First Name *

Last Name *

Email *

Phone *

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Lakeville
Rosemount
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Number of Children Enrolling *

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Child Care Schedule *

Monday

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Child Name *

Child Birthdate *

Child Preferred Enrollment Date *

Child Name (2) *

Child Birthdate (2) *

Child Preferred Enrollment Date (2) *

Child Name (3) *

Child Birthdate (3) *

Child Preferred Enrollment Date (3) *

Child Name (4) *

Child Birthdate (4) *

Child Preferred Enrollment Date (4) *

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