Building our Power- Childcare/Interpretation Request
This form is to request childcare or interpretation during the event. The childcare will be at the same venue as the townhall. If you would like to request childcare or interpretation please do so by Friday, October 11th. We will not be able to accommodate any childcare requests after that date.
Email address *
First Name
Your answer
Last Name
Your answer
Do you have interpretation needs? *
If yes, which language?
If other, please specify: *
Your answer
How many kids will you be bringing? Names and ages for each? *
Your answer
Do the kids have any allergies? if so to what? Please specify for each kid by name. *
Your answer
Are there any other things that our childcare providers should know? i.e. special needs the children have, things to avoid? *
Your answer
Never submit passwords through Google Forms.
This form was created inside of Black Futures Lab. Report Abuse