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Admissions Interest Form
Child's Name
*
First Name
Last Name
Parent or Guardian's Name
*
First Name
Last Name
Child's Date Of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Best number to reach you
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you find out about us?
*
Please Select
Wake County School System Preschool/ Office of Early Learning
Childrens' Developmental Services Agency (CDSA)
Childcare Subsidy Office/ Caseworker
Friend/Family Referral
Internet Search
Social Media (Facebook, Instagram, etc.)
Services Your Child Receives (or is waiting to receive)
*
Note any services(childcare, therapy, etc.) your child is currently receiving or any that you are planning to access.
What type of program are you interested in for your child? (Please include as much detailed information about your child to help our admissions team)
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