HIPPY Pre-Enrollment Form
Please complete the Pre-Enrollment form for the HIPPY Program
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Email *
Guardian Name/ Nombre del Guardian *
Child Name/ Nombre del Niño *
HIPPY Returning Child/ Niño que regresa a HIPPY *
Child date of birth/ Fecha de Nacimiento *
MM
/
DD
/
YYYY
Child Age/ Edad
Parent Primary Language/ Idioma Natal del Adulto *
Home Address, City, State, Zip/ Dirección, Cuidad, Estado, Código *
Phone Number/ Teléfono *
Reliable internet at home/ Internet en casa *
Comfortable with Virtual Visits/ Cómodo con visitas virtuales *
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