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Coastal Gan Pre-Application
* Indicates required question
Email
*
Record my email address with my response
Child's Full Name
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Child's Gender
*
Your answer
What Schedule of Care would you need?
*
Full Time Monday - Friday 9:00 am - 3:00
Full Time Monday - Friday plus Early Care 8:00-9:00 am
Full Time Monday - Friday plus After Care 3:00-4:00 (no aftercare on Friday)
2 days a Week (Tuesday, Thursday)
3 days a week (Monday, Wednesday, Friday)
Other:
Required
Previous Daycare or Schooling Experience
*
Your answer
Who does the child live with?
*
2 parents
Mother
Father
Other:
Parent's Name and Contact Number
*
Your answer
Have you visited our website?
www.coastalgan.com
*
Yes
No
2nd Parent's Name and Contact Number
Your answer
2nd Parent's Name
Your answer
Address
Your answer
Does your child have any allergies? If yes, which allergies?
*
Your answer
Please note any medical conditions or special circumstances to be considered
*
Your answer
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