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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name
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Your answer
Child's Middle Name
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Your answer
Name Child Is Called (Nickname)
*
Your answer
Address
*
Your answer
Zip Code
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Your answer
Telephone
*
Your answer
E-Mail Address
*
Your answer
Child's Birthday
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MM
/
DD
/
YYYY
Birthplace
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Your answer
Please Select One
*
Male
Female
Guardian's Information 1
Name
*
Your answer
Relationship To Child (i.e. mother, father, etc.)
*
Your answer
Occupation
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Daytime Phone
*
Your answer
Cell Phone
*
Your answer
Guardian's Information 2
Name
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Relationship To Child (i.e. mother, father, etc.)
Your answer
Occupation
Your answer
Daytime Phone
Your answer
Cell Phone
Your answer
Brothers and Sisters (Name, Birthday, Male or Female) - one per line
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Has your child been in school prior to Kindergarten? If so, where?
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Medical concerns or allergies of child
*
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The classroom environment in which my child learns best is . . . (Please do not include name of teacher.)
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Additional information that will be helpful to the teaching staff or that you would like to share about your child.
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