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Help Me Grow
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For Caregivers
Help Me Grow Application
Does the child live in Sumter County?
Yes
No
Enter the child's zip code
Is the child 8 years or younger?
Yes
No
Child's First Name
Child's Last Name
Reason for Referral
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Relationship to Child
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Parent/Guardian First Name:
Parent/Guardian Last Name:
Parent/Guardian Address:
Parent/Guardian Phone Number:
Parent/Guardian Email:
Language Spoken:
Choose an option
Are you a 2-1-1 representative filling out this form on the child's behalf?
Yes
No
I agree to the Terms and Conditions of the Help Me Grow Program.
View terms of use
Thanks for applying!
Submit Now
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