<?xml version="1.0" encoding="utf-8" ?> 
    <forms>
	<form id="14" title="Infant Enrollment Packet - Copy" type="embedded"  published="1" savedb="1" sendemail="1">
		<fields>
			<field id="5" type="type_name" w_field_label="Childs' Name" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_first_val="*********" w_title="*********" w_mini_labels="Title*********Middle" w_size="" w_name_format="normal" w_required="no" w_unique="no" w_class="" w_name_fields="no***no" w_autofill="no" w_attr_name="attribute=value, ">
			</field>
			<field id="9" type="type_date_fields" w_field_label="Date of Birth" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_day="" w_month="" w_year="" w_day_type="SELECT" w_month_type="SELECT" w_year_type="SELECT" w_day_label="day" w_month_label="month" w_year_label="year" w_day_size="70" w_month_size="135" w_year_size="90" w_required="no" w_class="wdform_date_fields dob-position" w_from="2010" w_to="2025" w_divider="*:*w_min_day*:**:*w_min_month*:**:*w_min_year*:*Date of birth does not meet specified requirements.*:*w_min_dob_alert*:*&amp;#160;/&amp;#160;" >
			</field>
			<field id="646" type="type_text" w_field_label="Age" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="150" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="%5E%28%5B0-9%5D%7C1%5B0%2C1%2C2%5D%29/%28%5B0-9%5D%7C%5B0%2C1%2C2%5D%5B0-9%5D%7C3%5B0%2C1%5D%29/%5B0-9%5D%7B4%7D%24" w_regExp_common="9" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="yes" w_class="" >
			</field>
			<field id="10" type="type_radio" w_field_label="Gender" w_field_label_size="" w_field_label_pos="top" w_field_option_pos="right" w_hide_label="no" w_flow="hor" w_choices="Male***Female" w_choices_checked="false***false" w_rowcol="1" w_required="no" w_randomize="no" w_allow_other="no" w_allow_other_num="0" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Male***Female" w_choices_params="***" w_class="" >
			</field>
			<field id="627" type="type_editor" w_field_label="Custom HTML627">
				<![CDATA[]]>
			</field>
			<field id="12" type="type_text" w_field_label="If Yes, Where and for How long?" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="11" type="type_text" w_field_label="Has your child been to a Preschool before?" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="18" type="type_editor" w_field_label="Custom HTML18">
				<![CDATA[<div class="sub-title-form-2 text-left"><p class="text-left">Please check the appropriate program Schedule &amp; Meal Pattern</p></div>]]>
			</field>
			<field id="19" type="type_editor" w_field_label="Custom HTML19">
				<![CDATA[<p class="text-left pt-6">Full Time 5 days a week</p>]]>
			</field>
			<field id="647" type="type_text" w_field_label="Monthly $&lt;span&gt;Full Time 5 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="650" type="type_text" w_field_label="Weekly $&lt;span&gt;Full Time 5 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="27" type="type_editor" w_field_label="Custom HTML27">
				<![CDATA[<p class="text-left pt-6">Part Time 3 days a week*</p>]]>
			</field>
			<field id="648" type="type_text" w_field_label="Monthly $&lt;span&gt;Part Time 3 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="652" type="type_text" w_field_label="Weekly $&lt;span&gt;Part Time 3 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="30" type="type_editor" w_field_label="Custom HTML30">
				<![CDATA[<p class="text-left pt-6">Part Time 2 days a week*</p>]]>
			</field>
			<field id="649" type="type_text" w_field_label="Monthly $&lt;span&gt; Part Time 2 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="651" type="type_text" w_field_label="Weekly $&lt;span&gt;Part Time 2 days&lt;/span&gt;" w_field_label_size="90" w_field_label_pos="left" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="month_box" >
			</field>
			<field id="653" type="type_matrix" w_field_label="Matrix(1)" w_field_label_size="200" w_field_label_pos="left" w_hide_label="yes" w_field_input_type="text" w_rows="***Breakfast***Lunch***Snack***Hours of Care (ex9-5)" w_columns="***Monday***Tuesday***Wednesday***Thursday***Friday" w_required="no" w_class="Table01" w_textbox_size="100" w_attr_name="attribute=value, ">
			</field>
			<field id="35" type="type_date_new" w_field_label="Request starting date" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="180" w_date="" w_required="no" w_show_image="no" w_class="" w_format="mm/dd/yy" w_start_day="0" w_default_date="" w_min_date="" w_max_date="" w_invalid_dates="" w_show_days="yes***yes***yes***yes***yes***yes***yes" w_hide_time="yes" w_but_val="..." w_disable_past_days="no" >
			</field>
			<field id="36" type="type_text" w_field_label="How did you hear about us" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="44" type="type_editor" w_field_label="Custom HTML44">
				<![CDATA[<div class="sub-title-form-maker">PARENT / GUARDIAN INFORMATION</div><div><br data-mce-bogus="1"></div><div style="text-align: left;" data-mce-style="text-align: left;"><strong><span style="text-decoration: underline;" data-mce-style="text-decoration: underline;">Mother's Information</span></strong><br data-mce-bogus="1"></div>]]>
			</field>
