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Personal Information
Full Names *
Email Address *
Phone Number *
Home Address
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Household & Care
No. of children in the home
Age of children in the home
No. of adults in the home
Child(ren) medical history
Any allergies?
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What should we know about health and safety in your home?
How do you scold your children?
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Are you open to occasional supervisory visits?
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Would you like us to enroll your child(ren) on playdates?
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