Child Information
You have to complete one application per child. All questions with * have to be answered (if not applicable, put NA or no).
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Child Name *
Gender *
Age and Date of Birth *
Social Security # (Optional)
Child school and grade *
Child's cell and email
Ethnicity (check all that apply) *
Required
Is your child currently on probation? *
If your child is on probation, what is the probation officer name and unit, and the reason for referral to juvenile probation
Does this child have a significant family member (parent, sibling, grandparent, etc.) who is *
Required
If you answer anything else than no to the question above, how does this person related to your child?
Does your child have or identify with any of the following: *
Required
Parent/Guardian Name *
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