Child Information

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* 1. School

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* 2. Last Name

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* 3. First and Middle Names

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* 4. Preferred Name

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* 5. Birthdate

Date

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* 6. Gender

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* 7. Home phone

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* 8. Cell phone

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* 9. Primary Address

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* 10. Mailing address if different from Q9

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12% of survey complete.

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