			<field id="45" type="type_text" w_field_label="Mother's Name " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="46" type="type_text" w_field_label="Social Security # " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="47" type="type_text" w_field_label="DL #" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="623" type="type_text" w_field_label="Address" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="622" type="type_text" w_field_label="City" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="624" type="type_text" w_field_label="State" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="625" type="type_text" w_field_label="Zip" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="54" type="type_submitter_mail" w_field_label="Email" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_unique="no" w_class="" w_verification="no" w_verification_label="Email confirmation" w_verification_placeholder="" w_autofill="no" >
			</field>
			<field id="55" type="type_phone_new" w_field_label="Home Phone" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="57" type="type_text" w_field_label="Place of Employment" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="56" type="type_phone_new" w_field_label="Cell Phone" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="58" type="type_text" w_field_label="Job Title" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="59" type="type_phone_new" w_field_label="Work Phone" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="60" type="type_own_select" w_field_label="Marital Status" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_choices="Select value***Single***Married " w_choices_checked="true***false***false" w_choices_disabled="false***false***false" w_required="no" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Select value***Single***Married " w_choices_params="******" w_class="wdform_select" >
			</field>
			<field id="61" type="type_text" w_field_label="Custody Information" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="654" type="type_editor" w_field_label="Custom HTML654">
				<![CDATA[<div class="sub-title-form-maker">\r\n</div><div><br data-mce-bogus="1"></div><div style="text-align: left;" data-mce-style="text-align: left;"><strong><span style="text-decoration: underline;" data-mce-style="text-decoration: underline;">Father's Information</span></strong><br data-mce-bogus="1"></div>]]>
			</field>
			<field id="655" type="type_text" w_field_label="Father's Name" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="656" type="type_text" w_field_label="Social Security #father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="657" type="type_text" w_field_label="DL # father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="658" type="type_text" w_field_label="Address father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="659" type="type_text" w_field_label="City father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="660" type="type_text" w_field_label="State father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="662" type="type_text" w_field_label="Zip father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="664" type="type_submitter_mail" w_field_label="Email father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_unique="no" w_class="" w_verification="no" w_verification_label="Email confirmation" w_verification_placeholder="" w_autofill="no" >
			</field>
			<field id="665" type="type_phone_new" w_field_label="Home Phone father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="666" type="type_text" w_field_label="Place of Employment father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="667" type="type_phone_new" w_field_label="Cell Phone father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="668" type="type_text" w_field_label="Job Title father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="669" type="type_phone_new" w_field_label="Work Phone father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="670" type="type_own_select" w_field_label="Marital Status father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_choices="Select value***Single***Married " w_choices_checked="true***false***false" w_choices_disabled="false***false***false" w_required="no" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Select value***Single***Married " w_choices_params="******" w_class="wdform_select" >
			</field>
			<field id="671" type="type_text" w_field_label="Custody Information father" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="62" type="type_text" w_field_label="List any allergies your child has" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="63" type="type_text" w_field_label="My child excels in" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="64" type="type_text" w_field_label="My child needs help in" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="65" type="type_text" w_field_label="Parent's evaluation of child's personality" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="66" type="type_text" w_field_label="Does your child have any special needs/problems/fears?" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="67" type="type_text" w_field_label="Additional information we should know about your child" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="68" type="type_editor" w_field_label="Custom HTML68">
				<![CDATA[<div class="form-body-text"><p class="pargh-text text-left">Return this completed application with your enrollment fees as soon as
possible to reserve your child's space. Enrollment fees do not include your
