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2. Name of Day Care
6. Contact Person Information
8. First Name
9. Last Name
11. Address1
13. Address2
15. City
16. State
17. Zip
19. Phone Number
20. Email
24. Days of Operation

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
25. Start of Day
    Start of Day
26. End of Day
    End of Day
28. Age Range of Children
30. Youngest
31. Oldest
35. Comments
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37. 1. Receive an email copy of this form.
38. Email address

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39. Submit Submit and Print

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