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Get the free If you are registering more than one child, please complete a separate form for each...

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Child s Name Anticipated Start Date Birth Date Child s Age as of 1st day of school mm/dd/yyyy Child s Grade Fall 2015 Child s School Teacher Address City State Zip Home Phone Resides with Parent/Legal Guardian s Email address es Cell Phone Please Check all that apply Program Grade Time Amount AM Bears K only 9am-12 20pm 11 30am-3pm AM Care Concord/GVES AM Care Bethel/GVMS K-5 1-8 6 45am-9am 3pm-6pm AM/PM Care Concord/GVES AM/PM Care Bethel/GVMS Total Monthly Amount 6 45am-9am/3pm-6pm Due on...
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