Great Start Registration
Date:
Parent Name:
Parent's Birth Date:(mm/dd/yyyy)
Mailing Address:
City, state, zip:
Home Phone:
Work Phone:
E-mail:
Name(s) of child(ren):
Birth date: (mm/dd/yyyy)
School District (if known):
By pressing the "Submit" button below, I consent and understand that the information from registration will be made available to Char-Em ISD, local school districts, and Great Start Alliance members for mailings and contacts notifying me of services and activities for my family. The project also includes data collection for population studies and quality control and I or my children will not be identified personally. This consent can be ended by notifying Great Start by phone, in person, or in writing.



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