first week's tuition</p><ul class="page-3-ul"><li>I understand I am signing up for specific days and times and I am responsible for Payment according to the school policy</li><li>I understand that the enrollment fees are non-refundable.</li></ul></div>]]>
			</field>
			<field id="70" type="type_date_new" w_field_label="Date" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="180" w_date="" w_required="no" w_show_image="no" w_class="" w_format="mm/dd/yy" w_start_day="0" w_default_date="" w_min_date="" w_max_date="" w_invalid_dates="" w_show_days="yes***yes***yes***yes***yes***yes***yes" w_hide_time="yes" w_but_val="..." w_disable_past_days="no" >
			</field>
			<field id="69" type="type_signature" w_field_label="Parent/Guardian's Signature" >
			</field>
			<field id="483" type="type_editor" w_field_label="Custom HTML483">
				<![CDATA[<div class="sub-title-form py-20">Village Preschool Academy Infant &amp; Preschool Infant Needs and Services Plan
</div>]]>
			</field>
			<field id="484" type="type_text" w_field_label="Childs Name: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="485" type="type_date_fields" w_field_label="Birth Date: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_day="" w_month="" w_year="" w_day_type="SELECT" w_month_type="SELECT" w_year_type="SELECT" w_day_label="day" w_month_label="month" w_year_label="year" w_day_size="70" w_month_size="140" w_year_size="90" w_required="no" w_class="wdform_date_fields dob-position" w_from="1901" w_to="2023" w_divider="*:*w_min_day*:**:*w_min_month*:**:*w_min_year*:*Date of birth does not meet specified requirements.*:*w_min_dob_alert*:*&amp;#160;/&amp;#160;" >
			</field>
			<field id="486" type="type_date_new" w_field_label="Todays Date:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="180" w_date="" w_required="no" w_show_image="no" w_class="" w_format="mm/dd/yy" w_start_day="0" w_default_date="" w_min_date="" w_max_date="" w_invalid_dates="" w_show_days="yes***yes***yes***yes***yes***yes***yes" w_hide_time="yes" w_but_val="..." w_disable_past_days="no" >
			</field>
			<field id="487" type="type_editor" w_field_label="Custom HTML487">
				<![CDATA[<div class="p-main-text"><p class="text-left">This form is to be completed then updated quarterly. Parents please bring any formula, bottles,
cups, food labeled with your child's name and the date. <b><i>All bottles of formula must be premixed as staff are not permitted to prepare formula.</i></b></p></div>]]>
			</field>
			<field id="488" type="type_editor" w_field_label="Custom HTML488">
				<![CDATA[<div class="sub-title-form"><div class="sub-title-form-3">Feeding Plan</div></div>]]>
			</field>
			<field id="489" type="type_radio" w_field_label="1. Is your child on a special diet? " w_field_label_size="" w_field_label_pos="top" w_field_option_pos="right" w_hide_label="no" w_flow="hor" w_choices="Yes***No" w_choices_checked="false***false" w_rowcol="1" w_required="no" w_randomize="no" w_allow_other="no" w_allow_other_num="0" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Yes***No" w_choices_params="***" w_class="" >
			</field>
			<field id="490" type="type_text" w_field_label="If yes please specify:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="491" type="type_radio" w_field_label="2. Does your child have any allergies? " w_field_label_size="" w_field_label_pos="top" w_field_option_pos="right" w_hide_label="no" w_flow="hor" w_choices="Yes***No" w_choices_checked="false***false" w_rowcol="1" w_required="no" w_randomize="no" w_allow_other="no" w_allow_other_num="0" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Yes***No" w_choices_params="***" w_class="" >
			</field>
			<field id="492" type="type_text" w_field_label="If yes, please list: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="493" type="type_text" w_field_label="3. Are there any foods your child should not eat for medical, personal, or religious reasons? " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="495" type="type_radio" w_field_label="4. Does your child use a bottle?" w_field_label_size="" w_field_label_pos="top" w_field_option_pos="right" w_hide_label="no" w_flow="hor" w_choices="Yes***No" w_choices_checked="false***false" w_rowcol="1" w_required="no" w_randomize="no" w_allow_other="no" w_allow_other_num="0" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:*Yes***No" w_choices_params="***" w_class="" >
			</field>
			<field id="497" type="type_text" w_field_label="What do you put in the bottle: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="496" type="type_checkbox" w_field_label="5. My child uses a: " w_field_label_size="150" w_field_label_pos="left" w_field_option_pos="right" w_hide_label="no" w_flow="hor" w_choices=" Fork ***Spoon ***Bottle ***Cup " w_choices_checked="false***false***false***false" w_rowcol="1" w_required="*:*w_limit_choice*:*You have exceeded the selection limit.*:*w_limit_choice_alert*:*no" w_randomize="no" w_allow_other="no" w_allow_other_num="0" w_value_disabled="no" w_choices_value="no*:*w_use_for_submission*:* Fork ***Spoon ***Bottle ***Cup " w_choices_params="*********" w_class="cus-checkbox-size box-496" >
			</field>
			<field id="498" type="type_text" w_field_label="6. Special likes and dislikes: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="499" type="type_text" w_field_label="7. Feeding Schedule" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="500" type="type_text" w_field_label="8. Timeline to introduce solids and specific consistency offoods:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="501" type="type_editor" w_field_label="Custom HTML501">
