Census Form | Wayland-Cohocton

Please list children living at home who are under school age

Please enter the Primary Contact for children below:

Child 1

Name (First, Middle, Last):

Date of Birth:

State where born:

Gender:

Child 2

Name (First, Middle, Last):

Date of Birth:

State where born:

Gender:

Child 3

Name (First, Middle, Last):

Date of Birth:

State where born:

Gender:

Child 4

Name (First, Middle, Last):

Date of Birth:

State where born:

Gender:

2. If you wish to be contacted concerning Pre-School Education about a child in your family please check here: