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First name*

Last name*

Email*

Phone*

Names and DOB of children*

Location*

East York - East - 1050 Plymouth Road York PA 17402

East York - Pleasant Acres - 118 Suite H Pleasant Acres Road York PA 17402

Jacobus - 99 York Road Jacobus PA 17407

Millersville - 236 Manor Avenue Millersville PA 17551

Middletown - 100 Brown Street Middletown PA 17057

Potty Trained*

Yes

No

Additional Comments:

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