Willow Vista ECA - Pre-Registration Form
Please fill out the information requested. Once your information has been submitted and reviewed, we will notify you.
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Child's Full Name / Nombre Completo de niño/a *
Child's Date of Birth / Fecha de nacimiento del niño/a *
MM
/
DD
/
YYYY
Sex / sexo *
Child's Language / Cual es idioma del estudiante *
Parent/Guardian's Language/ Idioma de Padres o Guardiantes *
Does your child have a disability? Tu niño/a tiene una discapacidad? *
If yes, please explain / Si es así, porfavor explique:
Do you have any concerns about your childs development? / Tienes preocupaciones del desarrollo de tu niño/a? *
If yes, please explain. / Si es así, porfavor explique:
Parent or Guardian Full Name / nombre completo del padre o tutor *
Are you an employee of the district? Eres empleado del distrito? *
Is your child a returning student to the district? Estan regesando de nuevo al distrito? *
Address / Dirección *
Mailing Address if Different / Dirección postal si es diferente
City / Ciudad *
State / Estado *
Zip Code / Código Postal *
Phone Number / Numero de teléfono *
Secondary Phone Number / Numero de teléfono secundario
Email / Correo electrónico *
Has your child ever been in Early Head Start or Head Start? A participado su estudiante en el programa de Head Start? *
What is the best way to contact you to complete your application/registration? Cual es la mejor manera de comunicarnos para completar su aplicacion? *
What is the best time to contact you?/A que hora prefieren para communicarnos con ustedes? *
Is there anything else you would like us to know in order to meet your child's needs?/ Hay algo mas que les gustaria que sepamos para prepararnos para ayudarle a su estudinte?
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