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Contact Us Name: Email Address: What is your child's current age? (Years and Months) Days Requested Monday Tuesday Wednesday Thursday Friday Hours Requested Extended Day (10 Hours) Full Day (8 Hours) Partial Day (6 Hours) Half Day (4 Hours) Other What date would you like your child to start care? Phone Number How did you hear about us? Referred by Friend Internet Search Newspaper Ad Early Education & Care Referral Child Care Circuit Referal Other Form provided by Freedback. This contact form was created by Freedback. After submitting form hit "Continue" Content copyright 2009. Patricia Coward. All rights reserved.