Marionville Elementary
After School Childcare Registry
Student Last Name
Student First Name
Guardian #1 - Name
Guardian #1 - Relationship to student
Guardian #1 - Phone Number
Guardian #2 - Name
Guardian #2 - Relationship to student
Guardian #2 - Phone Number
Guardian #3 - Name
Guardian #3 - Relationship to student
Guardian #3 - Phone Number
Anticipated use of Childcare program (check all that apply)
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