Application for Enrollment to Early Chilhood Laboratory | College of Education

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Child's Name

Sex

Date of Birth

Home Address

Zip Code

Home Phone Number

Parent/Guardian's Name(s), Employer(s), Work Phone Number(s) and Email Address(es):

Indicate program(s) interested in:

Infant/Toddler (6 weeks - 3 years)

Preschool (3 - 5 years)

Is there a special need to enroll your child in this program? If so, please explain: