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Daycare Provider Notification of Licensing or Registration
Tod Parker
2023-04-11T18:05:09-04:00
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Daycare Provider Notification of Licensing or Registration
Name of Provider / Program
*
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
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State
ZIP Code
Type of Service
*
Please Choose
Child Care Home - Class I
Child Care Home - Class II
Day Care Ministry
Day Care Center - Commercial Building
School Age Program
Group Family Day Care Home
Maximum Number of Children Licensed or Registered to Care For
*
Years of Age Range of Children Cared For
*
(Ex. 5 to 10)
I provide child day care on the following days and times:
Monday
Monday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Tuesday
Tuesday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Wednesday
Wednesday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Thursday
Thursday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Friday
Friday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Saturday
Saturday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
Sunday
Sunday
Open
:
Hours
Minutes
AM
PM
AM/PM
Close
:
Hours
Minutes
AM
PM
AM/PM
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