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Interest List Information Form

Thank you for your interest in Bright Beginnings! Please fill out the form below. If there is a spot available for your child we will contact you via phone or email upon receipt of this inquiry. If there is not a spot available at the time of your inquiry we will place your child on a waitlist and when a spot becomes available we will contact you to see if you are still interested.

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Child's Gender:
My child has been in the following child care situations (please select all that apply):
My child currently receives services such as (please check all that apply):
My child has had an evaluation:
My child has an Individualized Family Service Plan (IFSP) or an Individualized Education Program (IEP):

Program Preference:

Full Day 7:00 a.m. - 5:00 p.m. 
AM Program 8:45 a.m. - 11:15 a.m.
PM Program 11:45 a.m. - 2:15 p.m.
AM & PM Program 8:45 a.m. - 2:15 p.m.

Toddler Program Preferences (18-36 months):
Preschool Program Preferences (36- 60 months):
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