Hertz Preschool Deposit 2024-2025

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* 1: Child's Name (First and Last)

1: Child's Nickname

* 1: Date of Birth

* 2: Child's Name (First and Last)

2: Child's Nickname

* 2: Date of Birth

* 3: Child's Name (First and Last)

3: Child's Nickname

* 3: Date of Birth

* 4: Child's Name (First and Last)

4: Child's Nickname

* 4: Date of Birth

* Child(ren)'s Street Address 1

Child(ren)'s Street Address 2

* State

* City

* Zip Code

Parent 1 Information

* Parent 1: First Name

* Parent 1: Last Name

* Parent 1: Cell Phone

* Parent 1 Email

Parent 1 has the same address as Child

Street Address 1

Street Address 2

City

State

Zip Code

Parent 2 Information

Parent 2: First Name

Parent 2: Last Name

Parent 2: Cell Phone

Must be different from Parent 1

Parent 2 Email

Must be different from Parent 1

Parent 2 has the same address as Child