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Happy Hearts Intake Form

Please share some general information about your child to make their transition to Happy Hearts Family Daycare as smooth as possible.

General Information

Child's Gender
Male
Female
Prefer not to say
Other
What languages other than English are being used with your child?

Child Development

Tell us a little about what concerns you have.

How comfortable is your child in group situations?
Very uncomfortable
Quite uncomfortable
Neutral
Quite comfortable
Very comfortable
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