APPLICATION - SBC CHILD CARE CENTER
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SBC CHILD CARE CENTER
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APPLICATION
APPLICATION
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APPLICATION
1ST CHILD INFORMATION - REGISTRATION FEE $25
Gender
Male
Female
Photographs: May we take and maintain a photo of your child for security purposes?
Yes
No
2ND CHILD INFORMATION
Gender
Male
Female
Photographs: May we take and maintain a photo of your child for security purposes?
Yes
No
Boy
Girl
Infant
Relationship to Child
Parent
Guardian
PARENT/GUARDIAN INFORMATION
Marital Status
Married
Single
Divorce
Seperated
Widowed
Other
Marital Status
Married
Single
Divorce
Seperated
Widowed
Other
EMERGENCY CONTACTS & AUTHORIZED PICKUP PERSONS
Pick up:
Able to pick up all the children in the family
Not able to pick up the following children
Pick up:
Able to pick up all the children in the family
Not able to pick up the following children
Pick up:
Able to pick up all the children in the family
Not able to pick up the following children
Pick up:
Able to pick up all the children in the family
Not able to pick up the following children
ADDITIONAL COMMENTS & INFORMATION:
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