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