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Name:_________________________________________________
Address:_______________________________________________
Phone:_______________________WorkPhone:______________
Child'sName:_____________________________DOB:__________
Child'sName:_____________________________DOB:__________
Child'sName:_____________________________DOB:__________
Child'sName:_____________________________DOB:__________
Average Number of Hours Needed:____________________
Start Date:__________________
Wee Care Childcare is an Equal opportunity Employer