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Wishing Well Pre-enrollment
1.
Childs Full Name
2.
Child's Date of Birth
3.
Parent #1 Full Name
4.
Parent #1 Contact
5.
Child's Address
6.
Number of Days
2
3
4
5
7.
Am/Pm or Both
Am (9am-12pm)
Pm (12:30pm-3:30pm)
Both (9am-3:30pm)
8.
Guardian Email
*
9.
Desired Scheduled Days?
(Required.)
*
10.
Does your child have any allergies that may require monitoring or administration of medication during school hours?
(Required.)