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Get IL 444-1902 2016-2024

Ear: Date: Parent Please Read: By signing this log, I attest that this is an accurate record of the hours and day of attendance. Each individual child must be signed in and out. Child Name Parent/Guardian Name Signature Time In Signature: Time Out I attest that this is an accurate reflection of the hours and day of attendance for the above listed children. Provider Name: Provider Signature: * I no longer care for: as of (enter date): IL 444-1902 (N-06-16) IDHS Child Care Assistance .

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