Little Vikings Preschool Application
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Legal Student Last Name *
Legal Student First Name *
Legal Student Middle Name
Physical Street Address *
City *
Zip Code *
Mailing Street Address (if different)
City
Zip Code
Is your family currently experiencing transition with regards to permanent stable housing? *
If yes, please indicate which of the following applies:
Primary Phone Number *
Alternate Phone Number
Gender *
Birth Date *
MM
/
DD
/
YYYY
County of Residence *
Closest Crossroads *
Email Address *
What was your child’s primary form of care in the last year? *
CAPS has extended care available from 6:30 AM-6:30 PM Monday-Friday for an additional $13 per day.  Will your child need extended care? *
What is your child's race? *
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