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MONTHLY RESPITE
CHILDCARE RSVP
RSVP MUST BE SUBMITTED BY THE END OF WEDNESDAY PRIOR TO THE RESPITE
Respite Date:
May 22th
Respite Date
Parent's Full Name:
Phone#:
(xxx-xxx-xxxx)
Cell#:
(xxx-xxx-xxxx)
Email Address:
Please list only the first names of the children you are registering.
Name #1:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #2:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #3:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #4:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #5:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #6:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #7:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
Name #8:
Age:
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Sex:
M
F
Sex
Special Needs:
Yes
No
Need:
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