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Child's Name (First and Last)
Child's DOB
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Female
Address
Mother’s Name
Mother’s Phone
Mother's Occupation
Mother’s Email
Father’s Name
Father’s Phone
Father’s Occupation
Father’s Email
Allergies
Personal Information
Members of the household other than the parents:
Name
Age
Relationship
Name
Age
Relationship
List two friends/relatives who will assume temporary care of your child if you cannot be reached:
Name
Phone
Name
Phone
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