APPLICATION - SBC CHILD CARE CENTER

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APPLICATION

1ST CHILD INFORMATION - REGISTRATION FEE $25
 Male
 Female
 Yes
 No
2ND CHILD INFORMATION
 Male
 Female
 Yes
 No
 Boy
 Girl
 Infant
 Parent
 Guardian
PARENT/GUARDIAN INFORMATION
 Married Single Divorce Seperated Widowed Other
 Married Single Divorce Seperated Widowed Other
EMERGENCY CONTACTS & AUTHORIZED PICKUP PERSONS
 Able to pick up all the children in the family Not able to pick up the following children
 Able to pick up all the children in the family Not able to pick up the following children
 Able to pick up all the children in the family Not able to pick up the following children
 Able to pick up all the children in the family Not able to pick up the following children
ADDITIONAL COMMENTS & INFORMATION:
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© 2018 SBC CHILD CARE CENTER all rights reserved - web designed by AGM
2719 Sparrows Point Rd. Baltimore MD 21219  |  Tel:410-477-3228  |  www.sbcchildcarecenter.com
SHILOH BAPTIST CHURCH CHILD CARE CENTER
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