Preschool Readiness Group
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Child 's Name *
Date of birth *
MM
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DD
/
YYYY
Parent/Guardian Name *
Home Address *
Phone Number *
Email *
Is your child potty trained? *
Is your child currently receiving any therapies/services? *
What are your main goals for your child in joining the Preschool Readiness Group?
(This could include skills you’d like them to work on, areas they find challenging right now, or things you’d like them to practice before preschool.)
 *
Any additional information about your child you would like to share? 
How did you hear about us?
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