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Republic Parents As Teachers Enrollment
Please fill out this form to enroll in the Republic School’s Parents As Teachers program. For further information about our PAT program visit our PAT
website
.
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* Indicates required question
Email
*
Your email
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Clearly list children with their dates of birth (or due date for prenatal) and gender.
*List ALL children in the family prenatal up to kindergarten eligible.
*
example: Tiger Jones, 08/01/2022, male
Your answer
When are you available for home visits (weekdays)?
*
Daytime (before 4pm)
Evening (4pm or after)
Home address:
*
Your answer
Phone number:
*
Your answer
Any other info you’d like to share:
Your answer
A copy of your responses will be emailed to the address you provided.
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