				<![CDATA[<div class="sub-title-form"><div class="sub-title-form-3">Safe Sleeping Plan</div></div>]]>
			</field>
			<field id="502" type="type_text" w_field_label="1.  What is your child's normal sleeping environment? " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="503" type="type_text" w_field_label="2.  What is your child's normal sleeping schedule and habits? " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="504" type="type_text" w_field_label="3.  What are your child's rolling abilities at this time?" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="505" type="type_editor" w_field_label="Custom HTML505">
				<![CDATA[<div class="form-body-text"><p class="pargh-text"><b><i>*please note we are not permitted to use swaddles/blankets/other loose items in cribs\r\n
*Parents are to bring one crib sheet and to be sent home on Fridays. We change sheets daily 
and will provide sheets for the rest of the week. </i></b></p></div>]]>
			</field>
			<field id="506" type="type_editor" w_field_label="Custom HTML506">
				<![CDATA[<div class="sub-title-form"><div class="sub-title-form-3">Toileting Plan</div></div>]]>
			</field>
			<field id="507" type="type_text" w_field_label="1. How many wet diapers a day approx.:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="508" type="type_text" w_field_label="2. How often does your child have a bowel movement:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="509" type="type_text" w_field_label="3.  Any special comments or concerns in reference to diapering/toileting:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="510" type="type_text" w_field_label="4.  Method preferred for toilet training:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="511" type="type_text" w_field_label="5. Specific equipment used and time line of use as directed/provided by parent as well as a timeline of introduction of appropriate clothing:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="512" type="type_editor" w_field_label="Custom HTML512">
				<![CDATA[<div class="p-main-text"><p class="text-left">All parents are asked to please provide diapers and wipes for their child, as well as any&nbsp; ointments, powders, etc. that may be preferred by the parent. Please make sure all supplies are
clearly labeled with your child's name. </p></div>]]>
			</field>
			<field id="513" type="type_editor" w_field_label="Custom HTML513">
				<![CDATA[<div class="p-main-text"><p class="text-left">I have discussed my infant's needs and services plan with the center's Director and agree with
the information provided here.  I will notify the Director immediately of any changes in the needs
of my child. </p></div>]]>
			</field>
			<field id="514" type="type_text" w_field_label="Parents Name" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="515" type="type_date_new" w_field_label="Date (Toilet planing)" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="180" w_date="" w_required="no" w_show_image="no" w_class="" w_format="mm/dd/yy" w_start_day="0" w_default_date="" w_min_date="" w_max_date="" w_invalid_dates="" w_show_days="yes***yes***yes***yes***yes***yes***yes" w_hide_time="yes" w_but_val="..." w_disable_past_days="no" >
			</field>
			<field id="518" type="type_text" w_field_label="Center Representative:" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="517" type="type_phone_new" w_field_label="Daytime Phone# : " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="636" type="type_editor" w_field_label="Custom HTML636">
				<![CDATA[]]>
			</field>
			<field id="519" type="type_date_new" w_field_label="Date (Toilet planing 2)" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="180" w_date="" w_required="no" w_show_image="no" w_class="" w_format="mm/dd/yy" w_start_day="0" w_default_date="" w_min_date="" w_max_date="" w_invalid_dates="" w_show_days="yes***yes***yes***yes***yes***yes***yes" w_hide_time="yes" w_but_val="..." w_disable_past_days="no" >
			</field>
			<field id="516" type="type_signature" w_field_label="Signature (Toilet planing)" >
			</field>
			<field id="610" type="type_editor" w_field_label="Custom HTML610">
				<![CDATA[<div class="sub-title-form text-center py-20">VILLAGE PRESCHOOL ACADEMY 
</div>]]>
			</field>
			<field id="598" type="type_editor" w_field_label="Custom HTML598">
				<![CDATA[<div class="form-body-text"><div class="p-main-text" style="font-size:14px;">
18052 Imperial Hwy.\r\n
Yorba Linda, CA 92886</div></div>]]>
			</field>
			<field id="618" type="type_editor" w_field_label="Custom HTML618">
				<![CDATA[<div class="form-body-text"><div class="p-main-text" style="text-align:right!important; font-size:14px;">
Phone : 714-993-3444\r\n
Fax : 714-993-3470 
</div></div>]]>
			</field>
			<field id="600" type="type_editor" w_field_label="Custom HTML600">
				<![CDATA[<div class="form-body-text"><p class="pargh-text">Village Preschool Academy uses Remind, a text messaging service, to send out&nbsp; important reminders and/or safety alerts if ever needed. If you would like to be signed up for&nbsp; Remind text messages please provide your Name and preferred cell phone number below. One 
or both Parents are welcome to sign up. 
