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Child Enrollment Form

Adults Authorized to Pick Up The Child

Other Children in The Household

Experiences With Other Children

Has this child ever been involved in a Preschool/Parents Day Out before?

Toilet Habits


Does this child have any food allergies?
Does this child have any other allergies?

Name a person other than the parent who is authorized to act in an emergency if the parent cannot be reached.

Emergency Information

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