicates required question
Child's Legal Name (Last, First)
*
Your answer
Is Wines your neighborhood school?
*
Yes
No
If you answered no, what is your home school?
Your answer
Will your child be attending the Young 5's Program
*
Yes
No
Maybe
Child's Date of Birth
*
MM
/
DD
/
YYYY
Home Address
*
Your answer
Parent/Guardian #1 (Name, Phone, email)
*
Your answer
Parent/Guardian #2 (Name, Phone, email)
Your answer
Parent/Guardian #3 (Name, Phone, email)
Your answer
Parent/Guardian #4 (Name, Phone, email)
Your answer
Name of Pre-School Attended
Your answer
Does your child have any health issues we should know about?
*
Yes
No
Required
If you answered yes above, please explain briefly
Your answer
Is there anything else you would like to tell us about your child to help us get to know them better?
Your answer
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