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Parent / Guardian Name
Parent / Guardian Phone or E-mail
Number of Children
1
2
3
4
Child's Age
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0-12 months
12-18 months
18-24 months
2 years - 2.5 years
2.5 years - 6 years
Child Care Center you are interested in...
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Little Peoples
Capstone
Hillcrest
Three Bears
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