CIT Pre-KIT Registration Form

Please complete one form per child (ages 3-5)

Course Information

Please select course(s):*
Please select term:*
Please select Debrief term:*

Child Information

Name of Child*
Gender of Child*
Date of Birth*

Parent Information

Parent's Name*

Debrief Questionnaire

Has this child been on Home Assignment before?*

General Questionnaire

Prior to your arrival at CIT, what is the best way for us to contact you if we have a question about your child?*
What is your child's bathroom ability?*
Severity of food restriction/allergy, if applicable
Has your child been diagnosed with or do you have any concerns that your child may have any emotional, mental, or physical challenges?
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