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    Child's Details

    Age group:2-3 Years3-4 Years4-5 Years5-6 Years6-7 Years

    Father's Details


    Mother's Details


    Guardian's Details


    Parent/Guardian Status: MarriedSingleDivorcedSeparatedWidowed


    Preferred mode of transportation: School vanParent/Guardian drop off & pick up

    General Information

    Has your child been diagnosed with any special needs? YesNo

    Is your child toilet trained? YesNo
    (If not please provide 3 diapers and change of clothes on a daily basis)