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Hemingway Homecare Application
Please answer all questions to the best of your ability! Good communication and honesty is extremely important for me and the families that we have in our care!
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Name of Child
Birthdate
MM
/
DD
/
YYYY
Current Age
Elementary School they are/will be attending
Hours needed for care
Days of the week (check all that apply)
Parent/Gaurdian(s) Name(s)
Parent/Guardian(s) Occupations
Share with me a bit about your family:
What would be your ideal childcare setting for your child?
What are your child(ren)'s interests?
When would you be looking to start childcare?
How long do you plan for your child to be in childcare?
Does your child have any dietary restrictions?
Are you working through any development or behavioral delays/concerns with your child?
Anything else you would like to share:
Would you like to have a reference from another parent in our childcare program?
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