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Early Childhood Enrollment Collection for 2023-24
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* Indicates required question
Email
*
Your email
CHILD'S
LAST Name
*
Your answer
CHILD'S
FIRST Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Weeks born premature, if any
*
Choose
1
2
3
4
5
6
7
8
9
10
0
Gender
*
Male
Female
Complete Address (address & city)
*
Your answer
Parent/Guardian's first & last name
*
Your answer
Parent/Guardian's phone number
*
Your answer
Valid Email
*
Your answer
Relationship to child
*
Choose
Mother
Father
Grandparent or other relative
Foster Parent
Guardian
Teacher
Child Care Provider
Other
We are currently at compacity. You are being placed on a wait list for the 2023-2024 school year.
*
"I acknowledge that my child is being put on a wait list for Early Childhood for the 2023-2024 school year.
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