HANNAH'S OHANA DAYCARE
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For Inquiries, Submit Contact Info Below!
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Name
*
First
Last
Email
*
Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
IS CHILD'S ADDRESS SAME AS ABOVE?
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YES
NO
YOUR RELATIONSHIP TO CHILD
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MOTHER
FATHER
LEGAL GUARDIAN
OTHER
Age of Child
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Date of Birth
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MONTH THEY TURN 12 MONTHS OLD:
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January
February
March
April
May
June
July
August
September
October
November
December
YEAR THEY TURN 12 MONTHS OLD:
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Name of Child
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Gender
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Example: Male, Female, Non-Binary
Potty Training Required?
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--
Yes
No
Not Sure
TYPE OF CARE:
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Full-Time Care
Part-Time Care
Drop-In Care
Date Wishing To Enroll Your Child
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Duration of Care Needed for your child:
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Less than 3 months
3-6 months
6+ months
12+ months
18+ months
WHICH DAYS OF THE WEEK DO YOU NEED CARE?
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MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
WHAT HOURS OF CARE DO YOU NEED? (E.G. 8:30AM-4:30PM)
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IS YOUR CHILD CURRENTLY WAITLISTED AT A PRESCHOOL?
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YES
NO
NAME OF PRESCHOOL(S)
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APPROXIMATE START DATE
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Do you qualify for childcare subsidy or financial assistance?
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Yes
No
Not sure
WHAT IS YOUR MAX MONTHLY CHILDCARE BUDGET?
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WOULD YOU LIKE TO BE ADDED TO THE WAITLIST?
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YES
NO
How did you hear about us?
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ADDITIONAL Comments or Questions
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*
Hannah's Ohana Daycare may take several days to respond, as the weekdays are busy with childcare. However, if you have not heard back after one week, or i
f you have any issues submitting this form, p
lease email Hannah at
[email protected]
. Mahalo
!*
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