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* 1. What Head Start center does your child attend?

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* 2. Do you have a computer, laptop or tablet to support virtual and online learning activities?

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* 3. If you have a computer, laptop or tablet in your home, will it be shared with more than one child for distance learning?

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* 4. Do you have access to reliable internet or Wi-Fi services?

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* 5. Child’s First and Last Name

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* 6. Parent's Contact Information

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