</p></div>]]>
			</field>
			<field id="601" type="type_editor" w_field_label="Custom HTML601">
				<![CDATA[<div class="form-body-text"><p class="pargh-text">Please be aware this is a one way form of communication, no responses to Remind&nbsp;
messages will be received by Village Preschool Academy. Please always call the center directly&nbsp;
or stop by the office if you have any questions or concerns. </p></div>]]>
			</field>
			<field id="602" type="type_text" w_field_label="Child's Name: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="" >
			</field>
			<field id="603" type="type_text" w_field_label="Classroom: " w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="604" type="type_editor" w_field_label="Custom HTML604">
				<![CDATA[<div class="sub-title-form-maker">Contact 1</div>]]>
			</field>
			<field id="606" type="type_text" w_field_label="Contact 1 Name" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="607" type="type_phone_new" w_field_label="Contact 1 Cell Phone #" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="500" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="605" type="type_editor" w_field_label="Custom HTML605">
				<![CDATA[<div class="sub-title-form-maker">Contact 2</div>]]>
			</field>
			<field id="608" type="type_text" w_field_label="Contact 2 Name" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="" w_required="no" w_regExp_status="no" w_regExp_value="" w_regExp_common="" w_regExp_arg="" w_regExp_alert="Incorrect Value" w_unique="no" w_readonly="no" w_class="undefined" >
			</field>
			<field id="609" type="type_phone_new" w_field_label="Contact 2 Cell Phone #" w_field_label_size="" w_field_label_pos="top" w_hide_label="no" w_size="" w_first_val="" w_title="us*:*w_top_country*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:*" w_mini_labels="" w_required="" w_unique="" w_class="" >
			</field>
			<field id="611" type="type_editor" w_field_label="Custom HTML611">
				<![CDATA[<div class="sub-title-form text-center py-20">Infant and Toddler Supply List
</div>]]>
			</field>
			<field id="612" type="type_editor" w_field_label="Custom HTML612">
				<![CDATA[<div class="form-body-text"><p class="pargh-text text-center">Parents please make sure to supply your child's teacher with the 
following supplies. If your child is running low on a specific item they 
will notify you verbally or by sending home an "Oh No" report which 
will indicate which item/items they are running low on. Thank you for 
your support and cooperation! 
</p></div>]]>
			</field>
			<field id="613" type="type_editor" w_field_label="Custom HTML613">
				<![CDATA[<div class="form-body-text"><div class="pargh-text"><ol class="page-ol"><li>1 Crib sheet- to be sent home on Fridays for laundering. We will provide sheets for the rest of the week. </li><li>At least 1 pair of extra clothes.   </li><li>Diapers/Wipes and any other diapering supplies your child may require such as powder, ointment, etc.  </li><li>Infants only- 1 blanket for tummy time, also to be sent home on Fridays for laundering. </li><li>Infants only- Bottles and either formula or breast milk, as we do not supply food for the infants. </li><li>We also ask that infant/toddler parents provide a couple family photos for the children so that teachers can use them in the classroom. </li></ol></div></div>]]>
			</field>
			<field id="614" type="type_editor" w_field_label="Custom HTML614">
				<![CDATA[<div class="form-body-text"><p class="pargh-text text-center">Please remember any item brought into the infant/toddler classroom 
MUST be labeled with your child's name. Any food or bottle item&nbsp;
should be labeled with the child's ·name as well as the date it was&nbsp; brought in your child's teacher can assist you with this. 
