Kaihani Family Child Care
and
Preschool
Page 1
Name First:
Middle:
Last:
Date of Birth:
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2
3
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5
6
7
8
9
10
11
12
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2
3
4
5
6
7
8
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10
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12
13
14
15
16
17
18
19
20
21
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23
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25
26
27
28
29
30
31
2005
2006
2007
2008
2009
2010
2011
2012
Boy
Girl
First day of care:
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2010
2011
Days and hours of Care needed
:
Monday
Tuesday
Wednesday
Thursday
Friday
From
To
Home address and phone number
Street
City
State
Zip code
Home phone
(xxx) xxx-xxxx
Parents names and contacts:
Mom's name first
Middle
Last (if different)
Mom's cell
(xxx) xxx-xxxx
Work phone
(xxx) xxx-xxxx
Email
Dad's Name first
Middle
Dad's cell
(xxx) xxx-xxxx
Work phone
(xxx) xxx-xxxx
Email
Web address(URL):Mom's
Web address(URL):Dad's