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Childs Name:
Gender:
Female
Male
Date of Birth:
Relationship with the child:
Current Address:
Phone:
Email:
Proposed starting date:
Please tick the days you require for care:
Mon
Tue
Wed
Thu
Fri
What hours of care per day will you require:
Has your child attended child care previously?
Yes
No
Does your child have any special needs or care requirements?
Yes
No
How did you learn about Alphabeta Services?

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