Form

Family Life Conference Childcare Registration

Please complete form for as many children as will be in childcare
The cost for childcare at the conference is $5 per child per session and $2 per child for the Discussion Break childcare (for instance, the cost per child for all-day care would be $22). There is a maximum payment of $50.00 per family. You must pay for childcare at the Health and Rec Centerprior to the event on August 23rd in order to secure your spot.

Childcare will end promptly at the time specified for each session. If your child will be in childcare for consecutive sessions, there is no need to check in between them. There will be no childcare during the lunch break, 11:40am-12:45pm.
Parent's Name*
First Name Last Name

Address*

Child 1
First Name:*
Age*
Sex*
Please list any health concerns or allergies.*
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Child 2
First Name:
Age
Sex
Please list any health concerns or allergies.
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Child 3
First Name:
Age
Sex
Please list any health concerns or allergies.
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Child 4
First Name:
Age
Sex
Please list any health concerns or allergies.
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Child 5
First Name:
Age
Sex
Please list any health concerns or allergies.
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Child 6
First Name:
Age
Sex
Please list any health concerns or allergies.
Please select the session(s) for which you would like to register this child for care.

Session I Childcare: 8:15am-10:15am Session II Childcare: 10:00am-11:40am Session III Childcare: 12:45pm-2:40pm Discussion Break Childcare: 2:40pm-3:30pm Session IV Childcare: 3:30pm-5:40pm

Submit
By clicking submit, you are confirming that all of the above information is correct. You are also confirming that you will pay for the care for which you have registered prior to the event on August 23.
Should be Empty:

Family Life Conference Childcare Registration