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Foundations Early Learning and Family Center
6505 E J Oliver Blvd, FAIRFIELD, AL, 35064
1
Student info
2
Parent info
3
Authorized Pickup Info
4
Policy & Waiver
5
Review
Student #1
First Name
Last Name
Date of Birth
Select Date
Allergies
Medication Needs
Name/nickname he or she should learn to write:
Is the child's home address different from the parent or guardian's
Is the child's home address different from the parent or guardian's
If yes, what is the child's address?
Does your child have a history of
Does your child have a history of
Please explain items checked
What is your child's typical bedtime?
What is your child's typical rising time?
Does your child have a current (IEP/IFSP)?
Does your child have a current (IEP/IFSP)?
How many children's books are in the home?
How many children's book are in the home?
Last Attended School/Childcare Center
Your Child's Household
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Yes
No
Asthma
Difficulty waking up to use the restroom while napping/sleeping
Dizziness
Frequent colds
Frequent urination
Headaches
Hearing problems
Nose bleeds
Speech difficulty
Vision problems
Other
none
yes
no
0
1-4
5-10
more than 10