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PDO Form
Child’s Name
D.O.B.
Male / Female
Phone
Full Address
Parents’ Relationship to Each Other:
Married
Divorced
Separated
Single
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Child lives with:
Mother and Father
Mother
Father
Other
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if other:
Mother’s Name
Employer (Mother)
Work Phone (Mother)
Mobile Number (Mother)
Father’s Name
Employer (Father)
Work Phone (Father)
Mobile Number (Father)
Family’s Religious preference
What church do you attend regularly?
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