</p></div>]]>
			</field>
			<field id="626" type="type_submit_reset" w_field_label="type_submit_reset_626" w_submit_title="Submit" w_reset_title="Reset" w_class="" w_act="false" >
			</field>
		</fields>
		<form>
			<![CDATA[]]>
		</form>
		<form_front>
			<![CDATA[<div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view1" class="wdform_page" page_title="First Page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="true" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="5" class="wdform_row">%5 - Childs' Name%</div></div><div class="wdform_column"><div wdid="9" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%9 - Date of Birth%</div><div wdid="646" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%646 - Age%</div><div wdid="10" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%10 - Gender%</div><div wdid="627" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%627 - Custom HTML627%</div></div><div class="wdform_column"><div wdid="12" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%12 - If Yes, Where and for How long?%</div><div wdid="11" class="wdform_row">%11 - Has your child been to a Preschool before?%</div></div><div class="wdform_column"><div wdid="18" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%18 - Custom HTML18%</div></div><div class="wdform_column"><div wdid="19" class="wdform_row">%19 - Custom HTML19%</div><div wdid="647" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%647 - Monthly $<span>Full Time 5 days</span>%</div><div wdid="650" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%650 - Weekly $<span>Full Time 5 days</span>%</div></div><div class="wdform_column"><div wdid="27" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%27 - Custom HTML27%</div><div wdid="648" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%648 - Monthly $<span>Part Time 3 days</span>%</div><div wdid="652" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%652 - Weekly $<span>Part Time 3 days</span>%</div></div><div class="wdform_column"><div wdid="30" class="wdform_row">%30 - Custom HTML30%</div><div wdid="649" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%649 - Monthly $<span> Part Time 2 days</span>%</div><div wdid="651" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%651 - Weekly $<span>Part Time 2 days</span>%</div></div><div class="wdform_column"><div wdid="653" class="wdform_row">%653 - Matrix(1)%</div></div><div class="wdform_column"><div wdid="35" class="wdform_row">%35 - Request starting date%</div></div><div class="wdform_column"><div wdid="36" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%36 - How did you hear about us%</div></div></div><div valign="top" class="wdform_footer wd-width-100" wfd-invisible="true"><div class="wd-width-100"><div class="wd-width-100 wd-table" style="padding-top:10px;"><div class="wd-table-group"><div id="form_id_temppage_nav1" class="wd-table-row"><div valign="middle" align="left" style="display: inline-block; width: 40%;"></div><div id="page_numbersform_id_temp1" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_1" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div><div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view2" page_title="Page - 2" class="wdform_page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="true" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="44" class="wdform_row">%44 - Custom HTML44%</div></div><div class="wdform_column"><div wdid="45" class="wdform_row">%45 - Mother's Name %</div></div><div class="wdform_column"><div wdid="46" class="wdform_row">%46 - Social Security # %</div><div wdid="47" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%47 - DL #%</div></div><div class="wdform_column"><div wdid="623" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%623 - Address%</div><div wdid="622" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%622 - City%</div></div><div class="wdform_column"><div wdid="624" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%624 - State%</div><div wdid="625" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%625 - Zip%</div><div wdid="54" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%54 - Email%</div><div wdid="55" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%55 - Home Phone%</div></div><div class="wdform_column"><div wdid="57" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%57 - Place of Employment%</div><div wdid="56" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%56 - Cell Phone%</div></div><div class="wdform_column"><div wdid="58" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%58 - Job Title%</div><div wdid="59" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%59 - Work Phone%</div><div wdid="60" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%60 - Marital Status%</div><div wdid="61" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%61 - Custody Information%</div></div><div class="wdform_column"><div wdid="654" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%654 - Custom HTML654%</div></div><div class="wdform_column"><div wdid="655" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%655 - Father's Name%</div></div><div class="wdform_column"><div wdid="656" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%656 - Social Security #father%</div><div wdid="657" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%657 - DL # father%</div></div><div class="wdform_column"><div wdid="658" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%658 - Address father%</div><div wdid="659" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%659 - City father%</div></div><div class="wdform_column"><div wdid="660" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%660 - State father%</div><div wdid="662" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%662 - Zip father%</div><div wdid="664" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%664 - Email father%</div><div wdid="665" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%665 - Home Phone father%</div></div><div class="wdform_column"><div wdid="666" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%666 - Place of Employment father%</div><div wdid="667" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%667 - Cell Phone father%</div></div><div class="wdform_column"><div