Family Enrollment Form

Welcome to the Judy Center Early Learning Hub! The Judy Center supports families to ensure that all children enter school with the skills they need for lifelong success.

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Child's Name
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Gender
Clear selection
Child's Race
Does your child have an IEP or IFSP?
Clear selection
Please select all programs your child currently participates in.
If you selected other please list your child's program here.
Parent/Guardian Name
Relationship to child
Phone Number
Address
E-mail
How did you hear about the Judy Center?
Do you want to receive text messages (via Talking Points) about Judy Center activities?
Clear selection
What language do you speak at home?
Clear selection
I would like to enroll my child in the following Judy Center program(s).
Clear selection
Confidentiality - By submitting this form you are acknowledging the following statement.
I understand that the information I provide will be used for data collection by the program in which I am enrolled, as well as the Maryland State Department of Education, for the purpose of continued programming and funding. My information will not be shared with other programs without my consent.
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