TWEENIES DAYCARE

CENTRE
EST. 2013

APPLICATION FORM

CHILDS FULL NAME: ....................................................

CHILDS SURNAME: ....................................................
DATE OF BIRTH:

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ADDRESS:

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PARENT/GUARDIANS DETAILS
MOTHERS NAME:

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FATHERS NAME:

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SURNAME:

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ADDRESS:

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ALL CONTACT NO:

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I hereby willingly authorize my minors affiliation to above-named organization and pledge to
abide by all its rules.

Signed on this day of...........................................2013

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(Parent/Guardian)

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Louis Jones (Principal)
Contact: 078 271 1650

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SIGNATURE