Daycare registration form

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* 1. Child’s Name

First name

Last name

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* 2. Child's age

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* 3. Parent/Guardian Name

First name

Last name

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* 4. Parent/Guardian Email

Email address

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* 5. Parent/Guardian Phone

Country Code

Phone number

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* 6. Address

Street address

Street address 2

City

State

Zip Code

Country

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* 7. Hours of child care required

Full day

Half-day afternoon

Half-day morning

After school

Other (please specify)

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* 8. Days of the week childcare required (Select all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Daycare registration form

Question Title

* 1. Child’s Name

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* 2. Child's age

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* 3. Parent/Guardian Name

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* 4. Parent/Guardian Email

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* 5. Parent/Guardian Phone

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* 6. Address

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* 7. Hours of child care required

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* 8. Days of the week childcare required (Select all that apply)

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* 9. What allergies does your child have, if any?

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* 10. What medication does your child need to take, and at what time, if any?