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2024-2025
CIRCLE OF FRIENDS APPLICATION
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* Indicates required question
Email
*
Your email
Child's Full Name (Last Name, First Name)
*
Your answer
Child's Date of Birth
*
Your answer
Gender
*
Male
Female
Prefer not to say
What do you call your child at home? (Nickname)
*
Your answer
Parent/Guardian Full Name (Last Name, First Name)
*
Your answer
Address
*
Your answer
Parent Email Address
*
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
*
Your answer
Other Household Members
*
Your answer
Session Preference: (Please mark your preference)
Please note, your child must be 3 by September 1, 2024 to attend the 3 year old program and 4 by September 1, 2024 to attend the 4 Year old program.
*
AM (3 Year Old)
PM (3 Year Old)
Either (3 Year Old Program)
Full Day (4 Year Old)
Other:
Related Information: What is the Primary Language spoken at home?
*
Your answer
What language is spoken by child?
*
Your answer
Does anything about your child's speech and/or language cause concern?
*
Your answer
Do you have any other concerns about your child's development?
*
Your answer
Participants must be toilet trained.
Is your child toilet trained?
*
Yes
No
Maybe
Other:
Please include any additional information you feel would be helpful for us to know about your child.
*
Your answer
Has your child had any special evaluations?
*
Yes
No
Maybe
If yes, please explain below:
*
Your answer
What are your expectations for your child through your affiliation with Circle of Friends?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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