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Get RCEB Early Start Referral 2014-2024

Gency or individual) ____________________________________ Phone_________________________________ CONSENT: 1. 2. 3. Verbal or written consent by Parent / Legal Guardian is required prior to this referral. Referral cannot be processed if this is not completed. Verbal consent has been obtained from parent / legal guardian for referral of child to: The Early Start Program at Regional Center of the East Bay and/or LEA, and if eligible, they agree to participate. OR I hereby give consent for my chi.

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