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HOST APPLICATION
What kind of care are you available to work Monday - Friday?
Full Time (35+ hrs per week)
Part Time (35 hrs per week or less)
Weekend, Holiday, Summer: Check all that apply
Weekends
Holidays
Summers
None of the above
Caregiver/Parent applying to host (living in the house)
Full Name
Phone
Email
Home Address
Street Address
City
State
Zip Code
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Phone: (336) 355-8329
Email: Ourlittlevillages@gmail.com
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