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* 1. Parent Name

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* 2. Child Age

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* 3. Looking for full or part time (if part time list how many days a week and which days) and is this for preschool or before and after school care

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* 4. What is the best email and phone number to reach you

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* 5. What would is the start date you are looking for

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* 6. Is there any additional information or questions you have about our program

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* 7. Would you like to be contacted for a tour of the facility

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