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Screening Sign-Up
Please complete and submit this form to sign your child up for a preschool screening.
The email address you submit will be used to send all paperwork and screening materials. PLEASE be sure that you use an email address that you can check regularly.
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* Indicates required question
Email
*
Your email
Child's Name (FULL NAME)
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Parent's Name (FIRST AND LAST)
*
Your answer
Phone Number
*
Your answer
Best day of the week to contact you via phone (select ALL that work for you)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Best time of the day to contact you (choose a time between 8:00 AM and 4:00 PM)
*
Your answer
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This form was created inside of Taylorville Community Unit School District #3.
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