Child's full name as it appears on the birth certificate. *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Mother's full name (or guardian). *
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Father's full name (or guardian). *
Your answer
Residential address *
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Parent/Guardian Phone Number *
Your answer
Please check all that you think applies to your child...
Any special information that we should know about your child before August 2021 so that we can ensure your child's needs are met. (medical issues, custodial arrangements, special needs, etc.)
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