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TION A AND B: Applicant/Operator A Member of Household (age 18 and over) (Person s applying to operate a child care facility) 1 Member of Household* (ages 13 to 17) Employee/Volunteer of Household (foster care, day care or group day care home) *Parent/Guardian signature required Executive Director Foster Family Home Day Care Agency Youth Emergency Shelter B Group Day Care Home Child Welfare Agency Adopt Only Home Day Care Home Day Care Center Group Home Child Care Institution/Matern.

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