Child Information
This form complies with DCF 251.04(6)(a)1. and DCF 252.41(4)(a)1. respectively. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].
Instructions: The parent / guardian shall fill out the form completely, sign it and submit it to the center prior to the child's first day of attendance. Information on this form shall be kept current.
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Email *
Name of Person/relationship to child of person completing form (for example, Sue Smith, mother) *
Date of form completion *
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Child's name (first, last, middle initial) *
Child's address (address, city, state, zip) *
Child's Birthdate *
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Preferred first date of attendance at Fort Atkinson Preschool and Childcare *
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