Facebook Instagram Twitter Flickr Test Child Info Child's Name Date of Birth Age as of 10/19 Gender M/F Primary Language Spoken at Home Current/Previous Pre-School Provider Child's Name Date of Birth Age as of 10/19 Gender M/F Primary Language Spoken at Home Current/Previous Pre-School Provider Child's Name Date of Birth Age as of 10/19 Gender M/F Primary Language Spoken at Home Current/Previous Pre-School Provider Parent/Guardian Info Father's Name Father's Country of Origin Mother's Name Mother's Country of Origin Who does your child live with? Mother and FatherMotherFatherGrandparentsGuardianOther If "Guardian" or "Other," please specify: Student(s) Address: Home Phone Numbers Work Phone Numbers Cell Phone Numbers Sibling Info Do you currently have a Sibling(s) attending LEAP Academy University Charter School and/or the Rutgers Early Childhood Program? YesNo If Yes for LEAP... Name(s) Grade(s) Age(s) If Yes for Rutgers Pre-School Name(s) Age(s) Do you currently have any children ages 2 years or younger that are eligible to enroll in the Early Learning Research Academy Program for Infants and Toddlers? YesNo Name(s) Ages(s)/Grade(s) Name Email Address