wdid="668" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%668 - Job Title father%</div><div wdid="669" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%669 - Work Phone father%</div><div wdid="670" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%670 - Marital Status father%</div><div wdid="671" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%671 - Custody Information father%</div></div><div class="wdform_column"><div wdid="62" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%62 - List any allergies your child has%</div><div wdid="63" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%63 - My child excels in%</div><div wdid="64" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%64 - My child needs help in%</div></div><div class="wdform_column"><div wdid="65" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%65 - Parent's evaluation of child's personality%</div><div wdid="66" class="wdform_row">%66 - Does your child have any special needs/problems/fears?%</div></div><div class="wdform_column"><div wdid="67" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%67 - Additional information we should know about your child%</div></div><div class="wdform_column"><div wdid="68" class="wdform_row">%68 - Custom HTML68%</div></div><div class="wdform_column"><div wdid="70" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%70 - Date%</div></div><div class="wdform_column"><div wdid="69" class="wdform_row">%69 - Parent/Guardian's Signature%</div></div></div><div valign="top" class="wdform_footer" style="width: 100%;" wfd-invisible="true"><div style="width: 100%;"><div style="width: 100%; display: table;"><div style="display: table-row-group;"><div id="form_id_temppage_nav2" style="display: table-row;"><div valign="middle" align="left" style="display: inline-block; width: 40%;"><span id="page_previous_2" class="wdform-page-button" style="cursor: pointer;">Previous</span></div><div id="page_numbersform_id_temp2" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_2" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div><div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view20" page_title="Page - 17" class="wdform_page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="false" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="483" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%483 - Custom HTML483%</div></div><div class="wdform_column"><div wdid="484" class="wdform_row">%484 - Childs Name: %</div><div wdid="485" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%485 - Birth Date: %</div><div wdid="486" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%486 - Todays Date:%</div></div><div class="wdform_column"><div wdid="487" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%487 - Custom HTML487%</div></div><div class="wdform_column"><div wdid="488" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%488 - Custom HTML488%</div></div><div class="wdform_column"><div wdid="489" class="wdform_row">%489 - 1. Is your child on a special diet? %</div><div wdid="490" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%490 - If yes please specify:%</div></div><div class="wdform_column"><div wdid="491" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%491 - 2. Does your child have any allergies? %</div><div wdid="492" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%492 - If yes, please list: %</div></div><div class="wdform_column"><div wdid="493" class="wdform_row">%493 - 3. Are there any foods your child should not eat for medical, personal, or religious reasons? %</div></div><div class="wdform_column"><div wdid="495" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%495 - 4. Does your child use a bottle?%</div><div wdid="497" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%497 - What do you put in the bottle: %</div></div><div class="wdform_column"><div wdid="496" class="wdform_row">%496 - 5. My child uses a: %</div></div><div class="wdform_column"><div wdid="498" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%498 - 6. Special likes and dislikes: %</div></div><div class="wdform_column"><div wdid="499" class="wdform_row">%499 - 7. Feeding Schedule%</div></div><div class="wdform_column"><div wdid="500" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%500 - 8. Timeline to introduce solids and specific consistency offoods:%</div></div><div class="wdform_column"><div wdid="501" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%501 - Custom HTML501%</div></div><div class="wdform_column"><div wdid="502" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%502 - 1.  What is your child's normal sleeping environment? %</div></div><div class="wdform_column"><div wdid="503" class="wdform_row">%503 - 2.  What is your child's normal sleeping schedule and habits? %</div></div><div class="wdform_column"><div wdid="504" class="wdform_row">%504 - 3.  What are your child's rolling abilities at this time?%</div></div><div class="wdform_column"><div wdid="505" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%505 - Custom HTML505%</div></div></div><div valign="top" class="wdform_footer" style="width: 100%;" wfd-invisible="true"><div style="width: 100%;"><div style="width: 100%; display: table;"><div style="display: table-row-group;"><div id="form_id_temppage_nav20" style="display: table-row;"><div valign="middle" align="left" style="display: inline-block; width: 40%;"><span id="page_previous_20" class="wdform-page-button" style="cursor: pointer;">Previous</span></div><div id="page_numbersform_id_temp20" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_20" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div><div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view21" page_title="Page -18" class="wdform_page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="false" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="506" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%506 - Custom HTML506%</div></div><div class="wdform_column"><div wdid="507" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%507 - 1. How many wet diapers a day approx.:%</div><div wdid="508" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%508 - 2. How often does your child have a bowel movement:%</div></div><div class="wdform_column"><div wdid="509" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%509 - 3.  