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Programs
Preschool
Elementary
Adolescent
Community Preschool + Child Care
Adult Autism
Autism Services For Kids With Autism
Parents
COVID-19 Information
Calendar
Bus Schedules
Lunch Menu
Parent Resources
Scientific Findings
Pingree PTA
About Us
Our Facility
Do Your Blue
Success Stories
Meet The Team
Resources
Get Involved
Blog
In The News
Join Our Team
Contact
Pingree Center Referral Form
Donate
Pingree Center Referral Form
Pingree Center Referral Form
Parent/Guardian Full Name
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Child's Full Name
Child's Date of Birth
Date Format: MM slash DD slash YYYY
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Does child have a previous diagnosis of Autism (Yes/No)
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Please list any additional diagnoses your child has (e.g. ADHD, Anxiety etc.)
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