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Date: Room:
Child’s Name: Can Your Adult Name:
Child 9:0 11:0 (First and Last) 0 0 Cell Have Potty Cheerios? Trained Phone# Allergies 1 Yes No Yes No Yes No 2 Yes No Yes No Yes No 3 Yes No Yes No Yes No 4 Yes No Yes No Yes No 5 Yes No Yes No Yes No 6 Yes No Yes No Yes No 7 Yes No Yes No Yes No 8 Yes No Yes No Yes No 9 Yes No Yes No Yes No 10 Yes No Yes No Yes No 11 Yes No Yes No Yes No 12 Yes No Yes No Yes No 13 Yes No Yes No Yes No 14 Yes No Yes No Yes No 15 Yes No Yes No Yes No 16 Yes No Yes No Yes No 17 Yes No Yes No Yes No We have reached capacity! Please see a coordinator for a safer room! Thank you!
No. Last Name First Name Age Student/teacher Quality Taste Presentation 1 Dela Cruz Ninna 2 Mag Cammit Hyannis 3 Zeta Dia 4 Paras Odeine 5 D 6 7 8 9 10 11 12 13 14 15