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Parent/Guardian Information
First Name
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Last Name
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Relationship
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Mother
Father
Grandmother
Grandfather
Guardian
Joint Custody
Other
Address
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Email
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Phone
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Child Information
First Name
*
Last Name
*
Date of Birth
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Req. Start Date
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Location
Summer Breeze
Summer Breeze Child Care 2023 LTD
Victoria, BC
V9C 4J9
250-474-1368
Secure Payment
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