JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Child Care Registration Form
Phone: 262-782-3040; Email: SchoolOffice@ChristTheLordBrookfield.org
Hours: 11:30 a.m. - 5:30 p.m.; Rate Per Hour: $5.00; Additional Sibling: $2.50. Billing: Invoices are emailed to the beginning of each month.
Always update the registration form if your schedule changes. Thank you.
Sign in to Google
to save your progress.
Learn more
* Required
STUDENT INFORMATION
First & Last Name
*
Your answer
Grade
*
Choose
K3
K4
K
1
2
3
4
5
6
7
8
HEALTH CONCERNS
Ex: Regular medications, specific health concerns, allergies, including drug reactions, or other important information.
Health Concerns - Yes or No? If yes, specify under "Other"
*
Yes
No
Other:
Required
CHILD CARE REQUEST
Start Date
*
MM
/
DD
/
YYYY
Arrival Time
Time
:
AM
PM
Pick Up Time
*
Time
:
AM
PM
RECURRING
*
Yes
No
Specify all that apply
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
PARENT VOLUNTEER
Volunteer - Yes or No? If Yes, specify under "Other" the type of task (ex: coach, pioneer leader, art assistant, etc.)
*
Yes
No
Other:
PARENT INFORMATION
Parent First & Last Name
*
Your answer
Parent Primary Phone (include area code)
*
Your answer
Parent Email Address
*
Your answer
OTHER CONTACT PICKING UP
Other Contact First & Last Name
Your answer
Other Contact Primary Phone (include area code)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Christ the Lord Lutheran School.
Report Abuse
Forms