Child Care Pre-Registration Middle School 2020-2021
Email address *
Child First Name *
Child Last Name *
School *
Grade *
Address *
Parent(s) Name: (Please advise if name on check is different than child's last name) *
Home Phone Number: *
Cell Number 1 *
Work Number *
Monday AM
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Tuesday AM
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Wednesday AM
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Thursday AM
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Friday AM
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Monday PM
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Tuesday PM
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Wednesday PM
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Thursday PM
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Friday PM
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E-mail *
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