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1. Parent/Guardian Name:
First
Last
2. Relationship:
Mother
Father
Guardian
3. Cell Phone:
4. Home Phone:
5. Work Phone:
6. Email:
7. Parent/Guardian Name:
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Last
8. Relationship:
Mother
Father
Guardian
9. Cell Phone:
10. Home Phone:
11. Work Phone
12. Email
13. Home Address:
Street Address
Address Line 2
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14. Child Name:
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15. Age:
16. Birth Date:
17. Sex:
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18. Child's Present School:
19. Child Name:
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20. Age:
21. Birth Date:
22. Sex:
Male
Female
23. Child's Present School:
24. ACA Programs:
Infant (3 mos - 18 mos)
Toddler (18 mos - 3 yrs)
Primary (3 yrs - 6 yrs)
Kindergarten (5 yrs - 6 yrs)
After- School (K - 5th Grade)
Summer Camps
25. Anticipated ACA Start Date?
26. Why are you interested in Austin Children's Academy?
27. How did you hear about Austin Children's Academy?
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28. Comments/Notes/Special Requests:
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Phone
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Email
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Child's First Name
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Child's Birth Date
Questions or Comments
12310 Ranch Rd 620 N
Austin, TX 78750
512-331-2075
info@austinchildrensacademy.org
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