LINDENHURST UFSD
CHILDCARE APPLICATION - SCHOOL YEAR 2018-2019
Email address *
Student Name: *
Your answer
School of Attendance: *
Grade for School Year 18-19 *
Home Address *
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Parent Name & Priority Contact Phone #: *
Your answer
Type of Childcare: *
Please select Licensed Daycare
Private Childcare Information-List Name, Address & Phone Number
Your answer
Check Days of Week Student will Attend Daycare *
Required
Please select one: *
Comments: *
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Your answer
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