Child Care Registration for Omar Barghouti Panel
Little Vikings Flexible Child Care will be providing child care for this event. All the care providers have had background checks, training in CPR and First Aid, and are experienced child care providers. We will have a space for children ages 6 weeks to 3 years, and an adjoining space for children ages 3 to 12 years in Smith Memorial Student Union.
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What is your name? *
First and Last, please
What is your relationship to the child? *
What is your cell phone number? *
What is your email address? *
What is your child's name? *
If you have more than one child, you will need to fill out a questionnaire for each child.
How old is your child? *
Please list any allergies, dietary needs, or special needs this child has. *
If none, please write "none" in the answer box.
Please list one other person who may be picking up or dropping off child. If none, write "none". *
What is this person's relationship to the child? *
What is this person's cell phone number? *
Are you a: *
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