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ECLC Application
2019-2020 preschool application
Child's Name *
Your answer
Child's Birthdate *
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Child's Address *
Your answer
My child lives with *
Mother's phone number *
Your answer
Father's phone number *
Your answer
How old will your child be on Sept. 15, 2019? *
Please list any special needs your child has
Your answer
Do you prefer AM or PM class time? *
Do you think you may qualify for financial assistance?
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