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In accordance with the Children's Online Privacy Protection Act,
a person must be 13 years of age or older to complete and submit this form.

Request for Brochure:  
Name:
Address:
City:
State and/or Country:
Zip or Postal Code:
Home Phone #:
Work Phone #:
Email Address:
Child's Name and School Grade entering September, 2011
Name:
Grade in September 2011:
Name:
Grade in September 2011:
Name:
Grade in September 2011:
Additional Comments and/or Information:

Massachusetts Department of Public Heath Regulation 430.190 (D) states that all parents have the right to review background check, health care policies, discipline policies and grievance procedures upon request.