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Family Information Notebook (FIN) - Vanderbilt Kennedy Center

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CHILD’S NAME: DATE OF BIRTH:<br />

Name of Program / School:<br />

Name of School District:<br />

City: State:<br />

Name of Teacher: Grade or Child’s Age:<br />

Check One: Fall Spring Summer Year:<br />

Other school services (e.g. occupational therapist (OT), physical therapist (PT), remedial reading,<br />

speech, etc.):<br />

39<br />

Name of Teacher / Therapist: Type of Class / Frequency of Attendance<br />

Reason for leaving program / school:<br />

Name of Program / School:<br />

Name of School District:<br />

City: State:<br />

Name of Teacher: Grade or Child’s Age:<br />

Check One: Fall Spring Summer Year:<br />

Other school services (e.g. occupational therapist (OT), physical therapist (PT), remedial reading,<br />

speech, etc.):<br />

Name of Teacher / Therapist: Type of Class / Frequency of Attendance<br />

Reason for leaving program / school:<br />

© Junior League <strong>Family</strong> Resource <strong>Center</strong> 2005

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