2013 WRIGHTSTOWN COMMUNITY SCHOOL DISTRICT CENSUS

HEAD OF HOUSEHOLD INFORMATION

If you have children between the ages of 0-19 and live in the Wrightstown School District, please fill out the following questions.

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* 1. Please enter the following information.

Last Name (Head of Household) *

First Name: *

Address: *

Address 2:

City/Town: *

ZIP:

Spouse:

Email Address:

Phone Number: *

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* 2. Please check your Municipality

VILLAGE OF WRIGHTSTOWN

TOWN OF WRIGHTSTOWN

TOWN OF HOLLAND

TOWN OF LAWRENCE

TOWN OF MORRISON

TOWN OF ROCKLAND

TOWN OF BUCHANAN

TOWN OF KAUKAUNA

TOWN OF BRILLION

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* 3. Please list any household members ages birth to 19 (Any person who will not become 20 years old by 6/30/2013

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* 4. CHILD #1

Child's Name

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* 5. Child's Birthdate

Child #1

Date

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* 6. Gender (Child #1)

FEMALE

MALE

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* 7. CHILD #2

Child's Name

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* 8. Child's Birthdate

Child #2

Date

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* 9. Gender (Child #2)

FEMALE

MALE

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* 10. CHILD #3

Child's Name

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* 11. Child's Birthdate

Child #3

Date

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* 12. Gender (Child #3)

FEMALE

MALE

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* 13. CHILD #4

Child's Name

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* 14. Child's Birthdate

Child #4

Date

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* 15. Gender (Child #4)

FEMALE

MALE

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* 16. CHILD #5

Child's Name

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* 17. Child's Birthdate

Child #5

Date

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* 18. Gender (Child #5)

FEMALE

MALE

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* 19. CHILD #6

Child's Name

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* 20. Child's Birthdate

Child #6

Date

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* 21. Gender (Child #6)

FEMALE

MALE