CDC Waiting List Application .pdf
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Original filename: CDC Waiting List Application.pdf
Author: BRANDY.EDWARDS
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After School Program
Enrollment for CDC
Child Development Center
Waiting List
Lista De Espera Para el Centro de Desarollo Infantil
Please Fill Out Items Below / Por Favor Escribe Tu Informacion
Date: _________________
Fecha:____________________
Name of Child: _________________________________________________
Nombre De Estudiante: ___________________________________________
Date of Birth: _______________________
Fecha de Nacimiento:_________________
Potty trained?
yes___
no___
Entrenamiento par ir al bano? Si____
Age: ________________
Edad: _______________
No____
Name of Parent: ________________________________________________
Name of Padre: _________________________________________________
Work Phone: _________________________________
Telefono de Trabajo: ___________________________
Home Phone:_________________________________
Telefono De Casa:_____________________________
Schedule Needed
M T W TH F
Cuales Dias Necesita Cuidado L M M J V
Time Needed ____AM to ____PM
Horario Que Solicita ______AM ah ____PM
Public School Name:______________________
Escuela Puiblica:__________________________
Schedule:_______________________________
Horario:________________________________
Mailing Address/ Direccion
________________________________________________________________
Street/ Calle
________________________________________________________________
City/ Suidad
Zip Code/ Codico postal
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