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Grand Rapids
Religion-Based
Roof Repair of Grand Rapids
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Name
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Email
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Preferred Reply Day
Preferred Reply Day
As soon as possible
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Monday
Tuesday
Wednesday
Thursday
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Saturday
Preferred Reply Time
Preferred Reply Time
As soon as possible
12:00 am
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6:00 am
7:00 am
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11:00 pm
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Start Date
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Immediately
Within 1 Week
Within 2 Weeks
Within 3 Weeks
Within a Month
Within 2 Months
Within 3 Months
Within 4 Months
Within 5 Months
Within 6 Months
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Multiple Children
Multiple Children?
Yes
No
*
Age of Children
Services Needed:
Services Needed
Full-Time (30 hours or more)
Part-Time
Half-Day
Date Night
Before Hours
After Hours
Overnight
School Pick-Up
School Drop-Off
Afterschool
Door-to-Door Transportation
Weekends
Please select all that apply
Amount of Days Needed
How Many Days Do You Need Weekly?
1
2
3
4
5
6
7
Not Sure
Please Select Your Needed Days:
Selected Days
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Schedule Varies
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Subsidy Used
Are you using any subsidies?
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Type of Subsidy
Location
More Details
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