Child Care

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* 1. Full Name of Parent

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* 2. Cell Phone # of Parent

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* 3. Email Address of Parent

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* 4. Full Name of Other Contact

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* 5. Cell Phone # of Other Contact

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* 6. Email Address of Other Contact

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* 7. Number of Children

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* 8. Age/s

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* 9. Male/Female

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* 10. Dates/Times Child Care Needed
(Only Available During Session Hours)

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* 11. Do any of your children have food allergies? If yes, please explain.

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* 12. Do any of your children have any special needs such as: health, behavior, emotional, or academic concerns? If yes, please explain.