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Daycare
Date :
Preferred Time :
Start Time :
End Time :
Child's Information :
Name :
Gender :
Male
Female
Dob :
Year :
2017
2018
2019
2020
2021
2022
Month :
1
2
3
4
5
6
7
8
9
10
11
12
Date :
1
2
3
4
5
6
7
8
9
10
11
12
Grade :
Date of last tetanus booster :
Any special medicine, allergies to medicine or physical impairment :
Parent's Information :
Mother (Full Name):
Mother's Employer:
Designation:
Mobile :
Email :
Father (Full Name):
Father's Employer:
Designation:
Mobile :
Email :
Permanent Address :
Emergency Information
Person to ask for (Full Name):
Mobile (Incase parents aren't available , please provide guardian no) :
Relationship :
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