YWCA Young Wonders Child Care Center PRINCETON
Student First Name
Your answer
Student Last Name
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Student Ethnicity and Race
Please answer these questions to help us know the demographics of who we are serving and so we may serve you better.

American Indian or Alaska Native
A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American
A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Is the student Hispanic or Latino (of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?
Please select the racial category or categories with which you most closely identify the student. Check as many as apply.
Required
Student Allergies
Student Medications
Your answer
Student Doctor's Name
Your answer
Student Doctor's Phone
Your answer
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