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(ENGLISH) Registration Form - La Cabaña de la Abuela Childcare and Preschool
Welcome to
La Cabaña de la Abuela
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Student Information
Student's Name
*
Your answer
Student's Last Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Address (City, State, Zip Code)
*
Your answer
Allergies
*
Your answer
Mom's information
Name
*
Your answer
Last name
*
Your answer
Phone
*
Your answer
Email Address
*
Your answer
Place of Employment
*
Your answer
Dad's information
Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Phone
*
Your answer
Place of Employment
*
Your answer
Emergency Contacts
Name #1
*
Your answer
Telephone Number
*
Your answer
Name #2
Your answer
Telephone Number
Your answer
Person's authorized to pick child up
Name #1
Your answer
Phone Number #1
Your answer
Email Address #1
Your answer
Name #2
Your answer
Phone Number #2
Your answer
Email Address #2
Your answer
Our services
What service do you require?
*
Monday-Friday Care
Monday, Wednesday and Friday Care
Tuesday and Thursday Care
Spanish classes per hour
Required
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