Camp ELLI 2019 Information Capture

Note: **Child must be a resident of Norwalk in order to complete this survey**/ Nota **El niño debe ser residente de Norwalk para completar esta encuesta**

1. Parent or Guardian Name/ Nombre de Padre o Guardián *This question is required.

2. Address/ Dirección *This question is required.

3. Phone Number/ Teléfono *This question is required.

4. Email/ Correo Electrónico *This question is required.

5. Child Name/ Nombre del Niño *This question is required.

6. Date of Birth/ Fecha de Nacimiento *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

7. Is the child entering Kindergarten in the Fall of 2019?/ ¿Asistirá al Kinder en el otoño? *This question is required.

8. Does the child have Preschool experience?/ ¿Experiencia Pre-escolar? *This question is required.

9. If Yes, What is the child's preschool experience?/ En caso afirmativo: ¿Qué es experiencia preescolar del niño?
Full-time or Part-time?
How many years?
Type of program (home day care or center) (name of center) *This question is required.