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Please show days required as MON TUE WED THU or FRI with a gap between
each day you want eg MON WED FRI

Child's Full Name
Date of Birth
Male / Female
Mother's Full Name
Father's Full Name
Contact Address
Home Phone
Work Phone
Mobile Number
Email Address
Days Requested
Start Date Requested
Does your child have any ongoing medical condition or additional need (so that we can ensure that we will provide appropriate care).  If so please provide details below:                                                                
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