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Questions Form
Please answer the following questions to confirm the necessary compliance protocols for your service.
Child's Details (Our Little Gem)
First name
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Last name
*
Date of Birth
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Month
Day
Year
Parent / Guardian Contact
Parent / Guardian First Name
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Parent / Guardian Last Name
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Street Address
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Cell Phone Number
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Health & Safety (Crucial Information)
Please list all known allergies, dietary restrictions ( Vegetarian, vegan, e.tc) and any medications the child may need (with detailed instruction)
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