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* 1. Please add your name and the best way to reach you (phone number, email, etc.)

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* 2. Please add your child's name and age. If you have multiple children attending the center, please list all children in the textbox below.

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* 3. Please select the choice most applicable to your current situation. If you have different answers for different children, please note that in your response and leave a comment in the "Other" checkbox. Please leave any additional detailed information you'd like to share in the "Other" checkbox.

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* 4. Are you currently working in a field that is considered an "essential" service (example: health care, retail, grocery stores or supply chain, etc.)

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* 5. Do you feel comfortable with children over two years of age wearing masks?

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* 6. Will you abide with additional Health and Safety measures such as daily temperature and health checks at drop off, and handwashing/sanitizing before entering the classrooms?

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* 7. Has anyone in your household been diagnosed with, or come in to contact with anyone who contracted COVID -19 in the last month?

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* 8. Please list any questions or concerns you may have:

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