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Parent Questionnaire 
Parent/ Legal Guardian Information
Child's Information 
Child's Insurance 
Child Questionnaire 
CHECK ALL THAT APPLY
Self-Harming
Behavior Misconduct
Feelings of Anxiety
Depression
Disrespectful to property
Does your child have any open cases in the following orginzations?
If you clicked one of the orginzations, do you give permission to release information to the named orginiazation
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