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Welcome
Please submit this quick and easy Pre- Enrollment Questionnaire for each child that you wish to enroll. Someone from our team will get back to you within a week for further information.
8
Questions
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1
CHILD'S FULL NAME
First Name
Last Name
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2
CHILD'S BIRTHDATE
-
Year
Month
Day
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3
CHILD'S GENDER
MALE
FEMALE
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4
CHILD'S PROJECTED ATTENDANCE SCHEDULE
NOTE: Care is provided for up to 10 hours per day. If additional time is needed, let the provider know and they’ll let you know if there is a spot available during the requested time frame.
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5
PARENT/GUARDIAN NAME
First Name
Last Name
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6
PARENT/GUARDIAN RELATIONSHIP TO CHILD
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7
PARENT/GUARDIAN TELEPHONE NUMBER
Area Code
Phone Number
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8
PARENT/GUARDIAN EMAIL ADDRESS
example@example.com
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