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Parent/Guardian Information
First name
Last name
Email
*
Phone
Preferred Contact Method
Phone
Text
Email
Child Information
Child's First Name
Child's Last Name
Child's Age
Child's Date of Birth
Program of Interest
Preschool (3 & 4)
Enrollment Details
Desired Start Date
Month
Day
Year
Schedule Needed
*
Days Needed
Monday
Tuesday
Wednesday
Thursday
Friday
Funding Information
Are you participating in Preschool for All?
Yes
No
Interested in Learning More
Will you be using ERDC Child Care Assistance?
Yes
No
Not Sure
Additional Information
How did you hear about us?
Questions or Comments
*
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