Capital District Child Care Council

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Summer Camp Catalog Request

First and Last Name:
Email:
Phone:
Address:
Address 2:
City:
State:	Zip:
Age Of Child(ren):	Please use comma to separate ages
How did you hear about the Summer Camp Catalog:

I am eligible for assistance with paying for child care:
	Yes No
Would you like to receive information on financial aid:
	Yes No I'm Not Sure
If you have any questions, please feel free to call the Child Care Council at 518 426-7181

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