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* 1. Date:

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* 2. Parent Name:

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* 3. Name of Child: 

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* 4. Age of Child: 

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* 5. Can your child write his/her name? 

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* 6. Has your child had any experience with the following materials? 

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* 7. What are your expectations of this program?

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* 8. Is there anything you would like the teacher to know about your child?

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* 9. Any other questions or comments are welcome:

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