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Living Proof Early Learning Center Waiting List Form

Childs Name:

DOB:

Guardians Name:

Contact Information:

*Email:

*Cell:

Work:

Alternative Contact Info:

Date Childcare is Needed:

Does your child have any special needs we should be aware of:

Signature

Date

• Childs waiting list form must be updated every 30 days to remain on the waiting list.

Update Date

Update Date

Update Date

Update Date

Update Date

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