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Child's Name:
Child's Date Of Birth:*
Home Address:
Home Telephone:
Carer 1:
Relationship to child:
Mobile No.:
Work Tel:
Email:
Carer 2:
Full Day 7.30am to 6.30pm
Monday
Tuesday
Wednesday
Thursday
Friday
Full Day
*We offer a minimum of 1 day per week*
My proposed start date would be
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