BIC PreKindergarten Application
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Child's Name (as appears on birth certificate) *
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Race/Ethnicity *
Primary Language of Child *
Parents: *
Phone Number of Parents *
MAILING Address *
PHYSICAL Address *
Income of Primary Caregiver *
Income of Secondary Caregiver *
List all persons living in the household *
Parental Status *
Submit
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