Information of Child First Name:     Last Name:  Nickname:  Gender:  Boy Girl Date of Birth:  (mm/dd/yyyy) Age on September 1:   Primary language spoken at home:    Information of Parent(s) or Guardian(s) with Whom Child Lives #1   First Name:     Last Name:  Address:  City/Town:  State:  Zip:  Phone:  Cell Phone:  Email:  #2   First Name:     Last Name:  Address:  City/Town:  State:  Zip:  Phone:  Cell Phone:  Email:    Additional Information of Child  Has you child had any group experiences with other young children?    Is your child currently particiapting in a play group or enrolled in an early  childhood program?    When would you like your child to start in the preschool?    Do you have any questions/comments?

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