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Child's Application for Enrollment
Early Intervention and Family Services of Person County Schools
1397 Hurdle Mills Road, Roxboro, NC 27573
336-597-2218 fax 336-597-2124
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Child Information
Date of Birth *
MM
/
DD
/
YYYY
Last Name *
Middle Name *
First Name *
Nickname
Gender, Language and Race/ Ethnicity  
(Please select all that apply.)
Address (city and zip code)
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