Acelero WI Parent/Guardian Interest
Complete this form at time of initial parent/guardian contact regarding enrollment
Email address *
Your Name *
Your answer
Date of contact *
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Child Name *
Your answer
Child DOB *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Your answer
Parent/Guardian Gender *
Parent/Guardian DOB *
MM
/
DD
/
YYYY
Child Gender *
Parent/Guardian E-mail
Your answer
Telephone Number (use dashes) *
Your answer
Alternate Telephone Number (use dashes)
Your answer
County *
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