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Irst, middle) Physical Address: Telephone: Date of Birth: (Street, city, state, zip) (Must be listed and working) Mailing Address: (If different from physical address) County: Select County ... Hours of Operation: Section B Enrollment Information Complete the following information on each child including your own, related and foster children until they reach 12 years of age. Child s Name Is this child Is this your related to you? foster child? Age Days in FCCH (Ex.: Mon. Wed. F.

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