Classroom 1 Visual Arts Preschool Program Application
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Please list the best number to reach you during our programming: *
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Child's Full Name: *
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Date of Birth: *
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Age: *
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Number of households your child lives in: *
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Parent/Guardian 1: *
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Home phone: *
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Cell phone: *
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Address: *
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Occupation: *
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Business phone: *
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Parent/Guardian 2: *
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Home phone: *
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Cell phone: *
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Address: *
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Occupation: *
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Business phone: *
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Emails: *
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Other adults in home besides parents/guardians: *
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Names and ages of other children in family: *
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Physician: *
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Physician phone number: *
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Does your child have ANY specific allergies and/or medication needs? (If yes, please fill out our Allergy Form and/or Medication Forms found on our website). *
List any serious illnesses or hospitalizations, or separate developmental needs:
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Special precautions necessary regarding nutrition or daily activities:
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Helpful information about your child's latest interests, experiences and/or struggles:
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Other information or talents that either parent would like to share with our school:
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