I need childcare

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* 1. Full name

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* 2. Email address

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* 3. Phone number

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* 4. Zip/postal code

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* 5. Number of children

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* 6. Age of child(ren)

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* 7. Days/times childcare is needed

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning	Morning Monday	Morning Tuesday	Morning Wednesday	Morning Thursday	Morning Friday	Morning Saturday	Morning Sunday
Afternoon	Afternoon Monday	Afternoon Tuesday	Afternoon Wednesday	Afternoon Thursday	Afternoon Friday	Afternoon Saturday	Afternoon Sunday
Evening	Evening Monday	Evening Tuesday	Evening Wednesday	Evening Thursday	Evening Friday	Evening Saturday	Evening Sunday

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* 8. Additional information