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Child's First Name
Child's Last Name
Child's Birthday
Hours required
*
Full Day
Half Day Morning
Half Day Afternoon
Other
Days of week required (Select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Before or after school care?
*
Before school
After school
Both
Parent First Name
Parent Last Name
Relationship to child
Phone
Send
Child's name
Child's date of birth
Hours required
*
Full day
Half day morning
Half day afternoon
Other
Days of week required (Select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Before or after school care?
*
Before school
After school
Both
Parent name
Relationship to child
Phone
Email
Send
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