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Get Ny Queens Public Library Enrollment Packet Spanish 2014-2024

GUARDIAN Child s Last Name First Name Sex Middle Name 0 Female 0 Male Date of Birth (Month/Day/Year ) 2011 / / // 2008 Hispanic/Latino? Race (Check ALL that apply) 0 American Indian 0 Asian 0 Black 0 White 0 Yes 0 No 0 Native Hawaiian/Pacific Islander 0 Other Child s Address City/Borough State Zip Code Health insurance 0 Yes 0 Parent/Guardian Last Name (including Medicaid)? 0 No 0 Foster Parent 0 Uncomplicated 0 Premature: 0 None Cell Work If yes to any item, please exp.

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