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LVNS Application Form
Child's Date of Birth
Indicate your program of interest(check all that apply)
Parent & Me (start age 18 month, to be attended during year prior to starting preschool)
Yellow Group (start age 2½ to 3½)
Blue Group (start age 3½ to 4)
Red Group (start age 4 to 4!½)
Name and ages of siblings who have attended LVNS and which program attended (morning or afternoon school):
Child’s ethnic identity
Primary Home Address
Parent 1 Name
Parent 1 Telephone Number
Parent 1 Email
Parent 2 Name
Parent 2 Telephone Number
Parent 2 Email
Child’s special needs (Please indicate if your child requires special educational attention because of conditions such as physical, learning, speech, or visual handicaps; emotional or behavioral difficulties; chronic health impairment; allergies)
A copy of your responses will be emailed to the address you provided.
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