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Registration Form


Registration Cost Is $75

Primary Hours of Care of the week in care:

Medical Information

I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted. 

Emergency Contacts

Child will be released only to the custodial parent or legal guardian and the persons listed below.

The following people will also be contacted and are authorized to remove the child from the facility 

in case of illness accident or emergency. If for some reason the custodial parent or legal guardian

cannot be reached:

Thank You!

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