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* 1. How many children under the age of 5 do you have or care for? 

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* 2. Please enter the first name of each child under the age of 5 in the table below.

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* 3. Please enter the Month/Year of Birth of each child under the age of 5 in the table below.

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* 4. Since children have different needs and abilities, please respond to the questions below by focusing on one of your children. Please write the name of the child you will focus on. 

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