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* 1. Parent/Guardian Name, Relationship to Children

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* 2. Child 1 Name, Age

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* 3. Child 2 Name, Age

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* 4. Child 4 Name, Age

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* 5. Child 5 Name, Age

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* 6. What days between June 5th - June 10th (during conference hours) would you like child care for the listed children?

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