Any special comments or concerns in reference to diapering/toileting:%</div></div><div class="wdform_column"><div wdid="510" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%510 - 4.  Method preferred for toilet training:%</div></div><div class="wdform_column"><div wdid="511" class="wdform_row">%511 - 5. Specific equipment used and time line of use as directed/provided by parent as well as a timeline of introduction of appropriate clothing:%</div></div><div class="wdform_column"><div wdid="512" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%512 - Custom HTML512%</div></div><div class="wdform_column"><div wdid="513" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%513 - Custom HTML513%</div></div><div class="wdform_column"><div wdid="514" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%514 - Parents Name%</div><div wdid="515" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%515 - Date (Toilet planing)%</div></div><div class="wdform_column"><div wdid="518" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%518 - Center Representative:%</div><div wdid="517" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%517 - Daytime Phone# : %</div><div wdid="636" class="wdform_row">%636 - Custom HTML636%</div></div><div class="wdform_column"><div wdid="519" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%519 - Date (Toilet planing 2)%</div></div><div class="wdform_column"><div wdid="516" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%516 - Signature (Toilet planing)%</div></div></div><div valign="top" class="wdform_footer" style="width: 100%;" wfd-invisible="true"><div style="width: 100%;"><div style="width: 100%; display: table;"><div style="display: table-row-group;"><div id="form_id_temppage_nav21" style="display: table-row;"><div valign="middle" align="left" style="display: inline-block; width: 40%;"><span id="page_previous_21" class="wdform-page-button" style="cursor: pointer;">Previous</span></div><div id="page_numbersform_id_temp21" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_21" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div><div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view26" page_title="Page - 21" class="wdform_page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="false" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="610" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%610 - Custom HTML610%</div></div><div class="wdform_column"><div wdid="598" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%598 - Custom HTML598%</div><div wdid="618" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%618 - Custom HTML618%</div></div><div class="wdform_column"><div wdid="600" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%600 - Custom HTML600%</div></div><div class="wdform_column"><div wdid="601" class="wdform_row">%601 - Custom HTML601%</div></div><div class="wdform_column"><div wdid="602" class="wdform_row">%602 - Child's Name: %</div><div wdid="603" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%603 - Classroom: %</div></div><div class="wdform_column"><div wdid="604" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%604 - Custom HTML604%</div></div><div class="wdform_column"><div wdid="606" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%606 - Contact 1 Name%</div><div wdid="607" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%607 - Contact 1 Cell Phone #%</div></div><div class="wdform_column"><div wdid="605" class="wdform_row">%605 - Custom HTML605%</div></div><div class="wdform_column"><div wdid="608" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%608 - Contact 2 Name%</div><div wdid="609" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%609 - Contact 2 Cell Phone #%</div></div></div><div valign="top" class="wdform_footer" style="width: 100%;" wfd-invisible="true"><div style="width: 100%;"><div style="width: 100%; display: table;"><div style="display: table-row-group;"><div id="form_id_temppage_nav26" style="display: table-row;"><div valign="middle" align="left" style="display: inline-block; width: 40%;"><span id="page_previous_26" class="wdform-page-button" style="cursor: pointer;">Previous</span></div><div id="page_numbersform_id_temp26" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_26" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div><div class="wdform-page-and-images fm-form-builder" style="border-width: 1px;"><div id="form_id_tempform_view27" page_title="Page - 22" class="wdform_page" next_title="Next" next_type="text" next_class="wdform-page-button" next_checkable="true" previous_title="Previous" previous_type="text" previous_class="wdform-page-button" previous_checkable="false" style="" wfd-invisible="true"><div class="wdform_section"><div class="wdform_column"><div wdid="611" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%611 - Custom HTML611%</div></div><div class="wdform_column"><div wdid="612" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%612 - Custom HTML612%</div></div><div class="wdform_column"><div wdid="613" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%613 - Custom HTML613%</div></div><div class="wdform_column"><div wdid="614" class="wdform_row" style="position: relative; left: 0px; top: 0px;">%614 - Custom HTML614%</div></div><div class="wdform_column"><div wdid="626" class="wdform_row">%626 - type_submit_reset_626%</div></div></div><div valign="top" class="wdform_footer" style="width: 100%;" wfd-invisible="true"><div style="width: 100%;"><div style="width: 100%; display: table;"><div style="display: table-row-group;"><div id="form_id_temppage_nav27" style="display: table-row;"><div valign="middle" align="left" style="display: inline-block; width: 40%;"><span id="page_previous_27" class="wdform-page-button" style="cursor: pointer;">Previous</span></div><div id="page_numbersform_id_temp27" valign="middle" align="center" style="display: inline-block; width: 20%;"></div><div valign="middle" align="right" style="display: inline-block; width: 40%;"><span id="page_next_27" class="wdform-page-button" style="cursor: pointer;">Next</span></div></div></div></div></div></div></div></div>]]>
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