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6-9 months
10-12 months
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sits alone
is crawling
Pulls on furniture to stand up
Stands
Walks
Other…
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Parent First Name
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Parent Last Name
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Child's First Name
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Child's Last Name
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Child's age as of January 9th, 2019
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Currently, my child... (this information helps the facilitator plan activities).
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Cell Phone #
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Email address
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