Easterseals Academy Application

Do parents have shared (or joint) parental rights and responsibilities?*
Does either parent have final decision-making authority regarding educational decisions for the student?*
Are you interested in receiving information about our therapy services?*

Documentation
My signature below affirms that all of the information contained in this application is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this application may jeopardize my child's admission.
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Name*

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Date*

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Please verify that you are human*
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