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Email *
Student's Name: *
Date of Birth:
MM
/
DD
/
YYYY
Parent Name: *
Parent Email:
County residing in?: *
Which Class would you like your child to join? *
Are you interested in adding Extended Care? *
Language used at home: *
Has your child ever been tested, treated or do you have any concerns with speech, hearing, physical, emotional or social development? *
Please describe your child's concerns with speech, hearing, physical, emotional, or social development: *
Does your child have any possible medical needs during school hours? *
Name of medical condition and any helpful information for us? *
Tours are given during school hours, M-TH 9:30-11:30. During summer break, we will do our best to accommodate your schedule. Please let us know a good day and time that works for you and we will confirm by email.  *
A copy of your responses will be emailed to the address you provided.
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