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Purpose and Promise
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Intake form
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Name
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Email address
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Child's age
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0-1 years
1-2 years
2-3 years
3-4 years
4-5 years
Preferred schedule
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Full-time
Part-time
Drop-in
After school
Interested programs
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Infant Care
Toddler Care
Preschool
After School Care
Special Needs Programs
How did you hear about us?
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Friend/Family
Social Media
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Community Event
Which service or services are you interested in?
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Childcare programs
Parent support workshops
Youth enrichment activities
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